Patients with Type 2 diabetes have a three-fold increased risk for pancreatic cancer and a two-fold increased risk for biliary cancer, report researchers.

“Even though cardiovascular complications are a major cause of morbidity and mortality in patients with diabetes, this disease has also been associated with several cancers, most notably of the liver, endometrium, kidney, and pancreas,” say M Mazen Jamal (Veterans Affairs Medical Center, Long Beach, California, USA) and colleagues.

In this study, the researchers assessed the frequency of biliary and pancreatic cancers in 278,761 patients with a diagnosis of Type 2 diabetes (ICD-9 code 250.0) and 836,283 controls. The participants were aged an average of 65.3 years and 97.6% were male.

The data was obtained from the Austin Automation Center which has maintained the Patient Treatment File, containing data from all Veterans Health Administration hospitals, since 1969.

Writing in the World Journal of Gastroenterology, the authors report that following multivariate analysis, individuals with Type 2 diabetes were 3.22 times more likely to have pancreatic cancer than controls, at a frequency of 0.9% versus 0.3%.

In addition, diabetic patients were 2.20 and 2.10 times more likely to have gallbladder and extrahepatic biliary cancers, respectively, when compared with controls.

These associations were independent of other known risk factors such as cholelithiasis, pancreatitis, obesity, and smoking.

The results of this study “should further heighten our awareness of the many complications associated with insulin resistance and modify the intensity of our approach to these patients,” conclude Jamal et al.

“This could warrant a keener eye by the primary care physician for any abnormalities in his or her diabetic patients, which indicate the possibility of cardiovascular, renal and ophthalmic complications, as well as the rare but foreseeable possibility of a fatal pancreaticobiliary malignancy.”

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

Free fulltext

Diabetes symptoms come on gradually with no obvious signs such as a rash or cut. About a third of those who have type 2 diabetes have it for years without even realizing it.

Type 2 Diabetes Symptoms

Most often, diabetes is not diagnosed until you visit your doctor for other health reasons. Some of the signs to look for would be:

* Increased thirst - Excess sugar in your bloodstream can steal fluid from your bodys’ tissue, leaving you dehydrated and thirsty.
* Frequent need to urinate - This is a result from the extra drinks you consume to rehydrate your bodys’ tissue.
* Excess hunger - When you have a lack of insulin (what helps your cells process sugar into energy) the amount of energy present in your organs and muscles is greatly reduced. This leads to your body to desire extra food to replace what it has lost.
* Weight gain - This if from all the excess eating done in order to gain lost energy.
* Decreased or Blurred vision - When your blood sugar is too high, fluid may be taken from your eye tissue, affecting your ability to focus correctly.
* Slow healing sores - With type 2 diabetes your ability to fight infections and heal properly will take much longer.
* Frequent infections - You may see an increase in vaginal or bladder infections due to excess sugar in the urine.
* Fatigue - You may become tired if your cells are lacking their much needed energy.
* Numbness/tingling in your hands or feet - Diabetics tend to have poor circulation, therefore lacking proper sensation in the extremities.
* Impotency - This is due to poor circulation/improper blood flow.

Some type 2 diabetics have been known to have dark, velvety patches of skin in the creases/folds of their body (normally the neck or armpits.) This is a sign of insulin resistance called acanthosis nigricans.

Diabetic patients with more severe periodontal disease are at increased risk for neuropathic foot ulceration, say researchers.

“Diabetic neuropathy (DN) has been associated with oral dryness, tooth loss and an increased risk for foot ulceration, but the association between periodontal problems and DN has not been fully elucidated,” explain Helena Schmid (Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil) and team.

Writing in the journal Diabetes Research and Clinical Practice, the authors report that of 122 patients with Type 2 diabetes, none/mild and moderate/severe periodontal disease was observed in 40.2% and 32.0% individuals, respectively, and a further 27.8% of the group were edentulous.

The patients had a mean age of 60.5 years, duration of diabetes of 14.5 years, and glycated hemoglobin of 9.3%.

Degree of severity of periodontal disease correlated significantly with presence of neuropathic foot ulceration. Overall, 18.4%, 68.2%, and 61.8% of the participants who had none/mild or moderate/severe periodontal disease, or who were completely edentulous, respectively, had neuropathic foot ulceration.

Following adjustment for gender, age, diabetes duration, dental healthcare, and education, the researchers found that moderate/severe periodontal disease and edentulism increased the risk for neuropathic foot ulceration 6.6 and 4.9 fold, respectively, compared with none/mild periodontal disease.

Schmid and colleagues caution that “it is still unclear whether severe neuropathy or other simultaneous complications increase the chances of periodontal disease.”

They suggest: “Future prospective studies should be conducted to evaluate potential mechanisms of diabetic complications, such as systemic and inflammatory factors, neuropathy measurements, occurrence of ulcers and diabetes-associated periodontitis.”

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

Free abstract

Australian researchers suggest that a maternal family history of diabetes may reduce the risk for cardiovascular disease (CVD) in female, but not male, patients with diabetes.

David Bruce, from the University of Western Australia in Nedlands, and colleagues say that although they are unsure of the cause of the differential effect of maternal family history of diabetes in males and females, “gender differences resulting from genetic and epigenetic transmission in a range of common complex disorders, including CVD and Type 2 diabetes,” may be involved.

The researchers investigated the family histories of 1294 diabetic patients (663 women and 631 men) aged an average of 64.1 years, recruited from 1993 to 1996.

All-cause mortality, cardiac mortality, and myocardial infarction (MI) rates were monitored from recruitment until 2006.

In all, 20.4%, 8.3%, and 2.0% of the patients reported a maternal, paternal or bi-parental family history of diabetes.

Patients with a maternal history of diabetes had poorer glycemic control than those with a paternal history of diabetes, as reflected by significantly higher fasting serum glucose and percentage glycosylated hemoglobin levels, at 8.9 mmol/l versus 8.4 mmol/l and 7.9% versus 7.2% respectively.

As reported in the journal Diabetes Care, 493 patients died during the follow-up period - 197 died from cardiac causes, 278 had a MI, and 132 had a stroke.

Unadjusted all-cause mortality rates were significantly lower in patients with a maternal (29.5%) or paternal (34.0%) history of diabetes compared with those with no parental history of diabetes (41.9%).

All patients with a maternal history of diabetes had a reduced rate of all-cause and cardiac mortality compared with those with no parental diabetic history, at 29.5% versus 41.9%, and 8.7% versus 17.9%, respectively.

When analyzed by gender, female patients with a maternal diabetic history had a reduced risk for all-cause and cardiac mortality compared with patients with no parental history of diabetes, with a 37% and 68% risk reduction respectively.

The risk for a first MI was also significantly reduced by 55% among female patients with a maternal history of diabetes, compared with all patients with no parental history of diabetes.

However, this trend did not extend to male patients with a maternal history of diabetes. These individuals had a similar risk for all-cause and cardiac mortality, and first MI as male patients without a parental history of diabetes.

The researchers conclude: “These data indicate another source of heterogeneity in the clinical impact of Type 2 diabetes and have relevance for understanding the pathophysiology, epidemiology, and public health impact of cardiovascular disease in women 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; 2010

Free abstract

Study results suggest that fetal- and late-childhood exposure to the severe Chinese famine of 1959-1961 is associated with significantly increased risk for hyperglycemia or Type 2 diabetes in later life.

The researchers found that individuals with fetal exposure to the famine who later followed an affluent or western style dietary pattern or who gained higher economic status than their peers had the highest overall risk for hyperglycemia.

The findings are in agreement with the developmental origins hypothesis which suggests that “adaptations in response to fetal undernutrition lead to metabolic and structural changes, which are beneficial for early survival but may increase the risk of common diseases such as Type 2 diabetes in adulthood.”

Yanping Li (Chinese Center for Disease Control and Prevention, Beijing, China) and colleagues analyzed data on 7874 adults from rural areas of China who were born between 1952 and 1964.

The team categorized the participants into five different famine exposure cohorts, namely: non-exposed (born 1962-1964; n=1954), fetal-exposed (born 1959-1961; n=1005), early-exposed (born 1952-1954; n=1654), mid-childhood exposed (born 1954-1956; n=1588), and late-childhood exposed (born 1956-1958; n=1673).

Hyperglycemia was defined as a fasting plasma glucose of 6.1 mmol/l or more, a 2-hour plasma glucose level of 7.8 mol/l or more, a prior diagnosis of Type 2 diabetes, or a combination of at least two of these three factors.

Overall, 2.4%, 5.7%, 3.9%, 3.4%, and 5.9%, of the non-, fetal-, early-, mid-childhood, and late-childhood exposed groups, respectively, had hyperglycemia.

In severely, but not less severely, affected famine areas (above or below 50% excess death rate, respectively), fetal-exposure increased the risk for later hyperglycemia a significant 3.92 fold compared with non-exposure.

In severely and less severely affected areas, late-childhood exposure increased the risk for adult hyperglycemia a significant 2.38 and 2.27 fold, respectively, compared with non-exposure. There was no significant effect of early- or mid-childhood exposure on the risk for later hyperglycemia across all famine-affected areas.

Interestingly, fetal-exposed participants who followed an affluent or western style dietary pattern and had higher economic status in later adulthood had a significant 7.63- and 6.20-fold increased risk for hyperglycemia, respectively, compared with non-exposed participants.

“Together with previous studies, our study highlights that early life environment is critical for the risk of hyperglycemia in adult life,” conclude the authors in the journal 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; 2010

Free abstract

The dreadful diabetes is definitely treatable but how if we could actually detect and avoid it in the first step? If taken the right steps at an early stage, we can actually prevent, delay or even cure diabetes completely. Most of the times, diabetes is detected when it has already laid an impact on the body and the damage has already been done.

However, diabetes does warn you that it is arriving but only if you pay attention to its warnings and symptoms and take proper steps in an early stage.

Diabetes can either be of Type 1, Type 2 or the gestational diabetes (that occurs in pregnancy). Type 1 diabetes is caused by a virus that attacks and destroys the insulin producing beta cells of the pancreas thus disabling its sugar transporting capacity from the blood to other cells in the body. Type 2 diabetes is the most common type across people and is normally caused due to poor diet, obesity and is also hereditary. It results in a decreased insulin resistance. Gestational diabetes is almost similar to Type 2 diabetes, the only difference being that it is triggered by the hormones of pregnancy.

The top warning signs indicating that diabetes may be around soon are:

1. Frequently going to the bathroom: Excessive urination may be an indication of diabetes as there is too much glucose in the blood. Since the insulin is not effective anymore, the kidneys try to extract water from the blood to dilute the glucose.

2. Weakness and loss of energy: As the insulin is no more effective, the cells are longer able to generate enough energy from the glucose and you tend to feel tired and weak at shorter intervals.

3. Sudden loss of weight: This is an after effect of the second symptom and due to the lack of energy, you can notice a sudden loss of weight. This symptom is more prominent in the Type 1 diabetes and there is a gradual loss of weight in Type 2 diabetes.

4. Numb hands or legs(Neuropathy): Neuropathy is a result of the constant high glucose in the body which affects the nervous system and it normally happens gradually after a few years.

5. Additional symptoms: Itchy or dry skin, infections, cuts and wounds that heal after a long time and blurred vision are also few other symptoms of diabetes. The primary reason for all of them remains the same- increased glucose levels in the body.

Soy has been developing an almost “silver bullet” reputation of late, with those affected by type 2 diabetes piling it onto their plates at every opportunity.

Conflicting findings reported in the online American Journal of Clinical Nutrition on Marsh 24, 2010 give cause to re-thinking the playing field… while historic scientific findings have found that soy protein and soy isoflavone compounds, (phytoestrogen), are structurally similar to human estrogen and may actually help to control blood sugar levels. A few clinical trials have been held to create an empirical link to people actually suffering from type 2 diabetes.

In the reported study… Hong Kong researchers, Zhao-min and Associates at the Chinese University in Hong Kong, selected one hundred and eighty post-menopausal ladies who either displayed:

• pre-diabetes (where blood sugar levels are higher than they should be but not high enough to earn entry into the “type 2 diabetes club”), or
• early pre-treatment type 2 diabetes (where although the ladies had been diagnosed with type 2 they had not yet started treatment)

After randomly assigning the subjects to three groups, the researchers imposed the following treatment regimes:

• Group 1 took a powdered supplement that contained milk proteins
• Group 2 took the same supplement plus soy isoflavones
• Group 3 took a soy protein supplement plus soy isoflavones

The three groups were instructed to mix their prescriptions with liquid every morning but to otherwise stick to their normal diets. After six months the researcher’s found no clear evidence of Groups 2 and 3 having improved when compared to Group 1.

Although they did find marginal improvements among the Group 3 women, these peaked after two hours and then soon dissipated, leaving the researchers to conclude that neither soy nor isoflavone supplements had a beneficial effect on blood sugar levels among women.

Is this the final word on the subject? Surprisingly, Zhao-min and Associates say no. Noting that theirs appears to have been the first controlled trial of its nature, they ended their report with a remark that “additional studies that are based on longer trials and using different soy and phytoestrogen regimens are warranted before a final decision can be reached”.

A further study out of Japan, the Japan Public Health Center-Based Prospective Study, revealed a higher intake of soy products by overweight women was associated with a lower risk of type 2 diabetes. In view of this, researchers have declared the possible protective association of the intake of soy protein and soy isoflavone by overweight women deserves to be investigated further.

These findings are no reason for people living with type 2 diabetes to give up on their soy. At the worst it’s neutral and good for many other reasons besides lowering blood sugar levels.

Diabetes Can be Reversed

Diabetes is referred to by many as “The Silent Killer.” 5.7 million people in the U.S have one form of diabetes or another, but they are undiagnosed. This is frightening when you consider the consequences.

Diabetes has been with us for a very long time ago. Scientific research indicates that the problem began more than 100 years ago when people in the Western World began adding serious amounts of carbohydrates to their daily diets.

We Have Met The Enemy, and it is Sugar

The real culprit in this scenario is sugar! Today you will find it hard to find any “processed foods” that aren’t loaded with sugar and starches. As far as the body is concerned starches are just as bad since they are converted or “metabolized” into sugar by the insulin produced by the pancreas.

Is Your Pancreas Being Overworked?

Insulin converts sugar into glucose, and this substance is what the muscles and tissues need as a source of energy. The problem is that a good thing is being overdone. The pancreas can only produce so much insulin, and in the case of the diabetic, this sugar (glucose) overwhelms the ability of the pancreas to produce enough insulin to handle the load.

In some cases the pancreas just shuts down insulin production (Type 1 Diabetes). With others–it can’t produce enough insulin and it must be supplemented by injections (Type 2 Diabetes).

It has taken a very long time for medical science to realize that drugs and insulin shots are not treating the disease-they are merely treating the symptoms.

New discoveries, and thousands of diabetics reporting being free of the symptoms, has begun a new line of thought among the medical community. Here are four steps you can take to begin the process of reversing this dreaded disease:

Four Simple Steps Leading Back To a Normal Life

1. Reduce sugar intake. Avoid adding sugar to the foods you eat. Read the labels on the processed foods you buy. You will be amazed at the sugar content. Give your pancreas a break!

2. Reduce the amount of carbohydrates you eat every day. The things to avoid are the “white” foods like potatoes, white rice and any products manufactured from white flour like bread.

3. Add more fiber to your diet. Salads are a great source of fiber but check out the label on the salad dressing. Ideally, the safest and most beneficial dressing is made from balsamic vinegar and olive oil. Yes-olive oil is one of those “good” fats.

4. Exercise: If you can arrange it, and afford it, join a gym and work out at least three times a week. If this isn’t possible, walking briskly is a sensible substitute.

Honestly, is this really asking too much in order to return to a normal life?

The anti-anginal drug ranolazine significantly reduces both fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) when added to antidiabetic therapy in patients with poorly controlled Type 2 diabetes, analysis of MERLIN-TIMI 36 data indicate.

Previous results from the MERLIN-TIMI 36 (Metabolic Efficiency with Ranolazine for Less Ischemia in Non??”ST-Elevation Acute Coronary Syndromes??”Thrombolysis in Myocardial Infarction 36) trial, reported by MedWire News, demonstrated that ranolazine has a beneficial effect on HbA1c levels in patients with and without Type 2 diabetes.

The current study assessed the effects of ranolazine on HbA1c and FPG in participants of the MERLIN-TIMI 36 trial with Type 2 diabetes and a high HbA1c or FPG at randomization.

In the original study, 6560 patients with acute coronary syndrome were assigned to receive placebo or ranolazine 1000 mg twice daily (intravenous infusion followed by oral administration). In total, 770 of the participants who were treated with placebo and 707 who were treated with ranolazine were diabetic.

Writing in the journal Diabetes Care, the team report that diabetic patients with a baseline HbA1c of 8% or more (n=171) who were treated with ranolazine had a significant placebo-corrected decrease in HbA1c of 0.59%. This reduction amounted to approximately twice that achieved by patients with an initial HbA1c of 6??”8%.

Patients with an FPG of 150??”400 mg/dl at randomization (n=131), indicative of marked hyperglycemia, who were treated with ranolazine had a significant placebo-corrected reduction in FPG of 25.7 mg/dl. However, patients with normal to moderate fasting hyperglycemia (FPG below 150 mg/dl) treated with ranolazine had no significant change in FPG over the study period, compared with those treated with placebo.

“These results indicate that the previously reported lowering of HbA1c by ranolazine is positively correlated with HbA1c levels at randomization and is associated with a reduction in FPG in patients with hyperglycemia,” write the authors.

They conclude: “The mechanism of action of ranolazine to lower FPG and HbA1c is currently being investigated, however preliminary data from studies using rat and human pancreatic islets suggests that ranolazine may promote glucose-stimulated insulin secretion.”

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

Free abstract

MedWire Links
MERLIN-TIMI confirms favorable effects of ranolazine on HbA1c

Exenatide treatment plus lifestyle modification is effective for promoting weight loss and improving glucose tolerance in nondiabetic and prediabetic obese individuals, show study results.

Exenatide plus lifestyle modification has previously been shown to improve glycemic control and reduce weight in Type 2 diabetes patients when taken in combination with metformin or a sulfonylurea, as reported by MedWire News.

In this study, Julio Rosenstock (Dallas Diabetes and Endocrine Center at Medical City, Texas, USA) and colleagues assessed the efficacy of exenatide for improving weight and glucose tolerance in 152 nondiabetic obese individuals, of whom 25% had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). The participants had an average body mass index of 39.6 kg/m² and weight of 108.6 kg and were aged 46 years on average.

They were randomly assigned to receive exenatide 5??”10 µg (n=73) or placebo (n=79) twice daily before morning and evening meals for a period of 24 weeks. During this period a structured diet and exercise program was also implemented.

Writing in the journal Diabetes Care, the team reports that from baseline, patients in the exenatide-treated group lost 5.1 kg in body weight compared with a reduction of only 1.6 kg in the placebo group, amounting to a significant 3.3 kg difference .

In addition, by the end of the study 77% of exenatide-treated and 56% of placebo-treated individuals had normalized IGT or IFG.

The team notes that no deaths, serious adverse events, or hypoglycemia were observed during the study. Nausea and diarrhea were more common in the exenatide-treated patients than the placebo group, at 25% and 14% versus 4% and 3%, respectively.

“The current findings warrant further studies to explore the potential role of glucagon-like peptide-1 receptor agonists for the treatment of obese subjects with IGT or IFG,” conclude the authors.

They suggest: “Exenatide, in addition to lifestyle modification, has potential as a treatment for obesity in subjects at high risk for developing 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; 2010

Free abstract

MedWire Links
Exenatide treatment adds extra benefit to lifestyle modification