Prediabetes Treatment – improves health and is cost effective!

Google Health

After the early start-up days, Google, like many larger companies, has struggled with adjacent markets. The company missed the boat on social media and GoogleWave was a disaster. That said, their indexing and search, translation, mail, online office, webmaster tools, advertising and VOIP are best in class.

I think it is healthy for a tech company to fail once in a while… it shows their willingness to take chances, etc. rather than acquire (and stagnate) successful start-ups.

Type 2 Diabetes – an autoimmune disease

Type 2 diabetes is in the process of being redefined as an autoimmune disease rather than just a metabolic disorder.

A recent study, appearing in Nature Magazine, showed that an antibody called anti-CD20, which targets and eliminates mature B cells in the immune system, stopped diabetes type 2 developing in lab mice prone to develop the disease, and restored their blood sugar level to normal:

Chronic inflammation characterized by T cell and macrophage infiltration of visceral adipose tissue (VAT) is a hallmark of obesity-associated insulin resistance and glucose intolerance. Here we show a fundamental pathogenic role for B cells in the development of these metabolic abnormalities. B cells accumulate in VAT in diet-induced obese (DIO) mice, and DIO mice lacking B cells are protected from disease despite weight gain. B cell effects on glucose metabolism are mechanistically linked to the activation of proinflammatory macrophages and T cells and to the production of pathogenic IgG antibodies. Treatment with a B cell–depleting CD20 antibody attenuates disease, whereas transfer of IgG from DIO mice rapidly induces insulin resistance and glucose intolerance. Moreover, insulin resistance in obese humans is associated with a unique profile of IgG autoantibodies. These results establish the importance of B cells and adaptive immunity in insulin resistance and suggest new diagnostic and therapeutic modalities for managing the disease.

One of the many reasons that this is significant is that it could lead to future novel treatments.

The economics of obesity

Given the current administrations collectivistic approach to government I have to wonder what Michelle Obama’s shift in emphasis from good health to the economics of obesity means:

In the 10 cities with the nation’s highest obesity rates, the direct costs connected with obesity and obesity-related diseases are roughly $50 million per 100,000 residents. And if these 10 cities just cut their obesity rates down to the national average, all added up they combine to save nearly $500 million in health care costs each year.

This was the first lady’s message delivered earlier today.

Why do we continually hear that diabetes diagnoses and treatment are ineffective?

We continue to hear year after year that both diagnosis and treatment of diabetes is inadequaete.  For example:

Nearly 90 percent of U.S. adult diabetics — more than 16 million adults aged 35 and older — have ineffective treatment of blood sugar, blood pressure, and cholesterol. That percentage is 99 percent in Mexico, said the researchers at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

Frankly, I don’t know why a problem that is this often researched, reported and editorialized is not acted upon in an effective manner.  Here are a few guesses regarding why our progress in this area has been slow:

  1. Diabetes is a challenging disease to identify because is exists in a continuum of states begining with insulin resistance and hyperinsulemia.
  2. Finding an alternate or suplimentary tool for diagnosis faces stiff resistance among the medical community if it is not fully vetted with a large, mult-center and internationally approved clinical study.  After all, “new” mean changing the practice of medicine which requires significant proof. 
  3. The cost of (2) may be an large impediment
  4. Our society tends to rely too heavily on doctors and/or medications to cure with a sliver bullet.  Effective treatment of diabetes requires change in one’s lifestyle, expectations and resource allocation.  The disease is not life threatening (generally) on a day-to-day basis which makes it difficult for many to “sacrifice” their present desires for the future.

These were off the top of my head … I’ll add more as I think of them.

Thanks for reading.

Islet Transplantation for Type 1 Diabetes

At one time I believed that islet translation would lead to a therapeutic treatment and cure for Type 1 diabetes. Presentations by noted surgeons and their endocrinologist partners were hopeful and suggested that short-term trials were highly successful.
However, long term observations seem to have revealed two key factors: (1) the effectiveness of the transplanted cells diminishes through time and (2) their are risk factors associated with the immunosuppression drugs.

Consider the summary from a recent British Medical Journal Commentary:

Summary points
Islet of Langerhans transplantation is used in a select group of patients with type 1 diabetes with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawareness
The procedure is minimally invasive, with few procedure related complications
Two to three islet infusions are usually needed to achieve insulin independence

Most patients need insulin by five years post-transplantation owing to declining graft function; beneficial effects on the frequency of hypoglycaemic episodes and hypoglycaemia awareness remain

Most long term complications are related to systemic immunosuppression

The risk-benefit ratio of islet transplantation should be carefully weighed by the treating physician and the potential recipient, who should be given adequate information

As I understand it, the target population as those individuals with Type 1 Diabetes who are unable to achieve satisfactory (safe) results with conventional therapy. So, islet transplantation is not (yet) the holy grail many of us had hope but it is never-the-less beneficial for some individuals.

Gastric Bypass Surgery Reverses Heart Ailments!

gastric-bypass-surgery.jpgThis is fairly significant news…. gastric bypass does help lose weight and treat diabetes (more here):

Well- who is a candidate for these procedures? Usually patients with a BMI of over 40 or over 35 with health consequences that are obesity related. Does gastric bypass have any effect on diabetes? In a series of 1000 patients, 150 of whom had diabetes, 83% experienced resolution of their diabetes (defined by a normalization of A1c and coming of medications for diabetes) after the surgery

However, there now appears to be additional benefits:

A new report from the Journal of the American College of Cardiology reports that patients who had received gastric bypass surgery not only lost weight but had maintained healthier cardiac health, while also reducing previous cardiac complications spurred by obesity.

Often times when a patient is obese, an increase in the largest portion of the heart, the left ventricle can become larger in mass causing the heart to work harder to pump blood into the body. According to the study, echocardiograms, or ultrasounds of the heart showed a remodeling of the heart structure which included a reduction of left ventricular mass and right ventricular cavity area in patients that had received Gastric Bypass Surgery, a procedure Texas Bariatric Specialists performs.

“Patients now have another reason to add to their check-off list of the benefits of a gastric bypass. Why would anyone severely obese wait any longer when the health risks are too high,” says Texas Bariatric Specialists founder Dr. Nilesh A Patel.
A gastric bypass is a bariatric procedure that is the single largest contributor to these findings and is offered at Texas Bariatric Specialists. In the Laparoscopic gastric bypass surgery procedure, the surgeon makes a small stomach pouch at the top of the stomach, the pouch is later connected to the small intestine bypassing the larger stomach. The gastric bypass can result in complete resolution in type 2 diabetes, hypertension, high blood pressure, sleep apnea, and the loss of 65 percent of excess body fat.

Source: press release

Pre-diabetes

Pre-diabetes is a term used to describe a condition in which the body is insulin resistant, leading to an elevation in blood sugars but not high enough to be diagnostic of diabetes. Pre-diabetes is diagnosed when your fasting blood sugar falls between 100-126 mg/dl.
It is estimated that 16 million Americans over the age of 40 have this new diagnosis.
The condition is serious – an immediate concern is that pre-diabetes increases the risk of heart attacks, strokes and heart disease by 50 percent. With the new lower threshold, it is hoped that more cases of pre-diabetes will be detected early enough so there is time to turn things around.
The good news is that something can be done about it.

The High-Fat Smoking Gun?

Many studies have indicated a correlation between a lifestyle that correlates to diabetes. Causality, however, is generally assumed but not proven. As a result, I hesitate to get too excited about any one set of results. Nevertheless, this is interesting:

High-fat diet linked to diabetes
Scientists at the University of California, San Diego believe they have discovered a link between type 2 diabetes and high fat diets.
5 Jan 2006, 09:33 GMT – Their findings suggest that high fat diets suppress the production of GnT-4a, the enzyme which allows cells in the pancreas to balance the body’s glucose and insulin levels.
Though their experiments were carried out on mice, the team believes that should their findings hold true in humans there would be a significant breakthrough in our understanding of diabetes and the possibility of developing a treatment.
The research validates the widely held belief that diabetes is strongly related to a high-fat diet and obesity. High levels of insulin have also been implicated in contributing to other diseases such as cancer, cardiovascular disease and stroke.
The researchers said new forms of treatment may include inhibiting the GnT-4a gene to reduce insulin production.

Teenage Diabetes on the Rise

New government research shows the number of teenagers with type two, or adult-onset diabetes is skyrocketing.
Just 10 years ago, the disease was almost unheard of in children. Now, almost half the children diagnosed with diabetes have type two.
Doctors said almost all teenagers with type two diabetes are overweight.
“It’s become so commonplace that 12-year-olds who are 200 pounds don’t see themselves as being abnormal or overweight,” said Dr. Byron Cotton with Children’s Healthcare of Atlanta.
Weight is a factor, but so are genetics for diabetes.
“You’ll find diabetes in all populations, but you tend to find it more in people of color, African-Americans, Hispanics,” Cotton explained.
- more here

More kids found to have both types of diabetes

Health experts report a rising incidence of “double diabetes” patients: children with symptoms of both type 1 and type 2 versions of the disease. This is a troubling development for many young people who find that their bodies do not produce insulin and are insensitive to it.
more

Diabetes and Stem Cells Research

Type I diabetes, commonly diagnosed during childhood, is a condition in which the body does not produce insulin. Insulin is a hormone that is used in the body to process glucose by transporting it from blood into cells. Consequently, the disease is marked by chronically high blood glucose levels that over time lead to other health problems such as retinopathy (and blindness), heart disease and neuropathy.

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