Loneliness predicts development of type 2 diabetes

 New research has shown for the first time that people over 50 who report higher levels of loneliness are more likely to develop type 2 diabetes later in life.

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Untreated Diabetes Tied to Faster Dementia Progression

In a new study, psychologists from the University of Southern California (USC) found that patients with untreated diabetes developed signs of Alzheimer’s disease 1.6 times faster than people without diabetes. Read PsychCentral article here

NIHR Signal Being overweight or having diabetes are both linked to cancer

For western high-income countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a Body Mass Index [BMI] greater than 25). A high BMI was responsible for almost twice as many cancers as diabetes
.
Around 5.6% of cancers globally in 2012 were attributable to diabetes or high BMI. Because obesity is increasing globally, this number may rise by 25% by 2035.


From the NIHR Dissemination Centre

UHCW publication: Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids

Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids.
Jackisch L, Kumsaiyai W, Moore JD, Al-Daghri N, Kyrou I, Barber TM, Randeva H, Kumar S, Tripathi G, McTernan PG.
Diabetologia 2018 Feb 9. doi: 10.1007/s00125-018-4558-6. [Epub ahead of print]


Abstract
AIMS/HYPOTHESIS: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulatory macrophage-derived factor that increases with obesity and leads to a higher risk of cardiovascular disease (CVD). Despite this, its role in adipose tissue and the adipocyte is unknown. Therefore, the aims of this study were to clarify the expression of Lp-PLA2 in relation to different adipose tissue depots and type 2 diabetes, and ascertain whether markers of obesity and type 2 diabetes correlate with circulating Lp-PLA2. A final aim was to evaluate the effect of cholesterol on cellular Lp-PLA2 in an in vitro adipocyte model.METHODS: Analysis of anthropometric and biochemical variables from a cohort of lean (age 44.4 ± 6.2 years; BMI 22.15 ± 1.8 kg/m2, n = 23), overweight (age 45.4 ± 12.3 years; BMI 26.99 ± 1.5 kg/m2, n = 24), obese (age 49.0 ± 9.1 years; BMI 33.74 ± 3.3 kg/m2, n = 32) and type 2 diabetic women (age 53.0 ± 6.13 years; BMI 35.08 ± 8.6 kg/m2, n = 35), as part of an ethically approved study. Gene and protein expression of PLA2 and its isoforms were assessed in adipose tissue samples, with serum analysis undertaken to assess circulating Lp-PLA2 and its association with cardiometabolic risk markers. A human adipocyte cell model, Chub-S7, was used to address the intracellular change in Lp-PLA2 in adipocytes. RESULTS: Lp-PLA2 and calcium-independent PLA2 (iPLA2) isoforms were altered by adiposity, as shown by microarray analysis (p < 0.05). Type 2 diabetes status was also observed to significantly alter gene and protein levels of Lp-PLA2 in abdominal subcutaneous (AbdSc) (p < 0.01), but not omental, adipose tissue. Furthermore, multivariate stepwise regression analysis of circulating Lp-PLA2 and metabolic markers revealed that the greatest predictor of Lp-PLA2 in non-diabetic individuals was LDL-cholesterol (p = 0.004). Additionally, in people with type 2 diabetes, oxidised LDL (oxLDL), triacylglycerols and HDL-cholesterol appeared important predictors, accounting for 59.7% of the variance (p < 0.001). Subsequent in vitro studies determined human adipocytes to be a source of Lp-PLA2, as confirmed by mRNA expression, protein levels and immunochemistry. Further in vitro experiments revealed that treatment with LDL-cholesterol or oxLDL resulted in significant upregulation of Lp-PLA2, while inhibition of Lp-PLA2 reduced oxLDL production by 19.8% (p < 0.05).CONCLUSIONS/INTERPRETATION: Our study suggests adipose tissue and adipocytes are active sources of Lp-PLA2, with differential regulation by fat depot and metabolic state. Moreover, levels of circulating Lp-PLA2 appear to be influenced by unfavourable lipid profiles in type 2 diabetes, which may occur in part through regulation of LDL-cholesterol and oxLDL metabolism in adipocytes.


View details on PubMed at https://www.ncbi.nlm.nih.gov/pubmed/29427237

UHCW publication: Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes

Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes
Weickert MO, Pfeiffer, AFH
The Journal of Nutrition, Volume 148, Issue 1, 1 January 2018, Pages 7–12
Abstract
Large prospective cohort studies consistently show associations of a high dietary fiber intake (>25 g/d in women and >38 g/d in men) with a 20–30% reduced risk of developing type 2 diabetes (T2D), after correction for confounders. It is less well recognized that these effects appear to be mainly driven by high intakes of whole grains and insoluble cereal fibers, which typically are nonviscous and do not relevantly influence postprandial glucose responses [i.e., glycemic index (GI)] or are strongly fermented by the gut microbiota in the colon. In contrast, a dietary focus on soluble, viscous, gel-forming, more readily fermentable fiber intakes derived from fruit and certain vegetables yields mixed results and generally does not appear to reduce T2D risk. Although disentangling types of fiber-rich foods and separating these from possible effects related to the GI is an obvious challenge, the common conclusion that key metabolic effects of high-fiber intake are explained by mechanisms that should mainly apply to the soluble, viscous type can be challenged. More recently, studies in humans and animal models focused on gaining mechanistic insights into why especially high-cereal-fiber (HCF) diets appear to improve insulin resistance (IR) and diabetes risk. Although effects of HCF diets on weight loss are only moderate and comparable to other types of dietary fibers, possible novel mechanisms have emerged, which include the prevention of the absorption of dietary protein and modulation of the amino acid metabolic signature. Here we provide an update of our previous review from 2008, with a focus on mechanistic insights of how HCF diets may improve IR and the risk of developing T2D.


Read the full article at https://academic.oup.com/jn/article/148/1/7/4823705 (free access)

NIHR Signal New screening pathway could help to identify a rare, single-gene form of diabetes

A screening pathway using blood and urine tests followed by two genetic (DNA) tests identified all people with a rare subtype of diabetes called monogenic diabetes. The screening pathway performed better than current practice based on age at diagnosis and family history which misses 63%. It is, therefore, a useful approach for ruling out this form of diabetes and probably cheaper overall than offering every young person with diabetes DNA testing.


Monogenic diabetes, caused by a mutation in a single gene can be misdiagnosed as type 1 diabetes, leading to unnecessary insulin treatment. Those recruited for this study were 98% white and tested at an average of 14 years after diagnosis.


From the NIHR Dissemination Centre

Occupational Therapy May Aid Quality of Life for Younger Diabetics

Occupational therapy may significantly improve the health and quality of life of diabetic young people, according to a new study led by researchers at the University of Southern California (USC). Click here for PsychCentral article

Diabetic eye screening: approved cameras and settings

This document from Public Health England sets out the NHS diabetic eye screening (DES) programme's recommended cameras and settings for digital DES.

Admissions of inequality: emergency hospital use for children and young people

Does a child's socioeconomic background have an effect on rates of admissions to hospital for common conditions such as asthma, diabetes or epilepsy?  Report from the Nuffield Trust.

NIHR Signal Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously

Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group.

Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.

From the NIHR Dissemination Centre

Leading foot health experts call for an end to avoidable amputations

The College of Podiatry is calling on healthcare commissioners to prioritise diabetic foot care and end avoidable amputations that can have a devastating impact on the lives of patients and their families and cost the NHS millions.

Complications from diabetic foot disease are costing the NHS in England more than a billion pounds a year.

The College of Podiatry has launched an online commissioners’ guide that exposes in detail the comparative rates of amputations across England. It is calling on commissioners to take action and help end the postcode lottery of avoidable amputations.

UHCW audit on SGLT2 inhibitor (SGLT2-i) use

Endocrine Abstracts (2017) 50 P224 DOI:10.1530/endoabs.50.P224

After almost 2 centuries, SGLT2-i have made their comeback in human pharmacology through successful re-introduction in diabetes type 2 (T2D). Via restriction of renal glucose reabsorption, SGLT2-i have shown promising results. The aim of this audit was to ensure that current practice at UHCW NHS Trust is in line with the agreed national standards, whilst collecting clinical data from the use of SGLT2-i.

UHCW Research: Maria Mytilinaiou, Georgios K Dimitriadis, Allan Davasgaium, Diane Sambrook, Claire Hewins, Nilisha Nalawade, Dimitris K Grammatopoulos and Harpal S Randeva

Diabetes and learning disability, reasonable adjustments needed along a diabetes pathway

The prevalence rates of both Type 1 and Type 2 diabetes were identified to be higher in people with a learning disability compared to the general population.

To ensure the same care is available to people with a learning disability, NHS RightCare has published a pathway for diabetes including the reasonable adjustments expected to be made for people with a learning disability. This document will support commissioners applying the NHS RightCare Pathway for diabetes to people with learning disability, so that all receive the same level of care, understanding and outcomes.

GDm-Health for people with gestational diabetes [MIB131]

New:  Medtech innovation briefing from NICE:

GDm‑Health (Oxford University NHS Foundation Trust and The University of Oxford) comprises 2 parts: a patient-facing mobile app, which is downloaded to the patient's mobile device, and a secure clinician-facing website designed to allow remote blood glucose monitoring.

The mobile app is available for iOS and Android operating systems. The app downloads data from the user's blood glucose meter (through Bluetooth or near-field communication [NFC]). It then automatically sends these blood glucose measurements to the secure website through wifi or a mobile internet connection. The user may also enter notes alongside the measurements, such as explanations of unusually high readings, and these are also sent to the website.

Plasma irisin is elevated in type 2 diabetes and is associated with increased E-selectin levels

Cardiovasc Diabetol. 2017 Nov 9;16(1):147. doi: 10.1186/s12933-017-0627-2.

BACKGROUND: Irisin is a hormone released mainly from skeletal muscle after exercise which increases adipose tissue energy expenditure. Adipocytes can also release irisin after exercise, acting as a local adipokine to induce white adipose tissue to take on a brown adipose tissue-like phenotype, suggesting that irisin and its receptor may represent a novel molecular target for the treatment of obesity and obesity-related diabetes. Previous reports provide conflicting evidence regarding circulating irisin levels in patients with type 2 diabetes (T2DM).

CONCLUSION:These data suggest that elevated plasma irisin in T2DM is associated with indices of adiposity, and that irisin may be involved in pro-atherogenic endothelial disturbances that accompany obesity and T2DM. Accordingly, irisin may constitute a potentially novel therapeutic opportunity in the field of obesity and cardiovascular diabetology.

UHCW Research: Kyrou I and Randeva HS

Triheptanoin (UX-007) for glucose transporter type 1 deficiency syndrome (de vivo disease) – first line

Glucose transporter type 1 deficiency syndrome (Glut1 DS) is a rare genetic disorder that affects how the body moves glucose (used for energy) into the brain. The most common symptom of this condition is seizures (epilepsy), which usually begin within the first few months of life. However, the symptoms and severity of Glut1 deficiency syndrome can vary substantially from one person to another.

Triheptanoin is a novel drug being developed to reduce seizures and other symptoms in patients with Glut1 DS. The drug acts by producing a substitute compound that can produce glucose in the brain. The safety and efficacy of triheptanion is currently being evaluated. If marketed this will become the first licensed treatment in reduction of seizures in patients with Glut1 DS.

From the NIHR Innovation Observatory

Sotagliflozin tablets as an adjuct therapy to insulin for Type 1 diabetes mellitus

Sotagliflozin is a drug being developed to lower blood sugar levels in type 1 diabetes by increasing the amount of sugars excreted in the urine. It is taken once a day tablet in conjunction with insulin to prevent large rises and falls in blood sugar levels. This may be especially useful for people who cannot control their blood sugar levels with insulin alone. Sotagliflozin is currently in clinical trials which have shown that sotagliflozin has the potential to reduce and control blood sugar levels when taken with insulin.


from the NIHR Innovation Observatory

Diabetes UK Consensus Guideline for Flash Glucose Monitoring

Flash glucose monitoring (Flash GM) is a new technology that has recently been made available on the NHS Drugs Tariff. This means in principle it is available to people with diabetes in the UK on
NHS prescription. It is important that healthcare professionals and local health decision makers
are aware of the new technology so that they can make sure that people with diabetes have access
to Flash GM in their local area.

People with type 2 diabetes should 'save carbs for last'

"Diabetics should save bread for last at mealtime to keep their blood sugar under control," the Mail Online reports. A small study found that people with type 2 diabetes who saved their carbohydrates until the end of their meal were less likely to experience a sudden rise in their blood sugar (glucose) levels. The medical term for this spike in blood sugar levels is postprandial hyperglycaemia.

Postprandial hyperglycaemia is best avoided as not only can it make the day-to-day symptoms of diabetes worse, it has also been linked to an increased risk of developing cardiovascular disease.

It has been suggested that leaving carbohydrates until the end of a meal could slow the emptying of the stomach and give it a chance to digest the protein and vegetables first, which could help prevent a blood glucose spike. The researchers wanted to see whether this was true.

This study included just 16 people who ate the foods of their meal in different orders to test which order was most effective at lowering blood sugar and related hormones. They either ate carbohydrates first, carbohydrates last, or all nutrients together at the same time.

The researchers generally found that consuming carbohydrates last was better at lowering blood sugar levels and insulin secretion when compared to the other ways of eating carbohydrates.

While the results are interesting, the study was far too small to form the basis of any firm medical guidance. For now, it's best to follow current advice, which is to consume a healthy diet and keep active to help you manage your blood sugar level. This will also help you control your weight and generally feel better.

Heel casts do not improve heel ulcers in diabetes

Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference.

Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effectiveness of using a similar approach for heel ulcers.
This NIHR-funded trial indicates that specially-moulded heel casts do not improve healing rates or pain, and were not a good use of NHS resources compared with usual care.

Uncertainty remains over the optimal approach for managing heel ulcers in people with diabetes.https://discover.dc.nihr.ac.uk/portal/article/4000781/heel-casts-do-not-improve-heel-ulcers-in-diabetes