New approach to reduce risk of developing type 2 diabetes

An international clinical trial conducted by the University of Liverpool has shown that the drug liraglutide 3.0 mg may reduce diabetes risk by 80% in individuals with obesity and prediabetes according to a study published today in The Lancet.

This three-year SCALE obesity and prediabetes trial followed 2254 adults with prediabetes at 191 research sites in 27 countries worldwide. The aim was to evaluate whether liraglutide 3.0 mg can safely delay the onset of type 2 diabetes in participants with prediabetes.

Prediabetes, also commonly referred to as borderline diabetes, is a metabolic condition and growing global problem that is closely tied to obesity. If undiagnosed or untreated, prediabetes can develop into type 2 diabetes; which whilst treatable is currently not fully reversible.

Significant health cost

In the UK 1 in 10 of the population have prediabetes. The associated health care cost to the economy is significant. These individuals are at risk of a range of conditions that can affect their overall health including type 2 diabetes and its complications as well as cardiovascular disease and cancer.

Liraglutide promotes weight loss by interacting with the areas of the brain that control appetite and energy intake.

The participants in the study, which was conducted at University Hospital Aintree, were randomly allocated to either liraglutide 3.0 mg or a placebo delivered by injection under the skin once daily for 160 weeks. They were also placed on a reduced calorie diet and advised to increase their physical activity.

The study showed that three years of continuous treatment with once-daily liraglutide 3.0 mg, in combination with diet and increased physical activity, reduces the risk of developing type 2 diabetes by 80% and results in greater sustained weight loss compared to the placebo.

New therapeutic approach

Professor John Wilding, Professor of Medicine at the University’s Institute of Ageing and Chronic Disease and Honorary Consultant Physician is an obesity specialist was an investigator in the trial and an author of this study.

Professor Wilding, said: “In this study, we wanted to see if this drug in combination with a reduced-calorie diet and lifestyle intervention could delay the onset of type 2 diabetes in a high-risk population with obesity and prediabetes.

“On the basis of our findings, liraglutide 3.0 mg can provide us with a new therapeutic approach for patients with obesity and prediabetes to substantially reduce their risk of developing type 2 diabetes and its related complications.

“As healthcare professionals, it is important that we can offer a treatment to our type 2 diabetes patients that we are confident will achieve results in the real-world that are consistent with the results of the clinical trial programme.”

The study is a continuation of work started by Professor Wilding in 1996 when he was working at the Hammersmith Hospital in London, and was part of the team that first showed that the hormone GLP-1, on which liraglutide is based, was involved in the control of food intake.

Professor Wilding adds “It is very exciting to see a laboratory observation translated into a medicine that has the potential to help so many people, even though it has taken over 20 years.”

Source: University of Liverpool

Northwell Health, GE Ventures Announce Strategic Alliance

Northwell Health’s Feinstein Institute for Medical Research announced a strategic alliance with GE Ventures to support the Feinstein’s Center for Bioelectronic Medicine (CBEM). With this investment, the Feinstein Institute will continue its work in discovering, developing and commercializing new diagnostic and therapeutic solutions in bioelectronic medicine for a wide range of acute and chronic diseases and injuries, including neurodegenerative diseases, cancer, diabetes and hypertension.

The Feinstein Institute is the worldwide leader for the advancement of scientific knowledge and intellectual property for bioelectronic medicine. Bioelectronic medicine represents the convergence of three well-established scientific fields: neuroscience, molecular and cell biology, and bioengineering. The Feinstein Institute team, led by Kevin J. Tracey, MD, a neurosurgeon who pioneered the field, has been working in this area since 1998, and Northwell Health has already invested $75 million in support of the underlying research. As bioelectronic solutions are successfully identified, tested and refined, CBEM will foster the creation of new companies to bring life-changing solutions to market.

The new alliance will greatly build upon groundbreaking work that started between the Feinstein Institute and a team of GE scientists specializing in bioelectronics research at GE’s Global Research Center in Niskayuna, NY. The alliance will be headquartered at the Feinstein Institute in Manhasset, NY, with continued close collaboration on research at GE’s Niskayuna research facility.

More information: Brückenkopf GmbH

FDA approves APP enabled blood glucose monitoring system

Ascensia Diabetes Care announced it has received U.S. Food and Drug Administration (FDA) 510(k) clearance for the CONTOUR®NEXT ONE Blood Glucose Monitoring System (BGMS), marking a key step in making the next-generation system available to people living with diabetes in the U.S.

Continue reading “FDA approves APP enabled blood glucose monitoring system”

Diabetes: new hope for better wound healing

Diabetics often have to contend with wounds that heal poorly. Researchers at the Max Planck Institute for Biology of Ageing, the CMMC, the CECAD Excellence Cluster and the Institute of Genetics of the University of Cologne have now gained new insights into the underlying cellular mechanisms. Their findings could lead to the development of new treatment methods.

Time-lapse of a wound healing in Drosophila (from left to right): After removal of the nucleus (in yellow) the cell membrane (in pink) seals off the gap caused by the wound. You can order this photo from us by phone or e-mail. contact details appear below.
Time-lapse of a wound healing in Drosophila (from left to right): After removal of the nucleus (in yellow) the cell membrane (in pink) seals off the gap caused by the wound. You can order this photo from us by phone or e-mail. contact details appear below.

According to estimates by the International Diabetes Federation (IDF), some six million people in Germany suffer from diabetes mellitus, around 90 percent of whom have the type 2 form. The disease, which is triggered by a disturbance of insulin metabolism, has serious effects on the entire body. One problem these patients face is poor wound healing.

It had previously been assumed that high levels of glucose in the blood damages vessels and neurons and impairs the immune system, thereby accounting for the wound-healing problems. A Cologne-based research group headed by Linda Partridge, Director of the Max Planck Institute for Biology of Ageing, and Maria Leptin, professor at the Institute of Genetics of the University of Cologne, has now presented in a study that slowed insulin metabolism at the wound site directly affects neighbouring cells involved in wound healing.

Investigations of fly skin Parisa Kakanj, the author of the study, examined the skin of larvae of the fruit fly Drosophila melanogaster. These flies serve as models for diabetes, because insulin metabolism has been strongly conserved over the course of evolution, meaning that flies and mammals are very similar in this respect. Using a precision laser, Kakanj removed a cell from the outermost skin layer of fruit fly larvae and then observed what happens in the neighbouring cells live under the microscope.

“Immediately after a skin injury, the neighbouring cells respond by forming an actomyosin cable,” Kakanj explains. The cable consists of proteins that otherwise occur in muscle fibres, where they are responsible for muscular contraction. After an injury, the cable forms a contractile ring around the wound. It then contracts, sealing off the gap caused by the wound. “However, if insulin metabolism is impaired, as in our genetically modified flies, the cable is weaker and forms much later. This results in incomplete or slow wound healing,” as Kakanj relates.

New treatments for impaired wound healing could precisely target this mechanism. “Our findings raise hope of a potential treatment for diabetics. In future, it may be possible to treat wound sites with drugs that locally activate insulin metabolism,” Kakanj explains. The research team is now working closely with Sabine Eming, a senior dermatologist at the clinic and polyclinic for dermatology and venereology at the University Hospital Cologne, the CMMC and the Excellence Cluster for Ageing Research at the University of Cologne in order to investigate ways to implement this approach.

Source: University of Cologne / Universität zu Köln

Glycemic index is unreliable indicator of blood sugar response due to high variability

The glycemic index of a given food, a value that aims to quantify how fast blood sugar rises after eating it, can vary by an average of 20 percent within an individual and 25 percent among individuals, report scientists from the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HRNCA) at Tufts University.

In randomized, controlled, repeated tests involving 63 healthy adults, researchers found that individual blood sugar responses after consuming a fixed amount of white bread could range across all three glycemic index categories (low, medium, or high). Part of this variability could be attributed to insulin index and baseline HbA1c levels, which reflect long-term glucose control—evidence that glycemic index values are influenced by an individual’s metabolic responses to food.

“Glycemic index values appear to be an unreliable indicator even under highly standardized conditions, and are unlikely to be useful in guiding food choices,” said lead study author Nirupa Matthan, Ph.D., scientist in the Cardiovascular Nutrition Laboratory at the USDA HNRCA. “If someone eats the same amount of the same food three times, their blood glucose response should be similar each time, but that was not observed in our study. A food that is low glycemic index for you one time you eat it could be high the next time, and it may have no impact on blood sugar for me.”

Developed as a way to help diabetic individuals control their blood sugar, glycemic index is intended to represent the inherent effect a food has on blood sugar levels. However, glycemic index is becoming used for broader purposes such as food labeling, and has served as the basis for several popular diets.

To study whether glycemic index values are accurate and reproducible, Matthan and her colleagues recruited 63 volunteers, who underwent six testing sessions over 12 weeks. Volunteers fasted and abstained from exercise and alcohol before each session. They then consumed either white bread, a simple carbohydrate that served as the test food, or a glucose drink, which served as a reference control, in random order. Each contained 50 grams of available carbohydrate. Blood glucose levels were measured at multiple time points for five hours after eating, and glycemic index was calculated by standard formulas.

The team found that the average glycemic index value of white bread for the study population was 62, placing it in the category of a “medium” glycemic index food.

However, deviations averaged 15 points in either direction, effectively placing white bread in all three glycemic index categories. It would be considered a low glycemic index food (average values of 35 to 55) for 22 of the volunteers, intermediate glycemic index (57 to 67) for 23 volunteers, and high glycemic index (70 to 103) for 18 volunteers. Even within the same individual, glycemic index values could differ by more than 60 points between trials.

“Reports frequently tout the benefits of choosing foods with low glycemic index and glycemic load values. Our data suggest those values may not be reliable in terms of a daily intake. A better approach to choosing foods is to consume a diet primarily composed of vegetables, fruits, whole grains, nonfat and low-fat dairy products, fish, legumes (beans), lean meats with preference to preparing food with liquid vegetable oils, and equally as important, to choose healthy foods and beverages you really enjoy,” said senior study author Alice H. Lichtenstein, D.Sc., senior scientist and director of the Cardiovascular Nutrition Laboratory at the USDA HNRCA. Lichtenstein is also the Gershoff Professor at the Friedman School of Nutrition Science and Policy at Tufts.

The variability in glycemic index values occurred despite sample sizes larger than required by standard calculations. The study cohort of 63 individuals far exceeded the 10 individuals used by typical glycemic index methodology, as did the six feeding challenges and five-hour blood glucose measuring window.

The team also tested for the influence of biological characteristics: sex, body-mass index, blood pressure, physical activity, and several others. Most factors had only a minor statistical effect on glycemic index variability. Blood insulin response as measured by insulin index and HbA1c, a measure of longer term glucose control, had the largest effect, accounting for 15 and 16 percent of the variability, respectively.

The authors note their findings do not suggest that a high glycemic index food may be healthy, or that a low glycemic index food unhealthy. Both glycemic index and glycemic load—a value that adjusts glycemic index to serving size—reflect only food containing carbohydrates, and no one eats food in isolation. The high variability of glycemic index and glycemic load reveal limitations in their clinical and public health applicability, and glycemic index estimates and subsequent associations with chronic disease risk needs to be reconsidered, say the authors.

“Based on our results, we feel strongly that glycemic index is impractical for use in food labeling or in dietary guidelines at the individual level,” Matthan said. “If your doctor told you your LDL cholesterol value could vary by 20 percent, it would be the difference between being normal or at high risk for heart disease. I don’t think many people would find that acceptable.”

Source: Tufs University

 

 

Treatment could prevent neuropathy in diabetics

For the 25 percent of type-2 diabetes patients who suffer from numbness and extreme nerve pain in their feet, a new dermatological treatment being tested by Northwestern Medicine scientists could potentially help prevent and maybe even reverse the neuropathy.

In a study just published in Molecular Pain, Northwestern Medicine researchers showed that depleting a chemical called GM3 through genetic modification prevented the development of neuropathy in obese diabetic mice.

The researchers are now applying a gene therapy ointment to deplete GM3 and GM3 synthase, which is the enzyme that makes GM3. The hope is that this GM3-depleting ointment, applied just to the footpad of diabetic mice, will prevent or, even better, reverse the existing neuropathy.

The type of neuropathy the researchers are trying to treat goes beyond the typical numbness some patients with neuropathy experience, said first author Dr. Daniela Menichella, assistant professor of neurology at Feinberg whose focus is the clinical care and laboratory-based research of diabetic neuropathy.

Leading up to this treatment, the researchers had discovered that routine diabetic mice had a lot more GM3 and GM3 synthase in their nerves compared to normal mice. They found the same thing to be true in the skin of mice and humans with diabetes.

The scientists then compared the appearance and function of the nerves in mice in which GM3 was depleted by genetic manipulation. In routine diabetic mouse skin, the nerves had virtually disappeared from degeneration, but they were absolutely normal in appearance in the GM3-depleted mice, even though the mice were as obese and diabetic as the routine diabetic mice.

To test response to pain, researchers used filaments of increasing force to touch the paws of mice and then timed how long it took for the mice to withdraw their paw from the pain stimulation.

Based on these discoveries, the researchers have advanced the approach to regionally depleting GM3 in the feet with the novel ointment.

Source: Northwestern University