American Diabetes Association And Entelos Broaden Access To Testing With “Virtual Mice”
April 11, 2008
The American Diabetes Association (ADA) and Entelos, Inc. (LSE: ENTL) announced extending its in silico (computer simulation) diabetes research center capability and offering free access to Entelos’ Realab™ “virtual mice” testing platform to all ADA health professional members. Realab allows direct web access to Entelos’ state-of-the-art computer model of type 1 diabetes, enabling scientists and clinicians an unparalleled ability to investigate the onset, progression, and treatment of diabetes.
Using Realab, researchers can conduct simulations on drugs, drug combinations, dose levels, dosing regimens, therapeutic targets, biological pathways and functions on the primary animal model used to study type 1 diabetes. Realab’s virtual environments allow investigators to preview the likely effects of different therapeutic interventions, helping to inform the optimal design of lab experiments and clinical protocols.
The ADA and Entelos collaborated to develop the Type 1 Diabetes PhysioLab® platform, a large scale computer-based mathematical model of the non-obese diabetic (NOD) mouse, which is the simulation engine behind Realab for type 1 diabetes.
“There are now two ways that our members can benefit from Entelos’ cutting-edge simulation technology,” said Richard Kahn, Ph.D., chief scientific and medical officer, American Diabetes Association. “The first is through the diabetes research center capability, which is available via a grant process. The second is through direct online access of Entelos’ Realab for type 1 diabetes research, which we are now pleased to offer for free to all ADA health professional members. We believe that this will not only accelerate adoption of this innovative approach, it will also make a big impact on finding new therapies for type 1 diabetes, which primarily affects children and young adults.”
“One of the greatest disappointments for the pharmaceutical industry is having experimental compounds that show early promise in animals that later fail miserably when tested in humans,” stated James Karis, president and CEO of Entelos. “In building our initial model of a ‘virtual mouse’, scientific teams at Entelos discovered subtle but important differences between species that can have a big impact on interpreting results of animal studies and on designing clinical trials. Our models and predictive platforms help to better translate results and design experiments to make animal studies more meaningful and relevant for finding effective medicines for patients. We plan to increase access to Entelos’ powerful simulation technology to enhance researchers’ capabilities to rapidly test ‘virtual mice’ and ‘virtual patients’ and ultimately use fewer animals, run more decisive clinical trials, and save time and money.”
Realab currently has a virtual environment available for type 1 diabetes. Environments for rheumatoid arthritis, cardiovascular disease and type 2 diabetes are under development by Entelos. Details regarding Realab can be found at http://www.entelos.com
About Realab™
Realab™ was developed by Entelos to provide scientists and clinicians with personalized web-based access to Entelos’ award-winning PhysioLab® technology and computer models of human and animal disease physiology. Realab’s virtual environments allow investigators to preview the likely effects of different therapeutic interventions in advance, helping to inform the optimal design of research and clinical protocols in the real world.
The Realab web-based tool facilitates the design and submission of experiments and clinical protocols. The investigator uses a menu system to select from available predefined options for each simulation analysis including drugs, drug combinations, dose levels, dosing regimens, therapeutic targets, biological pathways, functions, patient or animal phenotypes and sampling intervals.
Once a Realab protocol is submitted, simulation results are available in Realab within 24 hours for later analysis at the user’s convenience. Researchers can visualize the predicted outcome of the Realab protocol using graphs and other tools to investigate the underlying biological mechanisms responsible for each predicted outcome.
Realab currently has a virtual environment available for type 1 diabetes with predefined experiments, about a dozen therapies and 75 possible model outputs. Access to Realab simulations for non-ADA members can be purchased online or via purchase order.
About the Type 1 Diabetes PhysioLab Platform
The Entelos® Type 1 Diabetes PhysioLab® platform is a large-scale, mathematical model of the non-obese diabetic (NOD) mouse designed to support research in type 1 diabetes. The platform captures the physiology of pancreatic cell autoimmunity and tolerance from birth until disease onset. Virtual NOD mice are constructed using equations that mathematically represent cellular functions and biochemical interactions in tissues critical for the pathogenesis of type 1 diabetes. The model encompasses two main tissues: pancreatic lymph nodes (PLN) and pancreatic islets. Antigen and antigen-presenting cells traffic from the islets to the PLN, and conversely, lymphocytes activated in the PLN can enter the blood and be recruited to the islets. Functions at the biochemical and cellular levels are integrated and the dynamic relationships over time quantitatively linked via mathematical equations, making simulation and prediction of biological outcomes possible.
About Entelos
Entelos, Inc. (http://www.entelos.com) is a US-based life sciences company applying next-generation predictive technologies to revolutionize the way medicines are discovered, developed, and utilized. The Company leverages its proprietary in silico disease models, “virtual patients”, and toxicology reference systems to develop safer and more effective drugs and support pharmaceutical R&D and commercialization. In addition to internal drug programs in rheumatoid arthritis and women’s health, Entelos provides customized technology and research services to global pharmaceutical and health-care companies in cardiovascular diseases, asthma, obesity, diabetes, hematopoeisis (anemia), cholesterol metabolism, and skin sensitization. The Company is also developing a model in oncology and is collaborating with the FDA to build a model of drug-induced liver injury. Entelos also offers cost-effective drug development capabilities through its strategic alliance with India-based Jubilant Biosys Ltd.
About the American Diabetes Association
The American Diabetes Association is the nation’s premier voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing services to hundreds of communities. The Association’s commitment to research is reflected through its scientific meetings; education and provider recognition programs; and its Research Foundation and Nationwide Research Program, which fund breakthrough studies looking into the cure, prevention, and treatment of diabetes and its complications.
American Diabetes Association
3,000 Walkers Braved Snow In Support Of Diabetes UK
April 11, 2008
On a bitterly cold morning with heavy snow across most parts of the country, the walk took place successfully at 13 BAPS Shri Swaminarayan Mandirs and Centres around the UK.
More than 3,000 walkers braved the challenging weather conditions across London, Ashton, Birmingham, Coventry, Havant, Milton Keynes, Leicester, Loughborough, Luton, Nottingham, Preston, Southend-on-Sea and Wellingborough.
BAPS had appointed Diabetes UK as their Charity of the Year at the start of 2008 and will be donating a percentage of the monies collected from this walk to the charity.
The opening ceremony in London began with a traditional prayer meeting at the BAPS Shri Swaminarayan Mandir in Neasden after which Douglas Smallwood, Chief Executive of Diabetes UK, (pictured, right) addressed the audience and joined the walkers.
Opening ceremony
Other invited guests at the opening ceremony included Dawn Butler MP (for Brent South), Barry Gardiner MP (for Brent North) and the Mayor of Brent, Councillor Harshad Patel.
Celebrity chef Manju Mahli, was present at the BAPS event. Manju appears on TV food programmes such as BBC’s Saturday Kitchen with Antony Worral Thompson and she was on the guest cookery slot on BBC2’s Food and Drink.
Raising awareness of diabetes in the South Asian community
As many as 20 per cent of the South Asian population have diabetes, in contrast to approximately 5 per cent of the general population. 300 people in the UK are diagnosed with diabetes every day - 60 of these are from the South Asian community.
Diabetes is a serious and deadly condition - it is a leading cause of heart disease, stroke, blindness, and amputation - yet if diagnosed early and treated accordingly, the risk of developing a complication can be decreased dramatically.
Making a difference to lives
Douglas Smallwood, Chief Executive of Diabetes UK said: “Diabetes UK is here for all people with diabetes. We hope our work with the BAPS Shri Swaminarayan community will develop into a long-term partnership. Our aim is for our services to be accessed by many people in these communities and make a real difference to their lives.”
Dr Mayank Shah, spokesperson for BAPS said: “BAPS has been involved in diabetes screening for a number of years and this partnership will allow both organisations to promote diabetes awareness and education to a larger section of the Asian and wider community. We were delighted that so many people attended the walk and supported BAPS and Diabetes UK.”
Diabetes UK
International Diabetes Federation To Provide Diabetes Education Courses To Diabetes Educators In Latin America
April 10, 2008
The International Diabetes Federation (IDF) South and Central America (SACA), which includes the Hispanic Caribbean, has begun providing diabetes education courses for educators throughout Latin America to increase knowledge and improve care for people with diabetes in the region.
The goal is to train future diabetes educators and improve the knowledge of current educators by teaching the latest guidelines and methods of care. “In 2007, a survey was carried out in the SACA region to identify the most urgent needs related to diabetes. The results indicated that it was essential to educate at all levels, in order to provide knowledge to people with diabetes and their families, increase awareness on diabetes and involve governments in tackling the diabetes epidemic,” said Esc. Susana Feria de Campanella, Chair of the SACA Region, International Diabetes Federation. “This will be made possible by implementing regional and national programmes, the latter through diabetes associations in each country”.
Through these courses, the IDF-SACA Region aims to change the traditional therapeutic approach to the management of diabetes and promote a more aggressive, preventive and self-managed approach. The Region also hopes to establish diabetes education as an essential pillar in the healthcare of people with diabetes and their families.
The diabetes education courses are intended to empower health professionals to produce a positive impact in the prevention, management, and education of diabetes. The goal is also to minimize the development of chronic diabetes complications, as well as supply the health professional with advanced knowledge in clinical diabetology, and the skills required to develop educative processes for people with diabetes.
The first SACA diabetes educators meeting took place in Brasilia, June 1-3 2007, with the financial and logistic support of the Juvenile Diabetes Association (AJD), the Ministry of Public Health and industry. Sixty educators from the region worked under the coordination of the SACA Regional Working Group on Diabetes Education, using the IDF Guidelines on Diabetes Education, and standardizing and adapting them to the region. The Working Group is coordinated by Mrs. Betty Rodriguez, MSN, CDE, Public Health Advisor and Professor Rosario García. The meeting saw the creation of the Latin-American Network of Diabetes Educators (RELAD). Following the meeting, each participant continued the work in their respective countries in order to achieve the objective of offering diabetes education courses in the entire SACA region.
The courses began last November in Uruguay during World Diabetes Day, and they will continue in May 2008 in Brazil and Argentina. The courses address a wide variety of content, ranging from the scale of the diabetes problem to models, methods and educational techniques. They also include the diagnosis, classification and therapeutic aspects of diabetes. “Everything will be developed under participatory and interactive methods, where educators will learn by thinking, doing and taking decisions. To achieve this, the courses will be complemented by case discussions and bibliographies, demonstrative workshops and other participative techniques,” said Prof. Garcia.
Rodríguez, who conducts the education courses, said, “Beforehand we need to establish the educator’s role and the minimum competence, knowledge, abilities, skills and attitudes needed to offer optimal diabetes care and education, as well as the content of the courses in accordance with the different levels: basic, medium or advanced.”
According to the International Diabetes Federation′s Diabetes Atlas, it is estimated that there are 16.2 million people with diabetes in the SACA region, or 6% of the adult population. In the next 18 years, the number of people with diabetes is expected to rise dramatically to 32.7 million.
“The progression of the disease is already a threat to the world, hence one of the objectives of the International Diabetes Federation SACA Region is to work towards empowering diabetes educators, so that they can reach people with diabetes with pedagogical tools and help them to understand the disease and the importance of managing it correctly,” said Esc. Feria de Campanella. “With diabetes education, we can ensure that those diagnosed accept their diabetes, adhere to treatments, and self-manage their condition, thereby preventing complications, and the extra costs that these bring to themselves, their families and the community.”
“Health professionals should be empowered so that they can, with their knowledge and conviction, effectively fulfill the wishes, attitudes and needs of people with diabetes. Enabling people with diabetes to accept and meet their obligations and responsibilities is the best way that they can be assisted,” she added.
Note
The International Diabetes Federation (IDF) is an umbrella organization of over 200 member associations in more than 160 countries, advocating for the 250 million people with diabetes, their families, and their healthcare providers. Its mission is to promote diabetes care, prevention and a cure worldwide. The International Diabetes Federation is an NGO in official relations with the World Health Organization and an associated NGO with the United Nations Department of Public Information. The International Diabetes Federation leads the World Diabetes Day campaign. Additional information is available at http://www.idf.org.
The International Diabetes Federation (IDF) South and Central America (SACA) region represents 37 IDF member associations in 21 countries. Its mission is to support the member associations to improve the lives of people with diabetes. The IDF-SACA coordinates activities with international organizations like the Pan American Health Organization (PAHO), World Health Organization (WHO) and the Diabetes American Declaration (DOTA). For more information visit http://www.idf.org/saca.
International Diabetes Federation
Insulin Problems In Mid Life Linked To Raised Alzheimer’s Risk
April 10, 2008
A new study on men living in Sweden suggests that a poor insulin response in midlife, the main characteristic of diabetes, is linked to an increased risk of developing Alzheimer’s disease up to 35 years later.
The study is published in the early online 9th April issue of Neurology and was conducted by Dr Elina R?nnemaa, from Uppsala University in Uppsala, Sweden, and colleagues.
R?nnemaa said the findings:
“Have important public health implications given the increasing numbers of people developing diabetes and the need for more powerful interventions.”
For the longitudinal study, 2,269 men living in Sweden underwent glucose testing for diabetes in 1970, when they were enrolled in the Uppsala Longitudinal Study of Adult Men at age 50.
The results showed that:
- Men who had a low insulin response at age 50 (baseline) were nearly 1.5 times more likely to develop Alzheimer’s disease than men who did not have insulin problems.
- The risk was still significant after adjusting for age, blood pressure, cholesterol, smoking, body mass index, insulin resistance and educational status.
- The link was stronger in those men who did not have the APOE4 gene, which is known to increase Alzheimer’s risk.
- Impaired glucose tolerance increased the risk of vascular dementia but not Alzheimer’s.
- Impaired insulin secretion, glucose intolerance, and estimates of insulin resistance, were all linked with elevated risk of any dementia and cognitive impairment.
The researchers concluded that:
“In this longitudinal study, impaired acute insulin response at midlife was associated with an increased risk of Alzheimer disease (AD) up to 35 years later suggesting a causal link between insulin metabolism and the pathogenesis of AD.”
R?nnemaa said the results suggested:
“A link between insulin problems and the origins of Alzheimer’s disease and emphasize the importance of insulin in normal brain function.”
She explained that perhaps insulin problems lead to damaged blood vessels in the brain, which causes problems with memory and Alzheimer’s disease, but she emphasized that further research was needed to discover the detailed underlying biology.
R?nnemaa pointed out that this finding shows that problems with insulin secretion are an important risk factor for Alzheimer’s disease, when the genetic risk from the APOE4 gene is absent.
“Impaired insulin secretion increases the risk of disease.”
E. R?nnemaa, B. Zethelius, J. Sundel?f, J. Sundstr?m, M. Degerman-Gunnarsson, C. Berne, L. Lannfelt, and L. Kilander.
Neurology, first published online on 09 April 2008.
DOI:10.1212/01.wnl.0000310646.32212.3a
Click here for Abstract.
Source: Neurology abstract, American Academy of Neurology press release.
Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Cholesterol, Blood Pressure Control May Reverse Atherosclerosis In Adults With Diabetes
April 10, 2008
Aggressively lowering cholesterol and blood pressure levels below current targets in adults with type 2 diabetes may help to prevent - and possibly reverse - hardening of the arteries, according to new research supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Hardening of the arteries, also known as atherosclerosis, is the number one cause of heart disease and can lead to heart attack, stroke, and death.
The three-year study of 499 participants is the first to compare two treatment targets for LDL (”bad”) cholesterol and systolic blood pressure levels, key risk factors for heart disease, in people with diabetes. Results are published in the April 9 issue of the Journal of the American Medical Association.
“This study provides good news for adults with type 2 diabetes,” said Elizabeth G. Nabel, M.D., NHLBI director. “These patients are two to four times more likely than people without diabetes to die from heart disease. For the first time, we have evidence that aggressively lowering LDL cholesterol and blood pressure can actually reverse damage to the arteries in middle-aged adults with diabetes.”
In the Stop Atherosclerosis in Native Diabetics Study (SANDS), approximately one-half of the participants (247) were asked to lower to standard levels their LDL cholesterol (to 100 milligrams per deciliter) and blood pressure (systolic blood pressure of 130 mmHg or lower), while the other half (252) aimed for more aggressive lowering of LDL cholesterol to 70 mg/dL or lower and of systolic blood pressure to 115 mmHg or lower. All participants were American Indians 40 years or older (average age of 56) who had diabetes, high blood cholesterol, and high blood pressure but no history of heart attack or other evidence of heart disease. The study was conducted at four clinical centers in southwestern Oklahoma; Phoenix, Ariz.; northeastern Arizona; and South Dakota. All participants continued to receive their medical care, including diabetes management, dietary and exercise counseling, and smoking cessation, from their health care providers with the Indian Health Service. Like the NIH, the Indian Health Service is part of the U.S. Department of Health and Human Services.
“American Indians have a high rate of diabetes and cardiovascular disease related to diabetes, but there are few clinical trials that address these issues in this population,” said Barbara V. Howard, Ph.D., of MedStar Research Institute in Hyattsville, Md., lead author of the paper. “These study results provide needed evidence to help develop community-based programs to treat and prevent the epidemic of cardiovascular disease among American Indians. At the same time, we are increasing our understanding of the effects of intensively lowering cholesterol and blood pressure in adults with type 2 diabetes, which might also apply to other populations.”
During the three-year study, participants were examined by study clinicians one month after enrollment, then every three months, to assess their blood cholesterol and blood pressure levels and general well being. Food and Drug Administration-approved blood pressure and cholesterol medications were added and adjusted as needed to help participants achieve their treatment goals. The same medications were available to participants in the standard and the aggressive treatment groups. Participants were also encouraged to follow lifestyle approaches to help meet their blood pressure and cholesterol treatment targets, such as following a heart-healthy eating plan, being physically active, maintaining a healthy weight, and not smoking.
To assess the impact of the treatments on the participants’ cardiovascular health, researchers used ultrasound to measure the thickness of the carotid (neck) artery — an indication of hardening of the arteries, a leading effect of high blood pressure and cholesterol and an early sign of cardiovascular disease. In addition, ultrasound was also used to measure the size and function of the left ventricle, the heart’s main pumping chamber. Enlarged hearts are known to be predictors of increased risk of heart attack and stroke. These measurements were taken at enrollment, at 18 months, and at 36 months, when the study ended.
On average, participants in both groups reached and maintained their target goals for blood cholesterol and blood pressure levels. The numbers of heart attacks and other cardiovascular events were similar between the two groups and lower than expected.
In addition, carotid artery thickness measurements of participants in the aggressive treatment group were significantly lower than those in the standard treatment group. Researchers report that, compared to baseline, carotid artery thickness increased slightly in the standard group and regressed in the aggressive treatment group, indicating a partial reversal of atherosclerosis. Furthermore, although heart size decreased from baseline in both groups, the beneficial change was significantly greater among participants in the aggressive treatment group.
“Many patients with diabetes do not reach their blood pressure and cholesterol goal levels and thus remain at high risk for heart attacks and stroke,” noted Howard. “In our study, participants successfully managed their blood cholesterol and blood pressure to reach their goal levels. Our message to doctors, nurses, and patients is that you can reach your goal levels, and we should work together to help you do that.”
As with any therapy, the benefits and risks must be considered for each patient. In SANDS, participants in the aggressive treatment group on average needed more medications and higher doses than the standard treatment group, and they were slightly more likely to have side effects from blood pressure-lowering medications than those in the standard group. Such adverse effects generally resolved, however, after the medication was changed or the dose reduced. There were no differences in side effects related to cholesterol-lowering drugs between the standard and the aggressive treatment groups.
“These encouraging findings from SANDS suggest that more aggressive blood pressure and cholesterol targets than those currently recommended in patients with diabetes may reduce their future cardiovascular risk,” said Jerome L. Fleg, M.D., NHLBI project officer of the study and a coauthor of the paper. “Longer term followup of this population as well as additional studies in other populations are needed to confirm the benefit and cost-effectiveness of these lower targets.”
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Medications used in this study were donated by First Horizon Pharmacy, Merck and Co., and Pfizer, Inc.
An estimated 21 million Americans have diabetes and 284,000 die from it each year. Sixty-five percent of the deaths are related to cardiovascular causes.
Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.gov.
The National Institutes of Health (NIH) - The Nation’s Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.
Resources:
* Your Guide to Living Well With Heart Disease, http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/living_well.htm
* Atherosclerosis, http://www.nhlbi.nih.gov/health/dci/Diseases/Atherosclerosis/Atherosclerosis_WhatIs.html
* National Diabetes Information Clearinghouse, http://diabetes.niddk.nih.gov/
* National Diabetes Education Program http://ndep.nih.gov/
Source:
NHLBI Communications Office
NIH/National Heart, Lung and Blood Institute
Potential Drug Target Identified For Diabetes
April 10, 2008
Scientists at the Toronto General Hospital Research Institute have discovered a novel signaling pathway between three organs the gut, the brain, and the liver which lowers blood sugar when activated.
A team led by Dr. Tony Lam used a rat model to discover that fats can activate a subset of nerves in the intestine, which then send a signal to the brain and subsequently to the liver to lower glucose or sugar production. But eating a high-fat diet for just three days can interfere with this signal, disabling it so that it does not signal the other organs to lower blood glucose levels.
The research was published in a paper entitled, “Upper intestinal lipids trigger a gut-brain-liver axis to regulate glucose production” as an advance on-line publication of the international science journal Nature.
“This is a new approach in developing more effective methods to lower glucose or blood sugar levels in those who are obese or have diabetes,” said Dr. Lam, who holds The John Kitson McIvor (1915 - 1942) Chair in Diabetes Research at the University Health Network and University of Toronto. Currently, those with diabetes lower their glucose through diet, exercise, anti-diabetic tablets or insulin injections (usually several times a day) and must regularly monitor blood glucose levels. High glucose levels can result in damage to eyes, nerves and kidneys and increase the risk of heart attack, stroke, blindness, erectile dysfunction, foot problems and amputations. Many laboratories around the world are in a race to find alternative and effective ways in which to lower glucose levels because of the severe complications which can result from high sugar levels.
“We already knew that the brain and liver can regulate blood glucose levels, but the question has been, how do you therapeutically target either of these two organs without incurring side effects?” noted Dr. Lam, who is also an Assistant Professor of Physiology and Medicine at the University of Toronto. “We may have found a way around this problem by suggesting that the gut can be the initial target instead. Much like a remote control device, the gut is able to relay a signal to the brain which in turn signals the liver to lower glucose production. If new medicines can be developed that stimulate this sensing mechanism in the gut, we may have an effective way of slowing down the body’s production of sugar, thereby lowering blood sugar levels in diabetes.”
Dr. Lam emphasized that it will take a number of years of experimental work to determine whether this approach is effective and safe in humans who have diabetes.
More than two million Canadians have diabetes. “Diabetes is an epidemic in Canada and around the world and its numbers are continuing to increase at an alarming rate, consuming our precious health care resources,” says Dr. Gary Lewis, Head of the Division of Endocrinology and Metabolism at the University Health Network and Mount Sinai Hospitals in Toronto and Professor of Medicine and Physiology at the University of Toronto. “We have good evidence from clinical trials which shows that lowering blood glucose levels towards normal in those who develop diabetes has a major impact in preventing its devastating complications, so it is critical that we learn how to control these levels in the most effective and least invasive ways possible. Dr. Lam’s work reveals a new regulatory circuit which provides novel sites and targets to lower these levels in diabetes and obesity.”
Dr. Richard Weisel, Director of the Toronto General Research Institute (TGRI), Professor and Chairman of Cardiac Surgery at the University of Toronto, welcomes any potential interventions which can help lower blood sugar levels. “Studies have shown that people with very high blood glucose levels are more likely to die from heart disease, so anything that we can discover to help lower these levels would help in decreasing the progression of and mortality from cardiovascular disease.”
“Tony’s discovery represents an exciting breakthrough that could eventually lead to new ways to treat diabetes,” observed Dr. Diane Finegood, Scientific Director of the Institute of Nutrition, Metabolism and Diabetes, part of the Canadian Institutes of Health Research (CIHR). “I am pleased that CIHR played a major role in funding this research”.
Working with rats, Dr. Lam and colleagues designed and performed a series of elegant experiments which showed for the first time that the lipids or fats which enter the small intestine trigger the afferent neuronal signal to the brain which then sends signals to the liver to lower glucose production and blood glucose levels in as little as fifteen minutes. No drop in levels occurred when nerves were cut or blocked between the gut and the brain or between the brain and the liver. The trigger to lower glucose was also disabled when rats were fed a high-fat diet for three days prior to the experiment, a finding which may suggest that those who eat a high fat diet lose this beneficial signaling pathway.
Other researchers involved in the study include Penny Wang, Liora Caspi, Carol Lam, Madhu Chari and Michelle Ang from TGRI; Xiaosong Li, Roger Gutierrez-Juarez and Gary Schwartz from Albert Einstein College of Medicine; Peter Light from University of Alberta.
The work was funded by the Canadian Institute of Health Research.
About Toronto General Hospital, University Health Network
Toronto General Hospital is a partner in the University Health Network, along with the Toronto Western Hospital and the Princess Margaret Hospital. These research hospitals are affiliated with the University of Toronto. The scope of research at Toronto General Hospital has made this institution a national and international resource for education and patient care, and a leader in diabetes, transplantation, cardiology, surgical innovation, infectious diseases and genomic medicine.
University Health Network (UHN)
Toronto, Ontario M5G 2M9
Canada
http://www.uhn.ca
Children At Highest Risk From Obesity Struggle With Change
April 9, 2008
A new study shows that children with obesity-related diabetes are reporting serious difficulties in making basic lifestyle changes that could save them from a lifetime of complications.
The study of 103 adolescents (ages 12 to 21) with type 2 diabetes, most of whom are overweight, shows many children and teens do not possess good self-management behaviors. The study was conducted by the Vanderbilt Diabetes Research and Training Center, working with patients at the Vanderbilt Eskind Pediatric Diabetes Clinic.
The respondents reported that making basic lifestyle changes that will lead to better future health, in areas such as diet and exercise, is more difficult than adjusting to medical management of their disease. Medical management includes daily medicines, blood sugar monitoring and injections of insulin. The study’s findings are published in the April issue of the journal Pediatrics.
“Type 2 diabetes in children is such a new problem that we don’t know a lot about these kids,” said Russell Rothman, M.D., deputy director of the Prevention and Control Division of the Vanderbilt Diabetes Research and Training Center. “This study is one of the most comprehensive to date to look at who these kids are and the challenges they and their families face trying to take care of themselves.”
Rothman and Shelagh Mulvaney, Ph.D., assistant professor in the School of Nursing, along with physicians and nurses from the Eskind Pediatric Diabetes Clinic, performed the telephone survey. Most children were either overweight or obese (possessing a body mass index (BMI) over 85 percent of the average for their age and weight).
More children (37 percent) reported the most difficult part of managing their disease was changing health habits like diet and exercise; 31 percent perceived taking insulin to be the most difficult part; and 18 percent had the toughest time adjusting to finger sticks for blood sugar tests.
More than 80 percent of patients reported taking medication regularly, and nearly 60 percent monitored their glucose twice daily. However, about 70 percent reported watching at least two hours of TV each day, and 63 percent said they did not currently participate in physical education classes. Children reported that barriers to making changes were: dealing with cravings or temptations, feeling stressed or sad, and frequently eating outside the home.
The study also found racial disparities. African-American patients had worse blood sugar control and were slightly more likely to act like adolescent peers without diabetes such as drinking sugary drinks and eating junk foods with regularity. The reasons for the disparities are not clear, and because this was not the target of the survey, this opens up the possibility for future surveys to better understand reasons for the disparities.
“These results indicate children are having a very difficult time now, and so you might think it would be very difficult to take care of themselves long-term,” Rothman said. “This will mean a major health crisis for the country to deal with later. We owe it to ourselves, as well as to these young patients, to find better ways to help them manage their obesity and diabetes.”
Vanderbilt University Medical Center
D-3237A Medical Center North
Nashville, TN 37232-2390
United States
http://www.mc.vanderbilt.edu
Thousands Of Diabetics Benefit Through Use Of The Electronic Health Record
April 8, 2008
Using the Electronic Health Record to actively engage diabetes patients in their own care results in improved blood sugar and cholesterol levels, better vaccination compliance and increased tobacco cessation rates, according to a new Geisinger study.
Geisinger Health System launched an Electronic Health Record-driven care program for its 20,000 diabetes patients in 2007. A study published in April’s Journal of General Internal Medicine showed improvements for most of those diabetic patients:
* the percentage of patients receiving pneumonia vaccinations increased from 56 to 80%;
* the percentage of patients receiving microalbumin test for possible kidney complications increased from 57 to 87%;
* the percentage of patients with an optimal cholesterol level increased from 54 to 57%;
* the percentage of documented non-smokers increased from 77 to 82%.
As part of the work, Geisinger developed a series of nine “best practice” guidelines that its clinical teams follow when caring for diabetics. Many of those guidelines rely on Geisinger’s $90 million Electronic Health Record.
The Electronic Health Record automatically generates reminders to make sure patients receive timely blood tests and vaccinations, allows patients and doctors to immediately review lab results and also provides instant feedback to physicians about the health of their patients.
A key part of the program also involves Geisinger’s Internet portal, MyGeisinger, where patients can e-mail their doctor results of home glucose tests, schedule health appointments and renew prescriptions.
“This approach shows the importance of incorporating information technology directly into patient care,” Geisinger Medical Director of Performance Improvement Frederick Bloom, MD said. “These tools can be used by patients at home and doctors in clinics and the result is better overall patient health.”
An estimated 16 million Americans suffer from diabetes. It is estimated that diabetes-related medical expenditures in the U.S. hit $116 billion last year.
“Diabetes is a huge public health problem in this country,” Geisinger Director of Internal Medicine Valerie Weber, MD said. “With that in mind, our doctors made small changes to their work routines that had huge benefits for their patients.”
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About Geisinger Health System
Founded in 1915, Geisinger Health System (Danville, PA) is one of the nation’s largest integrated health services organizations. Serving more than two million residents throughout central and northeastern Pennsylvania, the physician-led organization is at the forefront of the country’s rapidly emerging electronic health records movement. Geisinger is comprised of three medical center campuses, a 700-member group practice, a not-for-profit health insurance company and the Center for Health Research - dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes. For more information, visit http://www.geisinger.org/.
Source: Justin Walden
Geisinger Health System
Diabetes In Wisconsin Increased 27% Since 2005, Report Says
April 8, 2008
The incidence of diabetes among Wisconsin adults increased by 27% since 2007, bringing the percentage of the state’s adults with the disease to nearly 10%, compared with 8% three years ago, according to a report from the state’s Department of Health and Family Services, the Milwaukee Journal Sentinel reports. According to the report, 419,870 adults in the state have diabetes. In addition, the report found that about one million adults have prediabetes, a condition where blood sugar levels are elevated but not high enough to be considered diabetes but can still harm the heart and blood vessels.
The report found that:
- Diabetes-related hospitalizations from 2007 to 2007 increased by about 11% to 94,331;
- Hospital charges increased by 48%, from $1.35 billion to $2 billion; and
- Diabetes-related costs for the state increased 16% to $5.2 billion from $4.5 billion.
The Department of Health and Family Services compiled the report through a partnership with the National Kidney Foundation of Wisconsin and the Wisconsin Lions Foundation (Fauber, Milwaukee Journal Sentinel, 4/3).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Does Sugar Play A Role In Weight Gain? An International Conference Held In Paris Takes Stock
April 8, 2008
As part of the struggle against obesity, where the link between sugar and weight control is subject for debate, Institute Benjamin Delessert hosted an international conference last February 12th in Paris. The conference, chaired by Professor Bernard Guy-Grand (1), invited nine international experts to assess the current state of scientific knowledge on the topic.
Does sugar play a specific role in weight control? World-renowned experts ponder the question.
Weight gain is the result of an imbalance between energy intake and expenditure. The issue at stake is whether sugars present in liquid or solid food defeat food-intake, and incidentally weight, control mechanisms by creating passive consumption. Held on February 12th in Paris, the “Sugar and Weight Control” symposium surveyed the possible role of sugar in the overweight and obesity “epidemic”.
Numerous interventions presented the complex nature that exists between “sugar and weight control”. Talks given by world-renowned specialists approached the issue from a metabolic (metabolism of the various sugars, muscular energetic, the glycemic index / weight control relation) or epidemiological (analysis of data on sugar consumption and its impact on weight) standpoint. The following interventions focused on a behavioural and cognitive approach: the role of sugar in the food-intake control mechanism, the case of the sweet taste in acquired food preferences, the question of sweet-taste addiction, different social representations of sugar.
Conferences which contribute new elements of understanding
Here are a few preliminary elements of understanding on the complex relation between sugars and weight control gleaned from the interventions (2):
Sugar and weight: what does epidemiology teach us? Dr Alison Stephen (3) presented a detailed analysis of the data obtained from epidemiological literature associating sugar and the weight of populations. In those countries with relatively reliable data, sugar consumption did not increase over the past two decades, but food sources have changed. The results tend to show the lack of any link between sugar consumption and weight,
including in the case of sweetened beverages, for which there are fewer positive than negative correlations. Glycemic index, insulinemic index, and weight control. Tom Wolever (4) studied the ideas of glycemic and insulinemic indexes. Arguments drawn mostly from short-term studies lead to the conclusion that food with low glycemic indices fosters the maintenance of a stable weight by decreasing appetite. This effect is probably more closely related to other components than to the sugar content of such food.
Energy balance: is there any difference between sweet foods ingested in solid or liquid shape? Adam Drewnowski (5) considered the role of liquid foods, which might be less satiating than solid foods, thus resulting in a less controlled food intake. He underlined that as soon as the energetic density is the same, sweet liquids are as satiating as solid food. As regards the relation between sweet beverages and weight, he placed the blame on consumption behaviours rather than on sweet calories per se.
Role of sweet flavour in food-intake control. John Blundell (6) observed that the sweet taste is both a signal of energetic food and a source of pleasure and that - perhaps partly for genetic reasons - it has a pronounced effect on appetence. This effect is important if there is to be a desire to consume. However, there remain significant individual differences, based on sex and body fat, which do not allow overly general conclusions to be drawn.
Sweet-taste addiction: true or spurious debate? France Bellisle (7) stressed the importance of not misunderstanding the definition of addiction. She added that the excessive attraction for some foods (not necessarily sweet ones) may appear similar to a dependency on drugs because the mechanisms stimulated by the drugs are the same. Nevertheless, the fact remains that “sweet foods” may contribute to certain behaviour disorder, but not as a “drug” would”. Generally, these disorders appear under specific circumstances (bulimia).
Conclusion: a necessarily varied answer
One certainty arises from the wealth of these conferences: the question of the role of sugar in weight control is so complex that it cannot be satisfied with a unique answer. The question of sugars and weight control deserves a multidisciplinary approach, integrating metabolic, epidemiological, behavioural and socio-cultural aspects, among others. The answer today must be varied: while sugars, through sweet foods, contribute to dietary intake, they cannot be blamed specifically for the obesity epidemic.
Institute Benjamin Delessert
The Institute Benjamin Delessert has helped Research since its creation in 1976, by financing studies bearing, among others, carbohydrate metabolism and physiopathology. The purpose of the Research Projects Awards, created in 2002, is to support academic research in France. “Benjamin Delessert Conferences” periodically gather several renowned lecturers to analyse a theme of current interest.http://www.institut-benjamin-delessert.org
CEDUS
The Information and Resource Centre on Sugar is a multidisciplinary agency, created in 1932: its mission is to provide information and documentation on an essential product of the French agro-food sector: Sugar.
http://www.lesucre.com
References
(1) Bernard Guy-Grand, Professeur Honoraire de Nutrition, Ancien Chef du Service de Nutrition, H?tel-Dieu, Paris.
(2) A summary of lectures and a list of speakers are available on request.
(3) Dr Alison Stephen (PhD, Head of Population Nutrition Research at MRC Human Nutrition Research, Cambridge) UK.
(4) By Thomas MS Wolever, Department of Nutritional Sciences and Medicine, University of Toronto, Division of Endocrinology and Metabolism, St Michael’s Hospital, Toronto, Canada.
(5) Adam Drewnowski - Center for Public Health Nutrition and the Nutritional Sciences Program, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA
(6) John Blundell, Chair of Psychobiology, Institute of Psychological Sciences, University of Leeds, Leeds, LS2 9JT, UK
(7) France Bellisle, Institut National de la Recherche Agronomique (INRA), Centre de Recherche en Nutrition Humaine (CRNH - ?le-de-France), SMBH, Bobigny France.
http://www.lesucre.com
