Increased Consumption of Whole Grains Could Significantly Reduce the Economic Impact of Type 2 Diabetes

Increased consumption of whole grain foods could significantly reduce the incidence of type 2 diabetes and the costs associated with its treatment in Finland, according to a recent study by the University of Eastern Finland and the Finnish Institute for Health and Welfare. The findings were published in Nutrients.

“Our study shows that already one serving of full grains as part of the daily diet reduces the incidence of type 2 diabetes at the population level and, consequently, the direct diabetes-related costs, when compared to people who do not eat whole grain foods on a daily basis. Over the next ten years, society’s potential to achieve cost savings would be from 300 million (-3.3%) to almost one billion (-12.2%) euros in current value, depending on the presumed proportion of whole grain foods in the daily diet. On the level of individuals, this means more healthier years,” says Professor Janne Martikainen from the University of Eastern Finland.

Type 2 diabetes is one of the fastest-growing chronic diseases both in Finland and globally. Healthy nutrition that supports weight management is key to preventing type 2 diabetes. The association of daily consumption of whole grain foods with a lower risk of diabetes has been demonstrated in numerous studies.

“According to nutrition recommendations, at least 3–6 servings of whole grain foods should be eaten daily, depending on an individual’s energy requirement. One third of Finns do not eat even one dose of whole grains on a daily basis, and two thirds have a too low fibre intake,” Research Manager Jaana Lindström from the Finnish Institute for Health and Welfare says.

The now published study utilised findings from, e.g., national follow-up studies, such as the FinHealth Study, to assess the health and economic effects of increased consumption of whole grain foods on the prevention of type 2 diabetes.

“By combining population-level data on the incidence of type 2 diabetes and the costs of its treatment, as well as published evidence on the effects of how consumption of whole grain foods reduces the incidence of type 2 diabetes, we were able to assess the potential health and economic benefits from both social and individual viewpoints,” Martikainen says.

Source: University of Eastern Finland

Statins: Good for the Heart, Maybe Not So Good for Diabetes

Steven Reinberg wrote . . . . . . . . .

Statins are proven to lower cholesterol, but they may also come with a downside for patients with diabetes: A new study finds they may make the blood sugar disease worse.

Researchers found that among those taking statins, 56% saw their diabetes progress, compared with 48% of those not taking statins. And the higher the dose of the statin, the faster the progression of the diabetes.

“This study should be a start to more research examining the balance of benefits and harms of statins in patients with diabetes,” said senior researcher Dr. Ishak Mansi. He is a professor in the Departments of Medicine and Data and Population Science at the University of Texas Southwestern in Dallas.

“We know well about the benefits of statins, but the harms are much less investigated,” Mansi said. “Specifically, what is the population that may benefit less from the use of statins for primary prevention or be harmed? Answering these questions impact hundreds of millions of patients and cannot be postponed.”

He cautioned that based solely on this one finding, no patient should stop taking their statins and that association does not prove causation.

For the study, Mansi and his colleagues collected data on more than 83,000 diabetic patients who used statins and more than 83,000 who didn’t.

Those who were taking statins were more likely to see their diabetes progress and need to start using insulin and other types of drugs to lower high blood sugar levels sooner than those who weren’t taking statins.

“The study may alert clinicians that they may need to pay close attention and expect to adjust anti-diabetes medications when they initiate statins,” Mansi said.

Dr. Joel Zonszein, an emeritus professor of medicine at the Albert Einstein College of Medicine in New York City, said that blood sugar is not the only key to managing type 2 diabetes.

“Management of type 2 diabetes is not centered on lowering blood sugars,” explained Zonszein, who wasn’t part of the study. “In addition to lifestyle changes, medications are often necessary to prevent or attenuate complications. Statins are highly effective in lowering cholesterol and protecting against heart attacks and strokes.”

Statins do not cause diabetes and the modestly increased rate in precipitating new-onset diabetes is well-known, though the exact mechanism remains unknown, he said.

“The benefits of statins in patients with type 2 diabetes are far greater than the potential side effects,” Zonszein added.

Millions of people have been treated with statins, and its widespread application has been a major public health advance, he noted.

Treatment of obesity, hypertension and high cholesterol is as important as improving glycemic control, Zonszein added, and statins are one of the best medications for these in patients with type 2 diabetes.

“When prescribing any medication, a careful balance between benefits and side effects is discussed between the health care provider and the patient,” Zonszein said. “In the case of statins, the benefits, particularly in patients with type 2 diabetes, are by far better than potential side effects.”

The report was published online in the journal JAMA Internal Medicine.

Source: HealthDay

Study Uncovers New Link Between Long-term Arsenic Exposure and Type 2 Diabetes

A University of Arizona Health Sciences study has identified the biological mechanism linking long-term arsenic exposure to diseases such as cancer and Type 2 diabetes. The findings could result in potential new targets for drug development.

More than 34 million Americans have diabetes, according to the Centers for Disease Control and Prevention, and approximately 90-95% of them have Type 2 diabetes. One of the main risk factors is environmental toxicant exposure, particularly chronic exposure to arsenic, which has been shown to affect insulin production and sensitivity, blood sugar levels, and lipid profiles, all common features of diabetes onset and progression.

Because arsenic is a natural metalloid found in soil, it can be one of the most significant contaminants in drinking water globally, especially when ingested at unsafe levels. Arsenic is present in almost all groundwater sources in Arizona, particularly in rural areas. Combined with occupational exposures, such as mining, more than 160 million people worldwide are exposed to arsenic.

New research led by Donna D. Zhang, PhD, the Musil Family Endowed Chair in Drug Discovery at the UArizona College of Pharmacy and a member of the BIO5 Institute, uncovered a biological mechanism by which chronic arsenic exposure led to insulin resistance and glucose intolerance, two key features of diabetes progression.

The study examined the effect of arsenic exposure on nuclear factor-erythroid 2 related factor 2 (NRF2) activation. NRF2 is a protein that plays an important role in maintaining cellular homeostatis, especially during times of oxidative stress when there is an imbalance of free oxygen radicals and antioxidants in the body.

Long-term oxidative stress, such as that caused by cigarette smoke, radiation, diets high in sugar, fat and alcohol, or environmental toxins, contributes to the development of a range of chronic conditions including cancer, diabetes and neurodegenerative disease.

NRF2 is the body’s governing regulator against oxidative stress. When the body enters an oxidative stress state, NRF2 is activated and the process of cellular protection begins. When cellular homeostatis is restored, NRF2 levels return to normal.

Dr. Zhang and the research team found that arsenic exposure results in the prolonged and uncontrolled activation of NRF2, which previously was determined to be a driver of cancer progression and resistance to anti-cancer therapy. In this study, they found that arsenic exposure resulted in glucose intolerance and decreased insulin sensitivity. In particular, prolonged NRF2 activation by chronic arsenic exposure caused shifts in pathways that control amino acid, fatty acid, carbohydrate, lipid and drug metabolism.

The findings demonstrated that prolonged NRF2 activation in response to arsenic increased glucose production in the liver and the release of that glucose to the bloodstream, which could represent a key driver of changes in systemic blood glucose.

“Hopefully this study will serve as a foundation for future toxicant-driven diabetes research here at the University of Arizona Health Sciences and elsewhere,” said Dr. Zhang, who also is an associate director of the UArizona Superfund Research Center. “Our eventual goal is to generate effective preventive or interventive strategies to treat exposed populations.”

This study was published in Molecular Metabolism.

Source: The University of Arizona

Standing More May Help Prevent Type 2 Diabetes

Type 2 diabetes is one the most common lifestyle diseases worldwide, and its onset is usually preceded by impaired insulin sensitivity, i.e. insulin resistance. This refers to a state in which the body does not react to insulin normally, and the blood glucose levels rise.

Lifestyle has a strong impact on insulin resistance and the development of type 2 diabetes, and regular physical activity is known to have an important role in the prevention of these issues. However, so far, little is known about the impact of sedentary behaviour, breaks in sitting, and standing on insulin resistance.

In a study of Turku PET Centre and UKK institute, the researchers investigated the associations between insulin resistance and sedentary behaviour, physical activity and fitness in inactive working-age adults with an increased risk of developing type 2 diabetes and cardiovascular diseases. In the study published in Journal of Science and Medicine in Sport, the researchers observed that standing is associated with better insulin sensitivity independently of the amount of daily physical activity or sitting time, fitness level, or overweight.

– This association has not been shown before. These findings further encourage replacing a part of daily sitting time with standing, especially if physical activity recommendations are not met, says Doctoral Candidate Taru Garthwaite from the University of Turku.

Body Composition Strongly Associated with Insulin Sensitivity

The study also emphasises the importance of healthy body composition on metabolic health. The results show that increased body fat percentage was a more important factor in terms of insulin sensitivity than physical activity, fitness, or the amount of time spent sitting. Standing, on the other hand, was associated with insulin sensitivity independently, irrespective of body composition.

– Regular exercise is well known to be beneficial for health. It seems that physical activity, fitness, and sedentary behaviour are also connected to insulin metabolism, but indirectly, through their effect on body composition, Taru Garthwaite explains.

Causal effects cannot yet be predicted based on this study, but according to Garthwaite, the results suggest that increasing daily standing time may help in prevention of lifestyle diseases if physical activity recommendations are not met.

Next, the researchers aim to investigate how changes in daily activity and sedentariness impact cardiovascular and metabolic disease risk factors and metabolism by comparing two groups in an intervention study of a longer duration.

– Our aim is to study if reducing daily sitting time by an hour has an impact on energy metabolism and fat accumulation in liver and the whole body, for example, in addition to insulin sensitivity and blood sugar regulation, says Garthwaite.

The research article ”Standing is associated with insulin sensitivity in adults with metabolic syndrome” has been published in Journal of Science and Medicine in Sport

Source: University of Turku

Some Diabetes Meds Might Also Lower Alzheimer’s Risk

Amy Norton wrote . . . . . . . . .

Older adults who take certain diabetes drugs may see a slower decline in their memory and thinking skills, a new study suggests.

Researchers in South Korea found that among older people who’d been having memory issues, those using diabetes drugs called DDP-4 inhibitors typically showed a slower progression in those symptoms over the next few years. That was compared with both diabetes-free older adults and those taking other diabetes medications.

People on DDP-4 inhibitors also showed smaller amounts of the “plaques” that build up in the brains of people with Alzheimer’s disease.

Experts cautioned that the findings do not prove the drugs can prevent or delay dementia.

To do that, researchers would need to conduct clinical trials that directly test the medications, said Dr. Howard Fillit, chief science officer for the nonprofit Alzheimer’s Drug Discovery Foundation in New York City.

But, he said, the study adds to evidence that certain existing medications — including some for diabetes or high blood pressure — could be “repurposed” for protecting the aging brain.

In fact, other diabetes medications, such as metformin and GLP-1 agonists, are already being studied for slowing down declines in memory and thinking skills.

There has been less research, Fillit said, into DDP-4 inhibitors — which include oral medications like sitagliptin (Januvia), linagliptin (Tradjenta), saxagliptin (Onglyza) and alogliptin (Nesina). They share a similarity with GLP-1 agonists, in that they act on the same “pathway” in the body.

Fillit explained that DDP-4 inhibitors work by boosting blood levels of GLP-1, a gut hormone that stimulates insulin release. Insulin is a hormone that regulates blood sugar.

People with diabetes are resistant to insulin, which results in chronically high blood sugar levels. Some studies have found that people with Alzheimer’s also have problems with insulin resistance — and researchers have speculated that may contribute to the brain degeneration seen in the disease.

But Fillit said that diabetes medications might have effects beyond improving insulin resistance.

Animal research has suggested DDP-4 inhibitors can reduce brain inflammation and protect brain cells from Alzheimer’s-like injury.

For the current study, researchers led by Dr. Phil Hyu Lee of Yonsei University College of Medicine in Seoul reviewed the cases of 282 patients who had come to their clinic with complaints about their memory and thinking abilities. Brain scans had shown all had evidence of amyloid — the protein that makes up Alzheimer’s-related plaques.

Of those patients, half had diabetes: 70 were taking a DDP-4 inhibitor, and 71 were using other diabetes drugs, most often metformin and sulfonylureas.

On average, the researchers found, patients on DDP-4 inhibitors had less amyloid buildup than either the diabetes-free patients or those on other diabetes medications. And over the next few years, they also showed a slower decline on tests of memory and thinking.

The findings were published online in the journal Neurology.

Maria Carrillo, chief science officer for the Alzheimer’s Association, stressed that the study cannot prove DDP-4 inhibitors slow down the dementia process.

One of the study’s limitations, she noted, is that patients’ amyloid levels were only measured at the start. So it’s not clear whether those on DDP-4 inhibitors had a slower accumulation of brain plaques over time.

It’s well known, Carrillo said, that people with diabetes have a higher risk of developing Alzheimer’s than those without diabetes — though the reasons are not fully clear, she added.

Insulin resistance, as well as high blood sugar, may partly explain it, according to the Alzheimer’s Association. Carrillo noted that this study did not look at patients’ long-term blood sugar control — and whether that had any role in their rates of decline over time.

“There is some rationale for looking at these diabetes drugs in people with Alzheimer’s,” Carrillo said.

But like Fillit, she said only randomized clinical trials — where patients are randomly assigned to take a DDP-4 inhibitor or not — can prove whether there are benefits.

One question for future studies, Fillit said, is whether DDP-4 inhibitors can slow mental decline in people without diabetes, or only those with the disease.

Because Alzheimer’s is so complex, Fillit said it is likely that medication combinations — aimed at different mechanisms behind the disease — will prove most effective at treating or preventing the disease.

Both of the nonprofits encourage people to eat a healthy diet, exercise, avoid smoking and engage in mentally stimulating activities to help keep their bodies and minds in good shape as they age.

Source: HealthDay