Orally administered sebacic acid (C10) reduces postprandial blood glucose levels among patients with Type 2 diabetes and healthy individuals, researchers report.

This effect of C10 on blood glucose is less marked among healthy individuals than diabetics, and “occurs when C10 is either added to a mixed meal or substituted for lipids in an equivalent caloric manner,” say the researchers.

Geltrude Mingrone (Catholic University of Rome, Italy) and team recruited 10 obese (mean body mass index [BMI] of 27.98 kg/m2) patients with Type 2 diabetes, and 10 healthy individuals (mean BMI of 26.63 kg/m2) without diabetes.

All participants consumed a mixed meal consisting of 50% carbohydrates, 15% proteins, and 35% lipids. Participants were given either C10 0, 10, or 23 g with their meals, although those receiving C10 23 g had the lipid component of their meal omitted.

Mingrone and colleagues report in the journal Diabetes Care that participants who ingested C10 with their meal had smaller postprandial glycemic peaks than those who did not.

This reduction, however, was more pronounced among those who received C10 23 g than in those who ingested C10 10 g, with respective peak blood glucose reductions of 39% and 71%.

When the researchers used a time versus glucose curve to analyze their results, they found that incremental glucose area under the curve (AUC) decreased by 42% and 70% among the participants who took C10 10 g and 23 g, respectively.

Mingrone and colleagues also observe that the effect of substituting the lipid component of the meal for an additional 13 g of C10 produced a reduction in AUC of glucose rate of appearance by 18% among both the healthy controls and the diabetic patients.

In vitro investigations also revealed a 30% increase in insulin-mediated glucose uptake by L6 myoblasts in the presence of C10 compared with insulin alone. This increase was accompanied by a 70% increase in protein expression of the glucose transporter GLUT4.

Although unsure of the mechanism by which C10 suppresses endogenous glucose output, Mingrone and team hypothesize that reduced hepatic glucose output and/or increased peripheral glucose disposal are likely to be involved.

“More detailed studies are required to elucidate the mechanism of action of sebacic acid in Type 2 diabetes,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Researchers say that high levels of plasma lactate are strongly associated with increased prevalence of Type 2 diabetes in older adults.

Plasma lactate level is an indicator of the gap between oxidative capacity and energy expenditure, and evidence suggests that insufficient oxidative capacity may be indicated in the development of Type 2 diabetes.

To investigate this further, Jeffery Young (John Hopkins University, Baltimore, Maryland, USA) and colleagues tested plasma lactate levels in 1709 participants (18% with Type 2 diabetes) of the Atherosclerosis Risk in Communities Study Carotid Magnetic Resonance Imaging (ARIC CAR-MRI), aged 60-84 years.

The participants were divided into quartiles of lactate concentration, namely, less than 5.9 (n=378), 5.9-7.2 (n=480), 7.3-9.1 (n=458), and 9.2 mg/dl or above (n=393).

The team found that the prevalence of Type 2 diabetes increased significantly across increasing lactate quartiles, at 11%, 14%, 20%, and 30%, from the lowest to the highest quartile.

After adjustment for body mass index, physical activity, demographic factors, and waist circumference, risk for having Type 2 diabetes was a significant 1.64- and 2.23-fold higher for participants in the third and fourth quartiles, respectively, than for those in the first.

Young and team note that high lactate was also linked to increased levels of fasting glucose in those without Type 2 diabetes.

“Further work must be carried out to reassess the prospective association of plasma lactate and Type 2 diabetes in a modern cohort,” say the researchers.

However, “if confirmed, blood lactate measurement could be used as a marker of oxidative capacity in clinical and population studies,” they conclude.

The results of this study are published in the International Journal of Epidemiology.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Glycated albumin (GA) may be a better index for monitoring glycemic control in patients with Type 2 diabetes than glycated hemoglobin (HbA1c), suggest results from a Korean study.

HbA1c has been used as a “gold standard” for monitoring and diagnosing diabetes, but there is still some debate about suitable cut-off points for HbA1c in different ethnic populations and it can be affected by certain hematological disorders.

Byung Wan Lee (Yonsei University College of Medicine, Seoul) and colleagues therefore investigated the value of GA as a marker for short-term monitoring in 1038 Korean patients with Type 2 diabetes, aged 59.8 years on average.

The researchers divided the patients into a stably (n=270; HbA1c fluctuation of up to 0.5% over 6 months) and unstably (n=768; HbA1c fluctuation of more than 0.5% over 6 months) maintained group. They then compared HbA1c, GA, and the GA/HbA1c ratio in the two groups.

As reported in the journal Acta Diabetologia, Lee and team found that serum GA was strongly correlated with HbA1c in both groups.

Glucose levels (fasting and postprandial) were more strongly correlated with GA in the unstably maintained group and with HbA1c in the stably maintained group. In the overall group, fasting and postprandial glucose levels were more strongly correlated to a patients GA than HbA1c level.

The GA/HbA1c ratio increased with increasing HbA1c and was influenced by postprandial glucose levels and body mass index.

“In conclusion, our data show that serum GA may be a more useful glycation index than HbA1c for monitoring glycemic control in Type 2 diabetic patients with fluctuating and poorly controlled glycemic conditions,” write the authors.

“Further studies on clinical relevance of GA on Type 2 diabetic patients will make our observations useful for clinical management of these patients.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Cardiovascular disease (CVD) and all-cause mortality are significantly higher in women with diabetes and depression than those with one or neither condition, show results from the Nurses’ Health Study.

Previous research has demonstrated that patients with depression have increased CVD and all-cause mortality compared with the general population, with the risk similarly increased in patients with diabetes.

In this study, Frank Hu (Harvard School of Public Health, Boston, Massachusetts, USA) and colleagues assessed the individual and combined effects of diabetes and depression on mortality in 78,282 women who took part in the Nurse’s Health Study.

The women were aged 54-79 years at study initiation in 2000 and were followed up until 2006. Diabetes and depression were self-reported by questionnaire. Overall, 333,805 women had neither condition, 68,799 had depression alone, 23,561 had diabetes alone, and 6901 had both. Deaths were reported by next of kin or in the National Death Index.

Writing in the Archives of General Psychiatry, the authors report that women with depression or diabetes alone had a significant 1.76- and 1.71-fold increased relative risk for all-cause mortality, respectively, compared with women with neither condition.

Similarly, the corresponding risks for CVD mortality in these women were 1.81- and 2.67-fold higher compared with in those without depression or diabetes.

The combination of both conditions led to significantly higher risks for both all-cause and CVD mortality, with a respective 3.11- and 5.38-fold increased risk in these women compared with those without depression or diabetes.

The researchers note that multivariate adjustment for various confounders such as body mass index, smoking status, and major comorbidities did weaken the associations, reducing the increased risk for all-cause and CVD mortality to 2.07- and 2.72-fold in those with both conditions, respectively, but these increased risks were still statistically significant.

Patients who had a long duration of diabetes (over 10 years) or who were being treated with insulin and also suffered from depression were found to be at particularly high risk for all-cause or CVD mortality after multivariate adjustment (3.22- and 4.90-fold risk increase in those with both conditions compared with those without either condition).

“Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes,” conclude Hu et al.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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Consumption of vitamin D-fortified yoghurt, with or without additional calcium, improves glycemic control in patients with Type 2 diabetes, show study findings.

As reported by MedWire News, low levels of vitamin D have been linked to an increased risk for developing Type 2 diabetes. In addition, other studies have suggested that supplementation with vitamin D and calcium may improve glycemic control in diabetic patients.

Tirang Neyestani (Shahid Beheshti University of Medical Sciences, Tehran, Iran) and colleagues assessed the value of consuming vitamin D in a yoghurt drink for improving glycemic control in a group of 90 individuals with Type 2 diabetes.

The researchers assigned 30 patients to consume a plain yoghurt drink (no vitamin D; 150 mg Calcium per 250 ml), 30 to consume a vitamin D-fortified yoghurt (500 IU vitamin D; 150 mg Calcium per 250 ml), and 30 to consume a vitamin D and calcium-fortified yoghurt (500 IU vitamin D; 250 mg Calcium per 250 ml), twice a day for 12 weeks.

As reported in the American Journal of Clinical Nutrition, the team observed that serum vitamin D (25(OH)D₃) increased by 32.8 and 28.8 nmol/l in the vitamin D and vitamin D plus calcium groups, respectively, at 12 weeks.

In the same groups, fasting serum glucose decreased by 12.9 and 9.6 mg/dl, glycated hemoglobin (HbA1c) by 0.4% and 0.4%, and homeostasis model assessment of insulin resistance by 0.6 and 0.6 from baseline, over the same period.

In addition, waist circumference and body mass index were significantly reduced in the vitamin D and vitamin D plus calcium groups, by 3.6 and 2.9 cm, and 0.9 and 0.4 kg/m², respectively, from baseline.

All of the above reductions and improvements in glycemic control were significantly greater in the two vitamin D groups than in the plain yoghurt control group. The addition of calcium to the drink did not appear to greatly influence the results.

“Our findings have potentially important public health implications, because the modest effect of vitamin D intake on anthropometric and glycemic status in individual persons translates to a dramatic effect in the population as a whole,” say the authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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Vitamin D levels inversely correlated with incident diabetes in US women
Low serum 25-hydroxyvitamin D may increase diabetes risk
Vitamin D and calcium help lower HbA1c and weight in Type 2 diabetics

Reducing abdominal obesity can slow the progression of subclinical atherosclerosis in Type 2 diabetics, suggest study results.

Accelerated atherosclerosis is common in patients with Type 2 diabetes, highlighting the importance of identifying modifiable risk factors..

Chul Woo Ahn (Yonsei University College of Medicine, Seoul, Korea) and colleagues report the results of a study of 173 patients with Type 2 diabetes who had measurements of right and left carotid intima-media thickness (IMT) - a measure of subclinical atherosclerosis - taken at baseline and after 1 year.

The researchers also measured various anthropometric and metabolic factors including glycated hemoglobin (HbA1c) and abdominal obesity, measured by waist circumference (WC) at both time points.

Ahn and co-authors found that change in WC over 1 year was positively associated with changes in HbA1c and both left and right carotid IMT over the same period.

Of note, the association with carotid IMT was found to be independent of changes in body weight, body mass index, HbA1c, and use of lipid-lowering, antiplatelet, and thiazolidinedione drugs.

Writing in the journal Obesity, Research and Clinical Practice, Ahn and team suggest: “Controlling abdominal obesity seems to have a significant impact on the progression of subclinical atherosclerosis in patients with diabetes, and therefore, more efforts should be made toward reducing WC to inhibit overt atherosclerotic diseases.”

The researchers conclude that doctors should give more emphasis to the importance of lowering WC for reducing the progression of cardiovascular diseases such as atherosclerosis in patients with Type 2 diabetes.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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The effect of abdominal obesity on the frequency of diabetes is similar across different regions of Europe, despite regional differences in cardiovascular risk factors and rates of cardiovascular disease (CVD), study findings show.

“This lack of regional differences suggests that abdominal obesity has a major influence on the development of diabetes,” say Keith Fox (University of Edinburgh, UK) and colleagues.

The researchers conducted the International Day for Evaluation of Abdominal Obesity (IDEA) study, which involved 37,437 men and 53,809 women from 27 countries across Europe.

The frequency of diabetes, irrespective of age, was similar for the three study regions ??” Northwest Europe, Southern Europe, and Eastern Europe. In contrast, CVD was at least two-fold more frequent in Eastern Europe than in Northwest Europe and 2.5-fold more frequent compared with Southern Europe.

Waist circumference, as a measure of abdominal obesity, was associated with an increased risk for diabetes. After correcting for body mass index (BMI) and age, a one standard deviation increase in waist circumference in each geographic region increased the risk for diabetes 1.3- to 1.5-fold in men and from 1.5- to 1.8-fold in women.

The researchers note in the European Heart Journal that the frequency of diabetes according to waist circumference was “strikingly” similar in Northwest Europe, Southern Europe, and Eastern Europe for both men and women.

Waist circumference also predicted CVD, irrespective of regional differences in CVD prevalence. After adjusting for BMI and age, a standard deviation increase in waist circumference increased the risk for CVD in women 1.28-fold in Northwest Europe, 1.26-fold in Southern Europe, and 1.10-fold in Eastern Europe, with similar findings in men.

Fox et al estimate that the age-adjusted proportion of risk attributable (PAR) to increased waist circumference for CVD in men is 10.2% in Eastern Europe, 6.3% in Northwest Europe, and 7.0% in Southern Europe. The corresponding PAR for women was 11.8%, 4.9%, and 3.7%.

The PAR to increased waist circumference for diabetes in men was 11.8% in Eastern Europe, 12.1% in Northwest Europe, and 7.3% in Southern Europe. For women, the PAR was 10.3%, 10.8%, and 10.8%, respectively.

“The data suggest that frequency of diabetes could therefore be reduced by around 10% by eliminating abdominal obesity, but this may underestimate the longer-term impact,” write Fox and co-workers.

They conclude: “The high frequency of abdominal obesity presents a major challenge irrespective of the different sociodemographic characteristics across Europe and the impact on diabetes may offset future declines in CVD prevalence, even in regions with lower rates of CVD.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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High levels of the protein LIGHT are associated with high triglyceride and low high-density lipoprotein (HDL) cholesterol levels, report researchers.

In addition, people with high LIGHT (lymphotoxin-like inducible protein that competes with glycoprotein D for herpesvirus entry on T cells) levels are more likely to be obese or have Type 2 diabetes.

“LIGHT is a member of the tumor necrosis factor family, primarily expressed in lymphocytes, which was associated with the induction of pro-inflammatory cytokines and alterations of lipid homeostasis in animal models,” explain Jose-Manuel Fernández-Real (Hospital de Girona, Catalonia, Spain) and colleagues.

In this study, the researchers assessed associations between circulating concentrations of LIGHT and various metabolic variables in 190 Caucasian men, aged 51.5 years on average, with varying degrees of obesity and glucose tolerance.

As reported in the International Journal of Obesity, the team found that serum LIGHT concentrations were positively associated with body mass index (BMI), fat mass, glycated hemoglobin (HbA1c), and triglycerides, and negatively associated with HDL cholesterol.

In addition, LIGHT levels were significantly higher in morbidly obese (mean BMI= 46.88 kg/m²) than lean men, at 60.38 versus 41.21 pg/ml, and in those with Type 2 diabetes compared with men with normoglycemia, at 52.07 versus 40.77 pg/ml.

Increased levels of LIGHT were also associated with increased expression and secretion of the inflammatory factors interleukin (IL)-6, IL-8, growth-related oncogene, and monocyte chemotactic protein-1.

“The combined presence of high levels of LIGHT in morbidly obese and Type 2 diabetic patients [and] the positive correlations with serum lipid levels… may constitute additional factors that can contribute to aggravate the inflammatory state and dyslipidemia observed in these diseases and suggest a possible relationship between LIGHT and increased cardiovascular risk,” conclude Fernández-Real and co-authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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Type 2 diabetics often find it difficult to lose weight. Why is this you ask … well, fat cells make up a lot of the body of an overweight or obese person and these cells have become resistant to insulin. This is the reason your blood sugar levels are high and to add to this, your blood insulin levels are high also.

Our bodies don’t really like to lose weight, we are actually programmed to maintain or gain weight. Way back when it was necessary to hunt for food and there were times of scarcity, our cells learned to store fat so we would have energy when it was needed. This particular genetic blueprint exists to this day so that when you go to lose weight:

• your brain will tell you to eat more
• your cells will resist fat loss
• and your metabolism will slow down

It is also confusing to know which diet you should follow … there are so many diets that claim to help you lose weight quickly and they all have their own concept on how weight loss works. Plus all those wonderful testimonials claiming these various diets will help you to shed pounds/kilograms! And there are, and always will be, diet pills … fake, genuine, dangerous or effective.

Despite all this, the best way to lose weight is to eat the right amount of calories and not restrict yourself to one or two food groups, such as carbohydrates or proteins. Sounds boring but a healthy balanced diet is still the best way for a diabetic to lose weight.

Here are some approaches to help you with your weight loss:

1. Make a decision and commitment to lose weight. Think of all the advantages … you will have more energy and at least delay or avoid those diabetic complications you have heard about.

2. Determine your ideal weight. The best idea is to consult with a registered dietitian who will work out your body mass index (BMI), your ideal weight and a food plan that will include your likes and exclude your dislikes, plus work your meals and snacks in with your lifestyle and working hours.

3. Bring the whole family in on the concept of making better food choices, otherwise you will find it too hard to stick to the “good choices”.

4. To avoid temptation why not throw away any of those foods not included in your healthy eating plan.

5. If you eat more than the allotted calories/kilojoules … don’t despair. But if you do so every time, it really shows you are not committed to your goal of living a healthy lifestyle and losing weight.

6. When at the supermarket, stick to the outside isles. This is where the fresh foods usually are, stick to the foods on your shopping list.

7. Why not join up with a friend who is committed to losing weight, motivate each other.

8. Make sure your family are really aware you want to lose weight … ask for their support.

9. Post notes on the refrigerator to remind you not to snack when watching TV … sometimes this is done out of habit.

10. Reward yourself when you lose weight … maybe with a weekend away, or new clothes. You deserve it!

These are simple weight loss tips you can put into action today, even if you have type 2 diabetes and have been battling against being overweight.

Accounting for height does not alter the ability of waist circumference to predict incident diabetes, but may be useful for exploring differences in risk among racial/ethnic groups, US researchers believe.

Their conclusions are based on a study examining anthropmetric measures, ethnicity, and diabetes risk among 1730 participants in the San Antonio Heart Study. This was a population-based study involving Mexican Americans and non-Hispanic Whites living in San Antonio, Texas, USA.

“In San Antonio, Mexican Americans are more obese and have more Type 2 diabetes mellitus than non-Hispanic Whites, but are also shorter,” explain Carlos Lorenzo (University of Texas Health Science Center at San Antonio) and co-authors in the journal Metabolism Clinical and Experimental. “Therefore, height may explain to some extent the difference in diabetes risk between Mexican Americans and non-Hispanic Whites.”

To investigate, Lorenzo’s team developed six different risk-prediction models that incorporated age and ethnicity plus various combinations of anthropometric measures (eg, body mass index, waist circumference, height, and waist-to-hip ratio).

Receiver operating characteristic curves were then used to determine each model’s ability to predict incident diabetes over a mean follow-up duration of 7.4 years.

The areas under the curves were similar, at approximately 0.75??”0.78, for models that included waist circumference, waist circumference and height, and waist-to-height ratio, Lorenzo et al report.

However, the predicted risk for diabetes according to ethnicity (Mexican-Americans versus non-Hispanic Whites) was lower in a model that included the waist-to-height ratio than in a model that included just waist circumference. The odds ratios in the two models were 1.45 and 1.84, respectively, in women, and 2.00 and 2.74, respectively, in men.

Finally, after adjusting for age and ethnicity, height alone did not predict diabetes in either men or women.

The researchers conclude that correcting waist circumference for height “does not help explain a larger proportion of the risk of diabetes in either men or women, but attenuates more of the impact of ethnicity on incident diabetes.”

They add: “Height may be an anthropometric measure to consider in studies that examine differences in diabetic risk between populations of different race/ethnicity.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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