Diabetics Tips and Solutions!!!: 2017

Wednesday, 26 July 2017

Study finds 90 percent of American men overfat

Source: Frontiers
Summary:: Researchers reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world's population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings that up to 90 percent of adult males and 50 percent of children may be overfat.

FULL STORY

Rather than thinking of these disorders as separate, individual clinical problems, it might be best to consider the relationships between overfat, its various risks, and its associated downstream diseases as a spectrum or progression where the vicious cycle of overfat, insulin resistance and chronic inflammation lies at one end, (constituting the population with early measurable abnormality), while the presence of chronic conditions resides at the other end.

Credit: Maffetone, Rivera-Dominguez and Laursen; CC BY

Does your waist measure more than half your height?

If so, you may be part of the global overfat pandemic. A recent article, published in Frontiers in Public Health, suggests it to be even more prevalent in developed countries where up to 90 percent of adult males and 50 percent children may suffer from this condition. In the top overfat countries, 80 percent of women fall into this category.
The problem is particularly pervasive in the English-speaking countries of the United States and New Zealand, but also in Iceland and even Greece where people are generally thought to be healthy. This trend may be bad news for developing countries as well, since they have followed the trend of developed nations in the growing overfat pandemic.
            The term overfat refers to the presence of excess body fat that can impair health, and may include even normal-weight non-obese individuals. Excess body fat, especially abdominal fat, is associated with increased risk of chronic diseases, increased morbidity and mortality, and reduced quality of life.
Researchers Philip Maffetone, Ivan Rivera-Dominguez and Paul B. Laursen reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world's population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings.
            In addition, a recent rise in the incidence of abdominal adiposity, the unhealthiest form of excess body fat, has been observed in both adults and children, indicating a direct link to insulin-resistance, the body's natural propensity to convert and store carbohydrate foods as fat.
The relationship between the overfat condition and poor health is a spectrum or progression in which the vicious cycle of excess body fat, insulin resistance and chronic inflammation lie at one end, causing abnormal blood fats (cholesterol and triglycerides) and glucose, and elevated blood pressure, which then produces a variety of common diseases at the other end.
          Being overfat is linked to hypertension, dyslipidemia, coronary heart disease, stroke, cancer, Type 2 diabetes, gallbladder disease, osteoarthritis and gout, pulmonary diseases, sleep apnea and others.
Many physically active people, including professional athletes in various sports and active U.S. military personnel, also may fall into the overfat category.
Traditional means of assessment, such as stepping on a scale or calculating Body Mass Index (BMI), are ineffective at determining whether someone is overfat. Instead, researchers recommend taking a measure of the waistline (at the level of the belly button) and comparing it to height: The waist measure should be less than half a person's

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Saturday, 15 July 2017

USPSTF recommendation regarding behavioral counseling for cardiovascular disease prevention

Source: The JAMA Network Journals
Summary:: The US Preventive Services Task Force recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have high blood pressure, abnormal cholesterol or blood sugar levels or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of cardiovascular disease in this population.

FULL STORY

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have high blood pressure, abnormal cholesterol or blood sugar levels or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of cardiovascular disease (CVD) in this population. The report appears in the July 11 issue of JAMA.

            This is a C recommendation, indicating that the USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
Cardiovascular disease, which includes heart attack and stroke, is the leading cause of death in the United States. Adults who adhere to national guidelines for a healthful diet and physical activity have lower rates of cardiovascular illness and death than those who do not. All persons, regardless of their CVD risk status, can gain health benefits from healthy eating behaviors and appropriate physical activity. To update its 2012 recommendation, the USPSTF reviewed the evidence on whether primary care-relevant counseling interventions to promote a healthful diet, physical activity, or both improve health outcomes, intermediate outcomes associated with CVD, or dietary or physical activity behaviors in adults.
          The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.
                                                                                                                                                          Benefits of Behavioral Counseling Interventions
            The USPSTF found adequate evidence that behavioral counseling interventions provide at least a small benefit for reduction of CVD risk in adults without obesity who do not have the common risk factors for CVD (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes). Behavioral counseling interventions have been found to improve healthful behaviors, including beneficial effects on fruit and vegetable consumption, total daily caloric intake, salt intake, and physical activity levels.
Behavioral counseling interventions led to improvements in systolic and diastolic blood pressure levels, low-density lipoprotein cholesterol (LDL-C) levels, body mass index (BMI), and waist circumference that persisted over 6 to 12 months. The USPSTF found inadequate direct evidence that behavioral counseling interventions lead to a reduction in death or CVD rates.
                                                                                                                                                                       Harms of Behavioral Counseling Interventions
           The USPSTF found adequate evidence that the harms of behavioral counseling interventions are small to none. Among 14 trials of behavioral interventions that reported on adverse events, none reported any serious adverse events.
                                                                                                                                                                          Summary
           The USPSTF concludes with moderate certainty that behavioral counseling interventions to promote a healthful diet and physical activity have a small net benefit in adults without obesity who do not have specific common risk factors for CVD. Although the correlation among healthful diet, physical activity, and CVD incidence is strong, existing evidence indicates that the health benefit of behavioral counseling to promote a healthful diet and physical activity among adults without obesity who do not have these specific CVD risk factors is small.

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Machine-learning techniques used to unlock hidden benefit of weight loss interventions for overweight patients with type 2 diabetes

Source: Mount Sinai Health System
Summary:: Losing weight reduces the risk of long-term cardiovascular illness and mortality for the majority of patients with type 2 diabetes, but for a small subgroup, weight-loss intervention can lead to dramatically worse outcomes.

FULL STORY

Losing weight reduces the risk of long-term cardiovascular illness and mortality for the majority of patients with type 2 diabetes, but for a small subgroup, weight-loss intervention can lead to dramatically worse outcomes, according to new research published in The Lancet Diabetes & Endocrinology.

A team of data science researchers at The Arnhold Institute for Global Health of the Icahn School of Medicine at Mount Sinai reached these conclusions by applying new, advanced machine learning techniques to data collected during a trial that was halted in 2012 because its results lacked statistical significance.
The Arnhold Institute team, led by James H. Faghmous, PhD, Chief Technology Officer at the Institute, reanalyzed data from the trial known as Look AHEAD (Action for Health in Diabetes). They found that, despite the overall null findings of the trial, 85 percent of the study sample did experience a clinically meaningful, significant reduction in cardiovascular mortality and morbidity from the trial's intensive weight loss intervention.
            "Our analysis demonstrates that recent advances in machine learning for causal inference can increase the quantity of clinically relevant findings generated from large randomized trials," said Aaron Baum, PhD, Lead Economist, The Arnhold Institute for Global Health; Assistant Professor, Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai; and lead author of the study. "As researchers and data scientists, we are always concerned that an overall study result could mask important disparities in benefit or harm among different types of patients, which is exactly what this study revealed. Being able to identify individuals that could benefit from an intervention is fundamental to patient care."
"In addition to its clinical findings, this work shows the promise advanced machine learning methods can have on precision medicine beyond genetics," said James H. Faghmous, PhD, the study's senior author and an expert in machine learning and healthcare.
            The Look AHEAD study enrolled more than 5,000 overweight and obese patients with diabetes with a planned follow-up period of up to 13 years. Its intent was to determine whether modest weight loss through a lifestyle intervention reduced the rate of mortality and serious events like heart attacks and strokes. The trial was halted early by the National Institutes of Health (NIH) after finding no difference in the rates of cardiovascular events between the two groups.
"This research strengthens the role for data science and precision medicine as essential tools that can transform the way health care is delivered," said Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health and Chair of the Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai. "Identifying individuals that could benefit from an intervention is crucial for practicing clinicians, while ignoring subgroups that benefit might lead to lack of reimbursement for weight loss programs, which would neglect vulnerable populations."
             The team's findings indicated that 15 percent of subjects had substantially increased risk of cardiovascular events such as heart attack or stroke as a result of weight loss interventions. This could be the first suggestive evidence of an adverse reaction to what is generally considered a common-sense and innocuous intervention. This subgroup was defined by a combination of two baseline characteristics: mild or well treated diabetes (HbA1c less than 6.8 percent) and a negative perception of their health status (SF-36 general health score less than 48). The latter is strongly correlated to depression. This subgroup also:
• Reported substantially poorer compliance with the exercise portion of the intervention, which is consistent with the importance of assessing patients' readiness for change when recommending behavioral interventions;
• Experienced less improvement in several intermediate health outcomes, including blood sugar, mental health, and blood pressure.
"This analysis restores my faith in basic common sense," said Ronald Tamler, MD, Medical Director, Mount Sinai Clinical Diabetes Institute, and co-author of the study. "For the vast majority of people with diabetes, a healthy lifestyle with weight loss carries significant benefits; however, it's not for everyone. Thanks to this work, clinicians can infer which patients will benefit the most from such a lifestyle intervention."

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Diabetes causes shift in oral microbiome that fosters periodontitis, Penn study finds

Source: University of Pennsylvania
Summary:: People with diabetes are susceptible to periodontitis, a gum infection that can result in tooth loss. New research helps explain why: Diabetes triggers changes in the oral microbiome that enhance inflammation and the risk of bone loss

FULL STORY

Researchers found that diabetes (panel on right) shifts the oral microbiome, transforming it into a more inflammatory environment and promoting bone loss, characteristics of the gum disease periodontitis.

Credit: University of Pennsylvania

A new study led by University of Pennsylvania researchers has found that the oral microbiome is affected by diabetes, causing a shift to increase its pathogenicity. The research, published in the journal Cell Host & Microbe this week, not only showed that the oral microbiome of mice with diabetes shifted but that the change was associated with increased inflammation and bone loss.

"Up until now, there had been no concrete evidence that diabetes affects the oral microbiome," said Dana Graves, senior author on the new study and vice dean of scholarship and research at Penn's School of Dental Medicine. "But the studies that had been done were not rigorous."
Just four years ago, the European Federation of Periodontology and the American Academy of Periodontology issued a report stating there is no compelling evidence that diabetes is directly linked to changes in the oral microbiome. But Graves and colleagues were skeptical and decided to pursue the question, using a mouse model that mimics Type 2 diabetes.
               "My argument was that the appropriate studies just hadn't been done, so I decided, We'll do the appropriate study," Graves said.
Graves co-authored the study with Kyle Bittinger of the Children's Hospital of Philadelphia, who assisted with microbiome analysis, along with E Xiao from Peking University, who was the first author, and co-authors from the University of São Paulo, Sichuan University, the Federal University of Minas Gerais and the University of Capinas. The authors consulted with Daniel Beiting of Penn Vet's Center for Host-Microbial Interactions and did the bone-loss measurements at the Penn Center for Musculoskeletal Diseases.
The researchers began by characterizing the oral microbiome of diabetic mice compared to healthy mice. They found that the diabetic mice had a similar oral microbiome to their healthy counterparts when they were sampled prior to developing high blood sugar levels, or hyperglycemia. But, once the diabetic mice were hyperglycemic, their microbiome became distinct from their normal littermates, with a less diverse community of bacteria.
                 The diabetic mice also had periodontitis, including a loss of bone supporting the teeth, and increased levels of IL-17, a signaling molecule important in immune response and inflammation. Increased levels of IL-17 in humans are associated with periodontal disease.
"The diabetic mice behaved similar to humans that had periodontal bone loss and increased IL-17 caused by a genetic disease," Graves said.
The findings underscored an association between changes in the oral microbiome and periodontitis but didn't prove that the microbial changes were responsible for disease. To drill in on the connection, the researchers transferred microorganisms from the diabetic mice to normal germ-free mice, animals that have been raised without being exposed to any microbes.
These recipient mice also developed bone loss. A micro-CT scan revealed they had 42 percent less bone than mice that had received a microbial transfer from normal mice. Markers of inflammation also went up in the recipients of the diabetic oral microbiome.
               "We were able to induce the rapid bone loss characteristic of the diabetic group into a normal group of animals simply by transferring the oral microbiome," said Graves.
With the microbiome now implicated in causing the periodontitis, Graves and colleagues wanted to know how. Suspecting that inflammatory cytokines, and specifically IL-17, played a role, the researchers repeated the microbiome transfer experiments, this time injecting the diabetic donors with an anti-IL-17 antibody prior to the transfer. Mice that received microbiomes from the treated diabetic mice had much less severe bone loss compared to mice that received a microbiome transfer from untreated mice.
The findings "demonstrate unequivocally" that diabetes-induced changes in the oral microbiome drive inflammatory changes that enhance bone loss in periodontitis, the authors wrote.
               Though IL-17 treatment was effective at reducing bone loss in the mice, it is unlikely to be a reasonable therapeutic strategy in humans due to its key role in immune protection. But Graves noted that the study highlights the importance for people with diabetes of controlling blood sugar and practicing good oral hygiene.
"Diabetes is one of the systemic disease that is most closely linked to periodontal disease, but the risk is substantially ameliorated by good glycemic control," he said. "And good oral hygiene can take the risk even further down."

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Wednesday, 12 July 2017

Genome sequence of a diabetes-prone rodent

Genome sequence of a diabetes-prone rodent reveals a mutation hotspot around the ParaHox gene cluster

Source: University of Oxford
Summary:: Sequencing the genome of the sand rat, a desert rodent susceptible to nutritionally induced diabetes, revealed an unusual chromosome region skewed toward G and C nucleotides. This region includes the Pdx1 homeobox gene, a transcriptional activator of insulin, which has undergone massive sequence change, likely contributing to diabetes and adaptation to low caloric intake, implying that mutation rate varies within a genome and that hotspots of high mutation rate may influence ecological adaptation and constraint.

FULL STORY

The sand rat Psammomys obesus is a gerbil species native to deserts of North Africa and the Middle East, and is constrained in its ecology because high carbohydrate diets induce obesity and type II diabetes that, in extreme cases, can lead to pancreatic failure and death. We report the sequencing of the sand rat genome and discovery of an unusual, extensive, and mutationally biased GC-rich genomic domain.

This highly divergent genomic region encompasses several functionally essential genes, and spans the ParaHox cluster which includes the insulin-regulating homeobox gene Pdx1. The sequence of sand rat Pdx1 has been grossly affected by GC-biased mutation, leading to the highest divergence observed for this gene across the Bilateria. In addition to genomic insights into restricted caloric intake in a desert species, the discovery of a localized chromosomal region subject to elevated mutation suggests that mutational heterogeneity within genomes could influence the course of evolution.

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Promising target to protect bone in patients with diabetes

Source:
New York University
Summary:: Utilizing metabolomics research techniques, researchers investigated the underlying biochemical activity and signaling within the bone marrow of hyperglycemic mice with hopes of reducing fracture risks of diabetics.

FULL STORY

Researchers at New York University College of Dentistry (NYU Dentistry) have described a new target that may open the door to developing therapies for preventing bone fractures in people with type 2 diabetes.

In a study published in Nature Communications, the investigators report that hyperglycemic mice (or mice with type 2 diabetes) have a 24-fold higher accumulation of succinate, an intermediate metabolite, in the metabolic pathways of their bone marrow stromal cells. In comparison, succinate was barely detectable in the normal mice. An intermediate metabolite is a compound that is both a product of one-step in a biochemical pathway or cycle, as well as the substrate for the next step.
In the study, "Succinate and its G-protein-coupled receptor stimulate osteoclastogenesis," the researchers took samples of bone marrow from hyperglycemic male mice and healthy mice. They studied the bone metabolism at the cellular level using advanced imaging and computational techniques, which allowed them to identify 142 metabolites that were significantly altered by more than 1.5 times in the diabetic mice. Of 142 metabolites, 126 were upregulated (or increased) and 16 were downregulated (or decreased).
Succinate was the first metabolite in the energy pathway, and with its more than 20-fold increased concentration, it overwhelmed the energy pathways. Additionally, the diabetic mice had considerably lower spongy bone mass, known as trabecular bone, making it easy to fracture.
           "The bottom line is that the high level of succinate combined with the finding of more fragile bone points to a new target to protect bone," said Yuqi Guo, MD, associate research scientist at NYU Dentistry, and the study's first author.
"The results are important because diabetics have a significantly higher fracture risk and their healing process is always delayed," said Xin Li, PhD, associate professor of basic science and craniofacial biology at NYU Dentistry, and the study's senior investigator. "In our study, the hyperglycemic mice had increased bone resorption [the breakdown and absorption of old bone], which outpaced the formation of new bone. This has implications for bone protection, as well as for the treatment of diabetes-associated collateral bone damage."
            Dr. Guo and his team utilized a relatively new field of research called metabolomics to examine the bone marrow. The technique examines the small molecules, or metabolites, within cells, bio-fluids, tissue, or organisms and their interactions within the larger system, called a metabolome. Metabolomics is an extremely powerful tool because it can depict the underlying biochemical activity and signaling between cells and tissues. It is proving invaluable in identifying biomarkers and pinpointing potential drug targets for many diseases.
            This study builds on previous research by Dr. Li's laboratory that showed, for the first time, significant accumulation of succinate in the bone marrow and serum of hyperglycemic mice. It opens the door to pursuing regulating succinate for protecting bone in diabetics.
Diabetes affects 29.1 million Americans or 9.3% of the population in the United States, according to 2012 Centers for Disease Control and Prevention data. Bone complications, such as hip or back fractures, can be devastating. The Women's Health Initiative found that type 2 diabetes was linked to a 20% risk increase in fractures.

Diabetes complications are a risk factor for repeat hospitalizations, study shows

Source: Mayo Clinic
Summary:: For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia high blood sugar, or hypoglycemia low blood sugar), says new research.

FULL STORY

For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia -- high blood sugar, or hypoglycemia -- low blood sugar), says new research published in the Journal of General Internal Medicine.

People who were previously hospitalized for severe hypoglycemia or hyperglycemia are at highest risk for recurrent dysglycemic episodes in the short term (within 30 days of the prior episode) and over the long term. In addition, having multiple diabetes complications significantly increased the risk of readmission not only for severe dysglycemia, but also for all causes that are seemingly unrelated to diabetes.
                                                                                                                                                                     Are these hospitalizations preventable?
            Any illness or procedure requiring hospitalization carries with it the risk of unplanned hospital readmission after discharge. Readmission is costly, harmful and burdensome to the patient -- and it is potentially preventable. Thus, readmission within 30 days is one factor used to rate hospitals on quality of care and determine reimbursement.
Understanding what causes readmissions can lead toward improved patient outcomes and quality of care, and lower costs. New interventions can improve outcomes for patients, resulting in less readmissions.
Rozalina McCoy, M.D., an internal medicine physician and endocrinologist at Mayo Clinic and study lead author, researches ways to improve care and outcomes for patients with diabetes.
"We already knew that adults with diabetes carry a high risk for hospitalization and unplanned readmission," she says. "But the big question was why? And what role did episodes of very high and very low blood sugar play in this risk? Because if we knew what the problem was, and ultimately why it might be happening, we could then try to prevent it."
                                                                                                                                                              Finding answers
             Using the OptumLabs Data Warehouse, a database of de-identified, linked clinical and administrative claims information, Dr. McCoy and her team examined administrative data of 342,186 adult patients with diabetes who were hospitalized for various reasons nearly 600,000 separate times between Jan. 1, 2009, and Dec. 31, 2014.
The researchers determined that patients with diabetes are admitted to the hospital and experience unplanned readmissions for a wide range of reasons -- similar to patients without diabetes. The most common reason (5.5 percent) for these initial, or index, hospitalizations, was congestive heart failure. Severe dysglycemia caused 2.6 percent of the initial hospitalizations for these patients.
When their initial condition was treated or stabilized, and the patients were discharged, 10.8 percent of them found themselves back in the hospital within 30 days. Of these 68,212 readmissions, 2.5 percent were for severe dysglycemia -- regardless of the initial reason for hospitalization. But if their index hospitalization was also for severe dysglycemia, the risk of a recurrent episode requiring hospitalization was nearly ninefold higher after a severe hyperglycemic event and fivefold higher after a severe hypoglycemic event.
The research also found that younger patients (18-44) were twice as likely to be readmitted for severe dysglycemia than were older patients.
                However, most troubling to the researchers was the fact that a severe dysglycemic episode was a strong predictor of readmission for another dysglycemia event.
"Severe dysglycemic events can be prevented with good diabetes outpatient care and careful discharge planning for diabetic patients who have been hospitalized for any reason not just for severe hypoglycemia or hyperglycemia," says Dr. McCoy.
"We were especially concerned to find that, for patients whose index hospitalization was because of severe dysglycemia, if they were readmitted within 30 days, it was very likely to be for another dysglycemia event. Nearly 30 percent experienced back-to-back dysglycemia, rather than readmission for any other cause," she says.
                                                                                                                                                                     The rest of the story
              The study helps providers identify patients at highest risk for readmission, allowing intervention and prevention.
Dr. McCoy encourages health care providers of hospitalized diabetic patients to develop discharge plans that include follow-up with their primary care provider immediately after discharge, and discuss with patients not only the reasons for their hospitalization but their diabetes management, as well.
"The hospital follow-up visit allows patients and their providers to discuss the reason for hospitalization, any medication changes, their ability to take care of themselves at home, and potential ways to prevent readmission if problems arise in the future," Dr. McCoy says. "It also provides an opportunity to review the patient's diabetes management plan and blood sugar levels."
              Dr. McCoy also notes that, "Inpatient diabetes education has been shown to reduce risk of readmission, as have medication reviews, care transition programs, and other efforts to incorporate diabetes care into discharge planning and post hospital follow-up."
While this is true for all patients, it may be especially important for patients with diabetes, she says.
"Patients can do their part by learning to recognize severe dysglycemic episodes when they happen and reporting events to their care providers. They can work with their care providers to develop a plan on how to manage dysglycemia early, so symptoms don't become so severe as to require hospitalization," says Dr. McCoy.

Monday, 10 July 2017

Studies compare types of insulin for reducing episodes of low blood sugar for patients with Type 1 or 2 diabetes

Source: The JAMA Network Journals
Summary:: Treatment with the insulin degludec compared to glargine U100 for 32 weeks resulted in a reduced rate of hypoglycemic (low blood sugar) episodes among patients with type 1 or 2 diabetes and at least one risk factor for hypoglycemia, according to two studies.

FULL STORY

Treatment with the insulin degludec compared to glargine U100 for 32 weeks resulted in a reduced rate of hypoglycemic (low blood sugar) episodes among patients with type 1 or 2 diabetes and at least one risk factor for hypoglycemia, according to two studies published by JAMA.

In one study, Wendy Lane, M.D., of Mountain Diabetes and Endocrine Center, Asheville, N.C., and colleagues randomly assigned 501 adults with type 1 diabetes and at least one hypoglycemia risk factor to receive once-daily insulin degludec followed by insulin glargine U100 (n = 249) or to receive insulin glargine U100 followed by insulin degludec (n = 252) for two 32-week treatment periods. The patients were randomized to morning or evening dosing within each treatment sequence.
            Hypoglycemia, common in patients with type 1 diabetes, is a major barrier to achieving good glycemic control. Severe hypoglycemia can lead to coma or death.
Of the patients randomized, 395 (79 percent) completed the trial. The researchers found that insulin degludec compared with insulin glargine U100 resulted in lower rates of overall symptomatic hypoglycemic episodes and nocturnal symptomatic hypoglycemia in the 16-week maintenance period and a lower proportion experienced severe hypoglycemia during the maintenance period (10 percent vs 17 percent). The findings were consistent when analyzed over the full 32-week treatment period.
            A limitation of the study, the higher-than-expected withdrawal rate, may have been a result of the demanding nature of the trial, including its 64-week duration, two different treatments, and the use of a vial and syringe.
In another study, Carol Wysham, M.D., of the University of Washington School of Medicine, Spokane, and colleagues randomly assigned 721 adults with type 2 diabetes and at least one hypoglycemia risk factor who were previously treated with basal insulin with or without oral antidiabetic drugs to receive once-daily insulin degludec followed by insulin glargine U100 (n = 361) or to receive insulin glargine U100 followed by insulin degludec (n = 360), and were randomized to morning or evening dosing within each treatment sequence. The trial included two 32-week treatment periods. Hypoglycemia is a serious risk for insulin-treated patients with type 2 diabetes.
             Of the randomized patients, 580 (80 percent) completed the trial. The researchers found that treatment with insulin degludec compared with insulin glargine U100 resulted in a statistically significant and clinically meaningful reduction in the rate of overall symptomatic hypoglycemia and nocturnal symptomatic hypoglycemia during the 16-week maintenance period. The hypoglycemia findings were consistent when analyzed over the full treatment period, and they showed a significantly lower rate of severe hypoglycemia with insulin degludec. The proportion of patients experiencing severe hypoglycemia during the maintenance period were 1.6 percent for insulin degludec vs 2.4 percent for insulin glargine U100.
Limitations of the study are noted in the article.

Gut bacteria can help to predict how the body will respond to fatty foods

Source: Imperial College London
Summary:: Chemical signatures from gut bacteria that show up in urine can be used to predict how the body will respond to a 'junk' diet, report scientists.

FULL STORY

Chemical signatures from gut bacteria which show up in urine can be used to predict how the body will respond to a 'junk' diet.

Scientists have found that certain compounds, produced by microbes in the guts of mice, could be used to show which animals are at greater risk of becoming obese or developing health conditions such as diabetes or cardiovascular disease.
The group, led by scientists at Imperial College London and INSERM UMRS 1138 in Paris, tested the urine of mice for a number of these microbial compounds, finding that certain key chemical signatures could accurately predict how the animals would respond to a high-fat diet before they received it.
                According to the researchers, the findings are another crucial piece of the puzzle in how the microbiome -- the ecosystem of bacteria living in our digestive tracts -- helps to shape our health, and could lead to personalised diets for patients based on the makeup of their gut flora.
High-fat diets are a major driver of obesity and related health conditions, such as diabetes and cardiovascular disease. However, evidence from previous studies suggests different people eating the same high-fat diet may have different outcomes, making it hard to define a one-size-fits-all 'healthy diet'.
Previous research has shown that the hundreds of species of bacteria and other microbes which inhabit our gut work with our own cells to carry out a number of roles, and that this microbial garden can be shaped by what we eat or what medicines we take, such as antibiotics.
               In the latest study, published in Cell Reports, researchers used genetically similar mice to highlight the role that gut bacteria played in how the body responds to changes in diet and the impacts on health.
"We know that our environment and genetics can influence our risk of obesity and disease, but the effects of these communities of bacteria living inside us are less well understood," said Dr Marc-Emmanuel Dumas, from the Department of Surgery & Cancer at Imperial, who led the research. "By using a group of mice with the same genetic makeup, we were able to zoom in on the variability in animals switched to a high-fat diet."
Before animals switched diets, their urine was screened for compounds produced by their gut bacteria using magnetic resonance spectroscopy, giving the mice a profile of chemical signatures generated by metabolites from their microbiomes.
            The team found that once the mice were switched to the same high-fat diet they had a range of outcomes, with some animals gaining more weight than others or becoming less tolerant to glucose one of the early warning signs of diabetes.
Analysis revealed that key chemical signatures in their urine were predictive of some outcomes, such as changes in behaviour, weight gain and tolerance to glucose. One compound in particular, trimethylamine-N-oxide (TMAO), was shown to be predictive of glucose tolerance.
Professor Jeremy Nicholson, Head of the Department of Surgery & Cancer at Imperial explained: "When the microbiome develops in early life, we start off with very few bugs, acquiring more bacteria from our environment as we develop. This means that small differences in the local environment can result in a great diversity in terms of the microbiome."
          "This study is another fascinating example of the power of the microbiome to influence the host with respect to major health risks," said Professor Nicholson. "It shows that value of a diet is determined not only by your genes, but also the genes of your gut microbes. This work has implications in lots of different areas, which is why it's so exciting."
Senior investigator on the study, Dr Dominique Gauguier, from INSERM-Paris and a visiting professor at Imperial, added: "We tend to believe that obesity is caused by bad genes or by bad genes interacting with bad environment. Our findings indicate that an organism's gut microbiome can drive the adaptation to dietary challenges in the absence of genetic variation. They underline the need for deeper physiological and molecular phenotyping of individuals in large scale genetic studies."
The findings will be explored further as part of an ongoing large clinical trial of 2,000 patients, where details of their lifestyle, diet, medication and other factors, as well as their microbiomes, are being characterised. Pulling together all of these data, and building on previous findings, they will be able to reveal how people react to different diets, and how their microbiomes influence the outcome.
           According to the researchers, the hope is that in future, a patient's profile could be generated from urine and blood samples and used to predict which diet they will respond to best.
"Our findings reveal that measuring metabolites in urine before the diet switch, we can predict which animals will get fat and become intolerant to glucose and which ones won't," added Dr Dumas. "These findings open up really strong perspectives into designing personalised diets and harnessing our gut bacteria to promote health."

Thursday, 6 July 2017

According to Research, Burden of diabetes set to increase across sub-Saharan Africa, potentially diminishing health gains of recent years

Source: The Lancet
Summary:: As sub-Saharan African countries struggle to cope with the current burden of diabetes, new estimates suggest that costs associated with the disease could more than double and may reach up to US$59.3 billion per year by 2030 if type 2 diabetes cases continue to increase.

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As sub-Saharan African countries struggle to cope with the current burden of diabetes, new estimates suggest that costs associated with the disease could more than double and may reach up to US$59.3 billion per year by 2030 if type 2 diabetes cases continue to increase.

The new report proposes that diabetes and its complications have the potential to reverse some of the health gains seen in sub-Saharan Africa in recent years overwhelming the region's health systems and crippling patients' personal finances as they pay for their own healthcare.
Currently, only half of the people with diabetes in populations in sub-Saharan Africa are aware that they have the disease, and only one in 10 (11%) receive drugs they need.
          The Lancet Diabetes & Endocrinology Commission on diabetes in sub-Saharan Africa will be launched in London on July 6. It provides a comprehensive and up-to-date analysis of the burden of diabetes across sub-Saharan Africa, the challenges this burden poses for health systems, as well as potential solutions. More than 70 experts from around the world contributed to the report, which provides five key messages.
In recent years, rapid societal transitions that are producing increases in wealth, urbanisation, changing lifestyle and eating habits, more sedentary work practices and aging populations across sub-Saharan African countries have led to increased risk of type 2 diabetes.
The report estimates that the economic cost of diabetes in sub-Saharan Africa in 2015 totalled $19.5 billion, equivalent to 1.2% gross domestic product (GDP). On average, countries in the region spend 5.5% of their GDP on health.
         More than half of this economic cost (56%, $10.8 billion) was on accessing diabetes treatment, including medication and hospital stays -- and one half of these costs were out-of-pocket (paid for by the patients), putting a huge financial burden on people with diabetes. The remaining economic costs were a result of productivity losses, mostly from early death ($7.9 billion), as well as people leaving the workforce early ($0.5 billion), taking sick leave ($0.2 billion) and being less productive at work due to poor health ($0.07 billion).
          "These estimates show the vast economic burden that diabetes places on sub-Saharan Africa, and should motivate policy makers to increase resources and efforts to overcome this looming health challenge," says one of the three lead authors, Professor Rifat Atun, Harvard University, USA. "Our figures illustrate the economic cost of inaction. However, the wider cost of inaction is the risk of losing ground on some of the region's biggest health achievements of the past few decades, as diabetes cases further increase and costs spiral. In its current state, sub-Saharan Africa is not at all prepared for the increasing burden of diabetes caused by rapid, ongoing societal transitions."
            To measure the future impact of increased diabetes rates across all sub-Saharan African countries, the researchers modelled three scenarios to show optimistic and pessimistic projections. Their estimates suggest that, in an optimistic scenario, where diabetes death rates and prevalence remain the same for each country, the annual cost of diabetes would increase to $35.3 billion (1.1% GDP) in 2030. However, if these rates increased in line with the projected rise in each countries' income levels, economic costs would be $47.3 billion (1.4% GDP), and if rates doubled, the costs could total $59.3 billion (1.8% GDP).
Wealthier areas of sub-Saharan Africa seeing more societal changes had the highest rates of diabetes in 2015, with almost two-thirds of the region's diabetes costs coming from southern Africa (62%, $12.1 billion), in particular, wealthier South Africa. Less than a tenth of the costs (9%, $1.7 billion) originated from poorer countries in western Africa.
          In the projections for 2030, southern Africa is likely to see the greatest increases in annual costs, increasing to between $17.2 and $29.2 billion. However, the authors also predicted substantial growth in costs in eastern African countries (such as Ethiopia, Kenya and Tanzania), increasing from $3..8 billion in 2015 to up to $16.2 billion in 2030.
The Commission's analyses demonstrate a clear need for improvements at all levels of diabetes care. However, after decades of treating acute infectious diseases, health systems in sub-Saharan African countries are ill-prepared to handle the chronic disease.
           The authors of the Commission report conclude that gaps in care include a lack of equipment for diagnosing and monitoring diabetes, lack of treatments, and lack of knowledge about the disease among available healthcare providers. These gaps contribute to the fact that half of patients go undiagnosed, while only one in 10 (11%) receive the drugs they need. Many patients face delayed diagnosis and treatment, meaning the disease progresses and causes further ill health and risk of complications, for example myocardial infarction, blindness, and stroke, which are difficult and expensive to treat.
In order to counter these issues effectively, the researchers recommend rapidly scaling up interventions successfully trialled in sub-Saharan African countries, such as community-based care for high blood pressure, patient education, home glucose monitoring, and more education about diabetes for healthcare professionals.
        With the management of type 2 diabetes and its risk factors (such as obesity and physical inactivity) being simpler and cheaper than treating complications of later stage disease, the researchers note that prevention of disease onset and complications will be crucial to improve health and avoid further economic burden.
"Our estimates also illustrate the economic savings that could be achieved if type 2 diabetes rates were halted or reduced in sub-Saharan Africa. This could be done by improving prevention efforts and creating new interventions, and by improving early detection and management of the disease to help more people remain in good health so that they can continue to work," says Professor Atun.
Writing in a linked Comment, Dr Shabbar Jaffar, Liverpool School of Tropical Medicine, UK, says: "The prevalence of diabetes in sub-Saharan Africa has increased rapidly in the past 10 years or so, affecting people in all sectors of society but, in particular, and disproportionally compared with high-income settings, affecting younger people, with substantial economic effects. A repeating theme throughout the report is the scarcity of reliable evidence about diabetes in the region-for example, about the true magnitude of the burden of disease and its complications, and what interventions will or will not be effective in the sub-Saharan African context. Despite the scarcity of evidence, several simple and vital conclusions emerge from the report."

According to Research, Sufferers of both Type 2 diabetes and sleep apnea could lose eyesight within four years

Source: University of Birmingham
Summary:: Patients who suffer from both Type 2 diabetes and obstructive sleep apnea are at greater risk of developing a condition that leads to blindness within an average period of less than four years, new research has found.

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Research led by the University of Birmingham has discovered that patients who suffer from both Type 2 diabetes and obstructive sleep apnea are at greater risk of developing a condition that leads to blindness within an average period of less than four years.

Obstructive sleep apnea (OSA) is a condition where the walls of the throat relax and narrow during sleep, resulting in snoring and interrupting breathing, and it is common in patients with Type 2 diabetes. Meanwhile, diabetic retinopathy -the most common form of diabetic eye disease -- affects between 40 and 50 per cent of patients with diabetes and is a leading cause of blindness in the Western world.
Previous studies have shown a link between OSA and diabetic retinopathy. However, prior to this research led by the University of Birmingham, published in American Journal of Respiratory and Critical Care Medicine, there had been no published studies assessing the impact of OSA on the progression of diabetic retinopathy in patients with Type 2 diabetes.
         Corresponding Author Doctor Abd Tahrani, of the University of Birmingham's Institute of Metabolism and Systems Research, said: "Despite improvements in glucose, blood pressure and lipid levels, diabetic retinopathy remains very common.
"Meanwhile, OSA has been shown to be very common in patients with Type 2 diabetes, which is not surprising considering that excess weight contributes to the development of both of these conditions.
"However, most patients who have OSA are not aware that they have the condition and the disease could go undiagnosed for years.
"Our study is the first to prospectively examine the impact of OSA on diabetic retinopathy.
"Firstly, we showed that sight-threatening diabetic retinopathy was more common in patients with both Type 2 diabetes and OSA compared to those with Type 2 diabetes but without OSA.
"However, more importantly, we have shown that patients with OSA and Type 2 diabetes, compared to those with diabetes only, are at increased risk of developing advanced diabetic retinopathy over a period of three years and seven months."
           The study was carried out at two diabetes clinics at hospitals in the Midlands and involved 230 patients with Type 2 diabetes.
The study excluded any patients who were already known to have OSA or any kind of respiratory condition.
The patients were assessed for diabetic retinopathy using specialist retinal imaging, while OSA was assessed using a home-based, multi-channel cardio-respiratory portable device.
The results showed that diabetic retinopathy prevalence was higher in patients with OSA (42.9%) compared to those without OSA (24.1%).
The longitudinal study found that at a follow-up appointment, on average 43 months later, the patients with OSA (18.4%) were more likely to develop moderate to severe diabetic retinopathy compared to those without OSA (6.1%).
            Meanwhile, the study also showed that patients who received treatment for OSA using a machine connected to a face mask that delivers pressure to prevent the blockage of the airways during sleep had a lower risk of developing advanced diabetic retinopathy compared to patients who did not receive the treatment.
Dr Tahrani added: "We can conclude from this study that OSA is an independent predictor for the progression to moderate or severe diabetic retinopathy in patients with Type 2 diabetes.
"Our findings are important because improved understanding of the pathogenesis of diabetic retinopathy is important in order to identify new treatments.
"Following our research, it is important that clinicians treating patients with Type 2 diabetes are aware that their patients who also have OSA are particularly at increased risk of developing advance retinopathy and, hence, appropriate preventative measures should be put in place.
"Clinicians should consider testing patients for OSA as OSA is very common in patients with Type 2 diabetes."

Saturday, 1 July 2017

Simple step to protect people with type 1 diabetes against heart disease

Date: June 5, 2017
Source: Leeds Beckett University
Summary:: One additional injection of insulin three hours after eating has been shown to protect people with type 1 diabetes from cardiovascular disease -- the leading cause of death among people with the condition.

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One additional injection of insulin three hours after eating has been shown to protect people with type 1 diabetes from cardiovascular disease -- the leading cause of death among people with the condition.

A small preliminary clinical trial published in Diabetes and Vascular Disease Research has found the easy step allows people with type 1 diabetes to better regulate their blood sugar levels. Crucially, it also reduces fat and inflammatory markers in the blood that can damage blood vessels and heart disease. People with type 1 diabetes are up to ten times more likely to suffer from cardiovascular disease than the general population, and the condition accounts for more than half of all deaths in this patient group.
The team are now looking to continue with a larger trial over a longer period to look at blood vessel health and diabetes control.
               In the UK, most people with type 1 diabetes regulate their blood sugar levels by injecting insulin throughout the day. The dose after mealtimes is usually calculated from the amount of carbohydrate in the meal. But this doesn't account for how much fat is in the food, which is broken down by the body at a slower rate than carbohydrate.
Co-author of the study, Dr Matthew Campbell from Leeds Beckett University, explained: "Many people with type 1 diabetes struggle to regulate their blood sugar levels around mealtimes, because the fat content in their food is metabolised after their standard insulin injection has lost its potency or has left their blood. Most meals in a typical UK diet have a high fat content, and slower metabolism of this fat can lead to raised blood sugar levels -- with risk of hyperglycaemia and also higher levels of fat and inflammatory markers in the blood, which increase the risk of cardiovascular disease."
               The small trial held at the NIHR Newcastle Clinical Research Facility involved ten men with type 1 diabetes who were given three meals with identical carbohydrate and protein content. One of the meals had a low fat content and two had a high fat content. With the low fat meal, the volunteers administered their insulin dose as normal, calculated by the carbohydrate levels in the food. The volunteers did the same after one high fat meal, but with the other, they also administered a further insulin injection of one third of the original dose, three hours after eating. Blood samples were taken for analysis every half hour, until six hours after eating.
The team found that after the high fat meal and the standard insulin injection, sugar, fat and inflammatory markers in the blood were significantly elevated six hours after eating. However, when the extra insulin shot was taken, the blood analysis showed normal levels of sugar, fat and inflammatory markers, similar to after the low fat meal.
                Co-author Dr Daniel West, of Newcastle University, said: "Improving the sugar and fat levels in the blood after eating is important for the long-term health of the heart and blood vessels. But calculating insulin injection dose based on carbohydrates alone is clearly too simplistic, as most people eat meals that include fat and protein too."
Dr Campbell added: "Our findings show that, after a high fat meal, an extra dose of insulin provides a very simple way of both regulating blood sugar levels for short term health and protecting against the long term risks of cardiovascular disease. We feel strongly that the advice given to people with type 1 diabetes needs to be updated to take this new information into account."
The UK team urge people seek medical advice before altering their insulin injection. They are now intending to begin a larger scale trial.

New transplant technology could benefit patients with type 1 diabetes

Date: June 5, 2017
Source: Georgia Institute of Technology
Summary:: Combining a new hydrogel material with a protein that boosts blood vessel growth could improve the success rate for transplanting insulin-producing islet cells into persons with type 1 diabetes. In an animal model, the technique enhanced the survival rate of transplanted insulin-producing cells, restoring insulin production in response to blood glucose levels and curing these diabetic animals.

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Jessica Weaver, a postdoctoral researcher in Georgia Tech's Woodruff School of Mechanical Engineering, places hydrogel samples into multiwall plate for testing. Pancreatic islet clusters are shown on the microscope screen.

Credit: Christopher Moore, Georgia Tech

Combining a new hydrogel material with a protein that boosts blood vessel growth could improve the success rate for transplanting insulin-producing islet cells into persons with type 1 diabetes. In an animal model, the technique enhanced the survival rate of transplanted insulin-producing cells, restoring insulin production in response to blood glucose levels and curing these diabetic animals.

The technology could also help patients who must have their pancreas removed because of severe pancreatitis, an inflammatory disease. Using the material and protein combination, the researchers evaluated multiple locations for implanting the islet cell clusters, the first time such a direct comparison of transplant sites has been made.
            "We have engineered a material that can be used to transplant islets and promote vascularization and survival of the islets to enhance their function," said Andrés García, a Regents' Professor in the Woodruff School of Mechanical Engineering at the Georgia Institute of Technology. "We are very excited about this because it could have immediate patient benefits if this proves successful in humans."
The research, supported by the Juvenile Diabetes Research Foundation and the National Institutes of Health, was reported June 2 in the journal Science Advances.
             About 1.25 million Americans have type 1 diabetes, also known as juvenile diabetes, a disease characterized by the body's inability to produce insulin. To control the disease, patients must frequently test their glucose levels and inject insulin to maintain the proper balance. But some patients suffer life-threatening hypoglycemic episodes, and the disease has other serious health consequences.
           Using cells from cadavers, doctors have been experimentally transplanting pancreatic islets into humans for decades, but as many as 60 percent of the transplanted islets die immediately because they are cut off from their blood supply and are killed by an immune response due to direct injection into the bloodstream, and those that survive the transplant usually die within several months. In testing done so far, the islets have been placed into the vasculature of the liver, which has significant blood supply -- but might not be the ideal location because of the hostile immune environment.
           So García and collaborators, including Georgia Tech postdoctoral researcher and first author Jessica Weaver, set out to engineer a new approach to transplanting the cells. They developed a new degradable polymer hydrogel material used to deliver the cells as they are injected into the body. And they incorporated into the gel a protein known as vascular endothelial growth factor (VEGF), which encourages the growth of blood vessels into the transplanted cells.
           "The transplanted islets need a lot of oxygenation and a connection to the body's circulatory system to sense the glucose levels and transport the insulin," noted García, who is also the Rae and Frank H. Neely Endowed Chair in Mechanical Engineering. "In addition to protecting the islets, our engineered material promotes the formation of new blood vessels to nourish the cells."
VEGF has been tried before, but in quantities too large, it stimulates the growth of leaky blood vessels that don't provide long-term oxygenation. Too little VEGF doesn't grow vessels rapidly enough to maintain the transplanted islets, which are clusters containing hundreds of cells. Without sufficient vasculature in the clusters, the cells in the center don't survive.
              Weaver used diabetic mice to compare locations in the body where the transplanted cells could be placed. She studied locations in the liver, under the skin, in the mesentery regions near the intestines and in an epididymal fat pad in the abdomen.
"We were able to study the transplant sites in parallel and really look at the pros and cons of each to compare the survival rates of the cells in each area," said Weaver. "Islet cells are very precious because we get so few from each donor. We need them all to survive to help a patient with type 1 diabetes get off insulin."
                In the liver location, as many as three donors are now required to get enough transplantable islets to provide glucose control in a single patient. If researchers could reduce the loss of cells, they could one day treat two or even three times as many patients from the limited number of cadaver donors available, García noted.
Weaver studied the animal models for as long as 100 days, and found that the islet clusters transplanted with the hydrogel and VEGF developed many blood vessels and engrafted into their new locations. As expected, the hydrogel material disappeared and was replaced by new tissue which grew around the islets.
To track the long-term viability of the islet cells, she used cells with a gene that produces a green luminescence when excited by certain wavelengths of light. By measuring the signal returned from the transplant locations, she was able to determine how many of the cells survived. Introducing a dye into the bloodstream then allowed her to image the growing vasculature around the islets.
              The abdominal fat pad turned out to provide the most optimal transplant location. In humans, the equivalent structure is called the omentum, a blood vessel-rich region that other researchers are evaluating as an islet transplant location. Should the technique be used in humans, the cells could be placed there laparoscopically in a minimally-invasive procedure. The hydrogel would be injected in liquid form and would polymerize in the transplant site, creating a flexible gel that would conform to bodily structures to improve both blood vessel connections and tissue integration.
              As a next step, García and Weaver would like to study the technique in larger animals. After that, human clinical trials would be required to show whether the combination of hydrogel material and protein will benefit patients with type 1 diabetes. Ultimately, the researchers hope stem cells might provide a source of islets that could be transplanted without the need of cadaveric donor islets and immune system suppression.
Weaver, a researcher at the Diabetes Research Institute before joining Georgia Tech, said she was surprised at how well the new technology worked. The imaging provided a clear view of the growing vascular system surrounding the islet clumps.
"When we first started doing the imaging, I'm pretty sure I screamed the first time I saw it," said Weaver. "It was so beautiful to see the vasculature. I wasn't expecting to see such perfect blood vessel growth into the islets."

Research says that Gut microbiota plays a key role in treatment with classic diabetes medication

Date: June 1, 2017
Source: University of Gothenburg
Summary:: A clearer picture of how the classic diabetes medication metformin works has emerged. A recent study indicates that the clinical effect control of blood glucose is achieved through modulation of the gut microbiota.

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This is Fredrik Bäckhed.

Credit: Johan Wingborg

A clearer picture of how the classic diabetes medication metformin works has emerged. A recent study at Sahlgrenska Academy and University of Girona indicates that the clinical effect -- control of blood glucose -- is achieved through modulation of the gut microbiota.

"It is fascinating that it is not entirely clear how metformin works, although it has been used clinically for 60 years," says Fredrik Bäckhed, Professor of Molecular Medicine, and the leading researcher behind the study published in Nature Medicine.
         The human body contains more bacteria than human cells. Most of these bacteria exist in the gut, which is the most densely populated ecosystem known today, where their genes (microbiome) complements our own genome with 1000-fold more genes.
                                                                                                                                                                   Improved blood glucose control
             Fredrik Bäckhed's research group at Sahlgrenska Academy has previously shown that the gut microbiota is altered in patients with type 2 diabetes and after bariatric surgery. By conducting a clinical study in patients with new onset diabetes, the group could clarify how the gut microbiomeis affected by metformin.
Sequencing of the microbiome of 22 patients before and after treatment compared with a placebo treated group of patients showed that the gut microbiome was altered dramatically within two months of treatment. Through experiments in the laboratory, the researchers demonstrated that metformin increases the growth of several bacterial species that are linked to improved metabolism.
"Transplantation of the gut microbiota from patients before and after treatment to bacteria-free mice showed that the metformin-modified microbiota may at least partially explain the good effects of metformin on blood glucose control," says Fredrik Bäckhed.
                                                                                                                                                                                More help to come
            Some patients with type 2 diabetes can control their disease with metformin, while others are not helped. Perhaps this is due to their microbiome configuration. Moreover, the most common adverse events are intestinal problems such as diarrhea and abdominal pain.
"Imagine if we can change the intestinal flora in the future so that more people respond to treatment, and that adverse events can be reduced by changing the gut microbiota of patients who will take metformin," concludes Fredrik Bäckhed.