Type 2 Diabetes Tied to Raised Risk of Cancer and Deaths

Type 2 diabetes is associated with an increased risk of developing cancer and dying from certain forms of the disease, a new study suggests.

However, the researchers noted, the absolute increased risk is low.

“Our findings do not suggest that everyone who has diabetes will go on to develop cancer in later life,” said study leader Hulda Hrund Bjornsdottir, from the Swedish National Diabetes Register.

Her team analyzed data gathered between 1998 and 2014 from more than 450,000 people in Sweden with type 2 diabetes and more than 2 million people without diabetes who were followed for an average of seven years. The study focused on 12 types of cancer.

The study couldn’t prove cause-and-effect. However, compared to those without type 2 diabetes, people with the blood sugar disease had a 231 percent higher risk of liver cancer, a 119 percent higher risk of pancreatic cancer and a 78 percent higher risk of uterine cancer.

In addition, those with diabetes had an increased risk of penile cancer (56 percent higher), kidney cancer (45 percent higher), gallbladder and bile duct cancer (32 percent higher), and stomach cancer (21 percent higher). They also had a 20 percent higher risk of colorectal cancer and bladder cancer, and a 5 percent higher risk of breast cancer.

The research was to be presented Tuesday at the annual meeting of the European Association for the Study of Diabetes, in Berlin.

The findings don’t necessarily mean that diabetes somehow causes cancer, Bjornsdottir stressed. Instead, “diabetes and cancer share certain risk factors that might contribute to these associations, including obesity, smoking and diet,” she explained in a meeting news release.

When the investigators looked at the results over a 10-year period, they found there was a 38 percent greater increase in new cases of pancreatic cancer and a 30 percent greater increase in lung cancer incidence among people with type 2 diabetes than among those without the blood sugar disease.

The researchers also found that among patients with type 2 diabetes, death rates were 29 percent higher for prostate cancer, 25 percent higher for breast cancer and 9 percent higher for colon cancer, when compared with people without diabetes.

“With the number of people with type 2 diabetes doubling over the past 30 years, our findings underscore the importance of improving diabetes care,” Bjornsdottir said.

Now, with diabetes tied to cancer risk, “the importance of a healthy lifestyle is clearer than ever,” she added.

More than 415 million people worldwide have diabetes — about one in 11 adults — and the number is expected to rise to 642 million by 2040, the study authors noted.

Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

Source: HealthDay


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Genomic Study Brings Us Closer to Precision Medicine for Type 2 Diabetes

Leah Eisenstadt wrote . . . . . . . . .

Most patients diagnosed with type 2 diabetes are treated with a “one-size-fits-all” protocol that is not tailored to each person’s physiology and may leave many cases inadequately managed. A new study by scientists at the Broad Institute of MIT and Harvard and Massachusetts General Hospital (MGH) indicates that inherited genetic changes may underlie the variability observed among patients in the clinic, with several pathophysiological processes potentially leading to high blood sugar and its resulting consequences.

By analyzing genomic data with a computational tool that incorporates genetic complexity, the researchers identified five distinct groups of DNA sites that appear to drive distinct forms of the illness in unique ways.

The work represents a first step toward using genetics to identify subtypes of type 2 diabetes, which could help physicians prescribe interventions aimed at the cause of the disease, rather than just the symptoms.

The study appears in PLoS Medicine.

“When treating type 2 diabetes, we have a dozen or so medications we can use, but after you start someone on the standard algorithm, it’s primarily trial and error,” said senior author Jose Florez, an endocrinologist at MGH, co-director of the Broad’s Metabolism Program, and professor at Harvard Medical School. “We need a more granular approach that addresses the many different molecular processes leading to high blood sugar.”

It’s known that type 2 diabetes can be broadly grouped into cases driven either by the inability of pancreatic beta cells to make enough insulin, known as insulin deficiency, or by the inability of liver, muscle or fat tissues to use insulin properly, known as insulin resistance.

Previous research attempted to define more subtypes of type 2 diabetes based on indicators such as beta-cell function, insulin resistance, or body-mass index, but those traits can vary greatly through life and during the course of disease. Inherited genetic differences are present at birth, and so a more reliable method would be to create subtypes based on DNA variations that have been associated with diabetes risk in large-scale genetic studies. These variations can be grouped into clusters based on how they impact diabetes-related traits; for example, genetic changes linked to high triglyceride levels are likely to work through the same biological processes.

Early efforts to do so used a “hard-clustering” approach, in which each genetic variation was assigned to only one cluster. However, this failed to produce patterns that made biological sense.

Miriam Udler, an endocrinologist at MGH and postdoctoral researcher in the Florez lab, took another approach. She teamed up with Gaddy Getz and Jaegil Kim of the Broad’s Cancer Genomics team to apply a “soft-clustering” approach known as Bayesian non-negative matrix factorization, which allows each variant to fall into more than one cluster.

“The soft-clustering method is better for studying complex diseases, in which disease-related genetic sites may regulate not just one gene or process, but several,” said Udler.

The new work revealed five clusters of genetic variants distinguished by distinct underlying cellular processes, within the existing major divisions of insulin-resistant and insulin-deficient disease. Two of these clusters contain variants that suggest beta cells aren’t working properly, but that differ in their impacts on levels of the insulin precursor, proinsulin. The other three clusters contain DNA variants related to insulin resistance, including one cluster mediated by obesity, one defined by disrupted metabolism of fats in the liver, and one driven by defects in the distribution of fat within the body, known as lipodystrophy.

To confirm these observations, the team analyzed data from the National Institutes of Health’s Roadmap Epigenomics Project, a public resource of epigenomic data for biology and disease research. They found that the genes contained in the clusters were more active in the tissue types one would expect.

To further test whether each cluster had been assigned the correct biological mechanism, the researchers gathered data from four independent cohorts of patients with type 2 diabetes and first calculated the patients’ individual genetic risk scores for each cluster. They found nearly a third of patients scored highly for only one predominant cluster, suggesting that their diabetes may be driven predominantly by a single biological mechanism.

When they next analyzed measurements of diabetes-related traits from high-scoring subjects, they saw patterns that strongly reflected the suspected biological mechanism and distinguished them from all other patients with type 2 diabetes – for example, patients who fell into the obesity-mediated cluster were indeed found to have increased body-mass index and body fat percentage.

The results appear to reflect some of the diversity observed by endocrinologists in the clinic. For example, people who scored high on the lipodystrophy-like cluster were likely to be thinner than average but have insulin-resistant diabetes, similar to a rare type of diabetes in which fat accumulates in the liver, which is a fundamentally different process from insulin resistance that results from obesity.

“The clusters from our study seem to recapitulate what we observe in clinical practice,” said Florez. “Now we need to determine whether these clusters translate to differences in disease progression, complications, and response to treatment.”

In addition to paving the way to clinically useful subtypes, the work sheds light on the diverse pathophysiology underlying type 2 diabetes and offers a model for unraveling the heterogeneity of other complex diseases.

“This study has given us the most comprehensive view to date of the genetic pathways underlying a common illness, which if not adequately treated can lead to devastating complications,” said Udler. “We’re excited to see how our approach can help researchers make steps towards precision medicine for other illnesses as well.”

Source: Broad Institute


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Scientists Identify Hormone Link Between Diabetes and Hypertension

Physician researchers with The Ohio State University College of Medicine at the Wexner Medical Center say increased levels of the hormone aldosterone, already associated with hypertension, can play a significant role in the development of diabetes, particularly among certain racial groups.

“This research is an important step toward finding new ways to prevent a major chronic disease,” said Dr. K. Craig Kent, dean of the College of Medicine. “This shows how our diabetes and metabolism scientists are focused on creating a world without diabetes.”

Results of this study were published online today by the Journal of the American Heart Association.

“Aldosterone is produced by the adrenal gland. We’ve known for some time that it increases blood pressure. We’ve recently learned it also increases insulin resistance in muscle and impairs insulin secretion from the pancreas. Both actions increase a person’s risk of developing type 2 diabetes, but the question was – how much,” said Dr. Joshua J. Joseph, lead investigator and an endocrinologist at Ohio State Wexner Medical Center.

Joseph and his team followed 1,600 people across diverse populations for 10 years as part of the Multi-Ethnic Study of Atherosclerosis. They found, overall, the risk of developing type 2 diabetes more than doubled for people who had higher levels of aldosterone, compared to participants with lower levels of the hormone. In certain ethnicities, the effect was even greater. African Americans with high aldosterone levels have almost a three-fold increased risk. Chinese Americans with high aldosterone are 10 times more likely to develop diabetes.

“I looked into this as a promise to my father. He had high levels of aldosterone that contributed to his hypertension, and he thought it also might be linked to his diabetes. As my career progressed, I had the opportunity to research it, and we did find a link to diabetes,” Joseph said.

One question that remains is why there are wide differences in risk among various ethnic groups. Joseph said it could be genetics or differences in salt sensitivity or something else, and it needs further study.

Just over 30 million Americans have diabetes and nearly a fourth of them don’t know it, according to the Centers for Disease Control and Prevention. Another one in three Americans has prediabetes. Despite current preventive efforts, the numbers continue to climb among various racial/ethnic groups.

Next, Joseph will lead a federally funded clinical trial at Ohio State Wexner Medical Center to evaluate the role of aldosterone in glucose metabolism. African American participants who have prediabetes will take medication to lower their aldosterone levels. Researchers will study the impact on blood glucose and insulin in those individuals.

“We know there’s a relationship between aldosterone and type 2 diabetes. Now we need to determine thresholds that will guide clinical care and the best medication for treatment,” Joseph said.

He expects to start enrolling patients in that trial later this year.

Source: The Ohio State University


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Chinese AI System Could Predict Diabetes 15 Years in Advance

Alice Shen wrote . . . . . . .

Doctors at a hospital in Shanghai are hoping a new artificial intelligence system will help them to identify patients at risk of developing diabetes up to 15 years in advance.

In tests the model, known as Ruining Knows Sugar, or Ruining Zhitang in Chinese, achieved an accuracy rate of 88 per cent, according to 4 Paradigm, the Beijing-based company that developed the software and which has been working with medical staff at Ruijin Hospital in Shanghai since last year.

According to Tu Weiwei, a machine learning specialist at the tech company, the system was designed to identify those most at risk of developing type 2 diabetes – the most common form of the chronic disease – within the next three years.

It also gave risk forecasts for the next nine and 15 years as a reference, he said.

Ning Guang, a specialist in metabolic diseases and vice-president of Ruijin Hospital, said the new system used medical information from 170,000 individuals from across the country, some of whom had diabetes and others who did not.

The data, which was collected between 2010 and 2013 by the hospital’s diabetes research team, included gender, height, weight, blood sugar levels, smoking and drinking history, and education levels, he said.

The AI algorithm then used that information to make its predictions and “learned” from the results, Ning said.

Diabetes is one of the world’s most common and costly chronic illnesses, affecting one in 11 adults globally.

The ratio in China is similar, at about 10 per cent, but given the huge size of its population that means the country had about 110 million diabetes patients in 2016, according to figures from the International Diabetes Federation and World Health Organisation.

The prevalence of the disease had put a huge strain on China’s medical resources, Ning said.

“If the trend continues, we will need 100,000 more doctors,” he said.

Xu Aimin, a University of Hong Kong professor specialising in diabetes and cardiovascular diseases, said that early diagnosis of diabetes was key to providing timely treatment, prolonging lives and reducing the financial burden the disease has on the country.

“Without concerted action, the incidence is likely to increase,” he said. “Diabetes is not curable, but it can be prevented.”

Xu said also that type 2 diabetes was closely related to obesity and that people could reduce their risk of developing it by making healthy lifestyle choices.

The use of artificial intelligence to help predict and monitor diabetes is growing.

In June, American medical device company Medtronic, working with IBM Waston Health, released its Sugar.IQ app, which evaluates how a user’s blood sugar levels respond to variables such as food intake, insulin dosing and other daily routines.

Source : SCMP

Wholegrains Important for Preventing Type 2 Diabetes

​It doesn’t matter if it’s rye, oats, or wheat. As long as it is wholegrain, it can prevent type 2 diabetes. This is the finding of a new study from researchers at Chalmers and the Danish Cancer Society Research Center.

​The comprehensive study is a strong confirmation of previous research findings on the importance of whole grains for prevention of type 2 diabetes – previously sometimes known as adult-onset diabetes. Even if the link has been known for a long time, the role of different wholegrain sources has not been investigated earlier. It has also been unclear how much wholegrain is needed to reduce the risk of developing diabetes.

“Most studies similar to ours have previously been conducted in the USA, where people mainly get their wholegrain from wheat,” says Rikard Landberg, Professor at the Division of Food and Nutrition Science, and senior researcher on the study.

“We wanted to see if there was a difference between different cereals. One might expect there would be, because they contain different types of dietary fibre and bioactive substances, which have been shown to influence risk factors for type 2 diabetes.”

The amount matters

The study was conducted in Denmark, where there is a big variation in wholegrain-intake. The study showed that it made no difference which type of wholegrain product or cereal the participants ate – ryebread, oatmeal, and muesli, for example, seem to offer the same protection against type 2 diabetes.

What is more important is how much wholegrain one eats each day – and the study also provides important clarification to the scientific knowledge when it comes to daily dosages.

The participants were divided into 4 different groups, based on how much wholegrain they reported eating. Those with the highest consumption ate at least 50 grams of wholegrain each day. This corresponds to a portion of oatmeal porridge and one slice of rye bread, for example.

The proportion who developed type 2 diabetes was lowest in the group which reported the highest wholegrain consumption, and increased for each group which had eaten less wholegrain. In the group with the highest wholegrain intake, the diabetes risk was 34 percent lower for men, and 22 percent lower for women, than in the group with the lowest wholegrain intake.

“It is unusual to be able to investigate such a large range when it comes to how much wholegrain people eat,” says Rikard Landberg.

“If you divided American participants into 4 groups, the group that ate the most wholegrain would be the same level as the group that ate the least wholegrain in Denmark. In Europe, Scandinavia eats the most, Spain and Italy the least.”

Additionally, the study was uncommonly large, with 55,000 participants, over a long time span – 15 years.

In line with dietary advice

If you compare wholegrains’ role in the risk of developing type 2 diabetes against other foods that have been investigated in other studies, it is one of the most effective ways to reduce the risk when it comes to diet. Drinking coffee, and avoiding red meat, are other factors that can similarly reduce the risk of type 2 diabetes.

“Our results are in line with dietary advice, which recommends switching out foods containing white flour for wholegrains,” says Rikard Landberg.

“You get extra health benefits – white flour has some negative effects on health, while wholegrain has several positive effects, beyond protection against type 2 diabetes.”

Good to eat carbohydrates

Wholegrains are defined as consisting of all three main components of the grain kernel: endosperm, germ, and bran. Those who avoid all cereals, in an attempt to follow a low carb diet, therefore lose out on the positive health effects of wholegrain, which come principally from the bran and the germ. Rikard Landberg thinks that cereals, and carbohydrates in general, should not be avoided in diet.

“Carbohydrates are a very varied group of foodstuffs, including sugar, starch, and fibre. We should discuss these more individually, and not throw them together in one group, because they have totally different effects on our physiology and health. When it comes to wholegrains, the research results are clear: among the many studies which have been made, in varied groups of people around the world, there hasn’t been a single study which has shown negative health effects.”

Facts: Wholegrains

Wholegrains consist of all three main components of the grain kernel: endosperm, germ and bran. It can be both loose grains, and wholegrain flour. Grains such as oatmeal and rye, wheatberries, bulgur, and wholegrain couscous are all wholegrains. In bread and pasta, the wholegrain content can vary. Common cereals include wheat, rye, oats, corn, maize, rice, millet and sorghum.

Swedish dietary advice is to eat around 70g of wholegrain a day for women, and 90g a day for men. Some examples of how much wholegrain different foods contain:

  • One 50 g slice of rye bread: 16g wholegrain.
  • One 35 g serving of oatmeal porridge: 35 g wholegrain
  • One 12 g crispbread: 12 g wholegrain

Facts: The study

The study used data from a prospective Danish cohort study on diet, cancer and health. It covered more than 55,000 participants, who were between 50-65 years old when the study started. During the initiation of the cohort study in the early 1990s, healthy participants had filled in detailed forms of their eating habits. Through these, the researchers established the participants’ total wholegrain intake per day, which of the most common cereals they got their wholegrain from, (wheat, rye, oats, in grams per day), and the total number, and different types, of wholegrain products (in grams per day) – rye bread, other wholegrain breads, oatmeal porridge and muesli.

The cohort study was linked with data from Denmark’s national diabetes register, to investigate which participants developed type 2 diabetes during a 15 year period – which in total was over 7000 people.

Source: CHALMERS UNIVERSITY OF TECHNOLOGY


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