Category: Diabetes 101

The latest statistics of the International Diabetes Federation predict that diabetes rates will continue to rise in the coming years. By 2030, the IDF predicts, 552 million people could have the disease, or at least one in 10 adults worldwide.

The November 14 report from the IDF used factors such as demographic changes and aging to predict the increasing rates of the disease. According to the IDF, about one in 13 adults worldwide now has diabetes.

The number includes both variants of diabetes in addition to undiagnosed cases. The IDF predicts that the number of diabetes cases will jump significantly—about 90 percent—in Africa, where infectious diseases have typically claimed more lives than diabetes. The predictions may even be conservative, since increasing rates of diabetes due to obesity were not taken into account.

Today, the World Health Organization estimates that there are 346 million people living with diabetes around the world; over 80 percent of deaths from diabetes occur in developing countries. The WHO predicts that diabetes deaths will double by the year 2030 and that the International Diabetes Federation’s numbers are possible.

According to Gojka Roglic, the head of the diabetes unit at the WHO, the predictions are “a credible figure.”

“But whether or not it’s correct, we can’t say,” continued Roglic. She noted that the increasing rates of obesity were linked to the aging of the population rather than the obesity epidemic, although most people with diabetes have the Type 2 variant of the disease, which is related to obesity, poor diet and lack of exercise.

The good news is that many cases of Type 2 diabetes are preventable. “It’s worrying because these people will have an illness which is serious, debilitating, and shortens their lives,” said Roglic. “But it doesn’t have to happen if we take the right interventions.”

Such interventions could include counseling on healthy eating and getting regular exercise. Research has demonstrated that interventions which improve or reverse obesity and sedentary lifestyles are also helpful in controlling blood glucose levels in diabetes. In patients who receive both bariatric surgery and interventions to reduce risk factors of diabetes, the disease is almost completely eliminated.

The number of Type 2 diabetes cases has grown by leaps and bounds over the past several decades. In 1985, the IDF estimated that about 30 million people around the world had diabetes. By 2000, that number had increased to 150 million, and today estimates place the number around 366 million people. Half of those with diabetes are between the ages of 20 and 60, and the disease is expected to grow exponentially. About 4.6 million people die from diabetes each year; the disease also takes an immense financial toll due to health care costs, which run about $465 billion each year in treatment for the disease.

“The data from the latest edition of the IDF Diabetes Atlas show that the epidemic is out of control,” said Professor Jean Claude Mbanya, President of the IDF. “We are losing ground in the struggle to contain diabetes. No country is immune and no country is fully equipped to repel this common enemy.”

The International Diabetes Federation is an association of over 200 diabetes organizations, spanning over 160 countries around the world. Since 1950, the IDF has promoted awareness of the disease, proper care and prevention, and the search for a cure for both Type 1 and Type 2 diabetes.

Diabetics around the world are familiar with the routine of blood glucose testing that requires a prick on the finger to draw blood. Though the inconvenience of drawing blood is a small price to pay for accurate blood sugar control, some diabetics require several tests a day and the frequent pricks can be tiring.

For decades, scientists have pursued alternate methods of blood glucose testing, which could help diabetics improve their control over the disease. Some researchers have targeted tears as a vessel for testing blood glucose, and a recent study published in the journal “Analytical Chemistry” has demonstrated that this may be a viable option.

A research team at the University of Michigan developed a sensor that detects dilute glucose levels in animal tears. They conducted a study using 12 rabbits, demonstrating that the results of glucose tests using tears had similar results to testing using blood samples.

Doctors have made it known that an alternative to the finger-prick blood sugar test would likely be highly successful among diabetics.

“This is an incredibly hot area,” says Dr. George Grunberger, a member of the board of the American Association of Clinical Endocrinologists.

According to Dr. Grunberger, previous research into finding alternative blood sugar testing methods has been enthusiastic, though not always successful.

“People have been trying to read glucose through skin, through measurements attached on the earlobe. There have been machines on the market that got taken off the market because of unreliability and poor reproducibility,” said Dr. Grunberger.

According to the American Diabetes Association, about 25.8 million people in the United States have diabetes; about 7 million of those cases are undiagnosed. Diabetes is characterized by excessive levels of glucose in the bloodstream, which may be caused by a lack of production of the hormone insulin (as in Type 1 diabetes) or a resistance to insulin (as in Type 2 diabetes). Insulin’s job is to transport glucose out of the bloodstream; in diabetics, the body’s inability to use insulin effectively means that glucose remains in the blood.

To combat the effects of chronically elevated blood sugar levels, diabetics must monitor those levels to ensure that they stay in a normal range. For some diabetics, this means testing blood glucose levels “two, three, four or even 10” times a day, says Dr. Grunberger. Since blood sugar levels vary due to diet and physical activity, enough measurements must be taken to ensure proper monitoring.

A team of researchers headed by Jeffrey LaBelle at Arizona State University has previously worked with researchers from the Mayo Clinic to develop blood glucose testing technology that uses tears instead of blood. According to LaBelle, the idea of testing tears dates as far back as 1937, but the fluidity of the liquid makes glucose testing difficult. Tears also contain much less glucose than blood, which means that sensors must be sensitive to small amounts of glucose.

“Levels of glucose in tears have been found to be typically 30-50 times lower than in blood,” wrote the authors on the University of Michigan Study. They noted that physicians would need to establish guidelines for each individual using tears for blood glucose monitoring: “The use of tears as an alternate sample to assess blood glucose in human subjects will likely require that the ratio of glucose in tears and blood be established first for a given individual.”

“The major challenges are evaporation, lower concentration in glucose in tears than blood, lower volume—there’s a lot more blood than tear fluid—and not stimulating the eye; not rubbing it,” says LaBelle.

“Glucose is also a stress responder, so if you stress the eye you can get an inaccurate reading,” he continued.

Medtronic, Inc., the world’s largest medical technology company, recently announced that it received approval from the U.S. Food and Drug Administration for its Investigational Device Exemption (IDE) in conducting a pivotal clinical trial in the ASPIRE study, an investigation of the in-home efficacy of the Low Glucose Suspend feature of Medtronic’s MiniMed Paradigm insulin pump system. The FDA’s approval means that the ASPIRE study will be the first in-home pivotal trial of a closed loop system for treating Type 1 diabetes.

According to David Klonoff, Medical Director of the Diabetes Research Institute at Mills-Peninsula Health Services, the ASPIRE (Automation to Stimulate Pancreatic Insulin Response) study is leading the way in ensuring that hypoglycemia does not get out of control when patients are unable to respond to their low blood glucose conditions, such as when they’re asleep.

“This study leads an industry-wide effort to close the diabetes treatment loop by tackling the important challenge of reducing the risk of hypoglycemia even when a person is asleep or unable to react,” said Klonoff. “The new Low Glucose Suspend integrated system is designed to help improve patients’ ability to manage nocturnal hypoglycemia, which can be one of the most frightening aspects of living with Type 1 diabetes. Until now, we have never had a therapy designed to automatically intervene when blood glucose becomes severely low.”

Francine Kaufman, Chief Medical Officer and Vice President of Global Clinical Affairs at the diabetes division of Medtronic, said that the FDA’s approval is “an important milestone toward bringing Low Glucose Suspend technology to the U.S. market.

“It’s also a critical step toward our ultimate goal — the development of an artificial pancreas,” continued Kaufman. “We believe this innovation has the potential to provide patients with added protection by lowering the risks associated with nocturnal hypoglycemia.”

According to Kaufman, Medtronic worked closely with the FDA to ensure that approval for the study was reached as quickly as possible. “FDA review of the ASPIRE IDE application was conducted through an interactive review process that involved frequent communication with the FDA review team, allowing issues to be resolved quickly and avoiding any unnecessary delays during the review.  We appreciate the valuable input provided by members of the FDA’s Artificial Pancreas Working Group,” said Kaufman.

The ASPIRE study is now in its second phase, with the first phase—an in-patient clinical study—now complete. ASPIRE is a randomized, pivotal in-home study spanning several investigational facilities. The study is intended to test the MiniMed Paradigm insulin pump developed by Medtronic, specifically the efficacy and safety of the equipment, which uses sensors to monitor blood glucose and deliver insulin when necessary. Medtronic has developed a blood glucose sensor called Enlite which will also be tested in the ASPIRE study.

Researchers will study data on hypoglycemic events from two groups of individuals: one with the Low Glucose Suspend feature switched on and the other with the feature switched off. The data will be provided by patients using the system at home to ensure that the results are accurate where the system will ultimately be used. The research team plans to demonstrate that the use of the Low Glucose Suspend feature is safe and will not result in glycemic deterioration; HbA1c levels will be used to determine the efficacy of the system. Additionally, the researchers intend to demonstrate that using the Low Glucose Suspend feature in-home will decrease nocturnal hypoglycemia when patients cannot respond to their own low blood sugar.

Findings from a new study suggest that people who have previously suffered from kidney stones could have a higher risk of developing Type 2 diabetes later in life. Previous research has shown that kidney stones appear to be more common in individuals who have diabetes, but scientists have been unsure as to whether the reverse is true as well.

The new study was conducted at Taipei Medical University in Taiwan. Dr. Herng-Ching Lin and his colleagues analyzed medical records from over 94,000 Taiwanese adults and found that individuals with a history of kidney stones demonstrated a 30 percent increase in their chance of being diagnosed with diabetes over five years than were individuals who did not have kidney stones.

The medical records showed that out of 23,000 adults who had received treatment for kidney stones, 12.4 percent later developed Type 2 diabetes. Of the 70,700 adults who did not have kidney stones, only 9.6 percent developed diabetes.

According to the researchers, some of the overlap between kidney stones and diabetes could be caused by common risk factors between the two conditions. Older age and obesity are commonly listed among the risk factors for both.

However, the researchers accounted for age, obesity, and other health risks when investigating the relationship between kidney stones and diabetes, and they still found that individuals with kidney stones had a one-third higher risk of developing diabetes.

The researchers stated that they were uncertain about the mechanism that causes the relationship. They hypothesized, however, that both kidney stones and diabetes could be caused by some of the same processes.

Kidney stones are formed due to the presence of excessive amounts of crystal-forming substances, such as uric acid, calcium, and oxalate. The minerals cannot be diluted by the available fluid and form small stones which typically do not cause long-term damage but can be very painful when they pass through the urine.

According ot Lin’s research team, there is evidence suggesting that insulin, the hormone responsible for regulating blood glucose levels, could be associated to the formation of kidney stones in some way. Previous research in both animals and humans has suggested that elevated insulin levels can alter the chemical composition of urine, making the formation of kidney stones more likely. Since Type 2 diabetes is associated with high insulin levels due to the body’s inability to use it correctly, the two conditions could be related through the actions of insulin.

Lin’s team noted that their own study had limitations, namely the fact that they used existing medical records—which can be inaccurate—to arrive at their findings. The researchers also did not have access to information about the diet, exercise habits, and family history of the conditions due to the lack of that information in the medical records. Such data could have helped the researchers determine the source of the association between kidney stones and diabetes.

According to the research team, it’s still possible that the formation of kidney stones could be a warning sign that the individual could have an increased risk of developing diabetes. Those who find themselves diagnosed with kidney stones may also benefit from making lifestyle changes that reduce the chances of developing diabetes, including eating a healthy diet and getting more exercise.

Previous research has showed that people with diabetes and insulin resistance have highly-acidic urine, which is a risk factor for developing kidney stones, and especially uric acid kidney stones.

A new study suggests that doctors may be able to help diagnose diabetes and related warning signs through the use of a “muffin test.” The test would be a type of oral glucose tolerance test designed to identify diabetes and impaired glucose tolerance by analyzing the body’s ability to utilize glucose properly.

Oral glucose tolerance tests commonly require an individual to fast for one night and drink a high-sugar beverage the following day. Doctors monitor the individual’s physiological responses to the high dose of sugar, especially how long blood glucose levels remain elevated.

The study suggested that muffins might be a better food for conducting oral glucose tolerance tests—the test would be more tolerable for patients and it might even give doctors a more accurate idea of the individual’s response to food intake.

According to Dr. Michael Traub with Albert Einstein College of Medicine in New York, current glucose tolerance tests are unpleasant, especially for women. Dr. Traub, who worked on the study, suggested that consuming a muffin would be more pleasant than the glucose solution for most people, noting that many people feel ill following the test.

Dr. Traub commented that a muffin test might also provide more accurate results since it more closely matches what people actually eat.

According to the findings of the study, doctors were able to use muffins in oral glucose tolerance tests to predict impaired glucose tolerance; muffins were also cheaper than standard glucose drinks. Another researcher who did not take part in the study, however, noted that muffin tests may not be as effective as the study indicated and that it may not make the tests more convenient after all.

According to Dr. William Herman, director at the Michigan Diabetes Research and Training Center in Ann Arbor, results from muffin tests may be difficult to measure because no two muffins are exactly the same in nutritional content, especially in different areas of the world. A glucose drink, on the other hand, contains an exact amount of sugar and allows for more accurate measurements.

“Getting a standardized muffin across the United States and across the world I think would be challenging,” said Dr. Herman. Glucose drinks are “probably more convenient. Glucose solutions have a longer shelf-life. We know exactly what’s in them,” he continued.

The muffin study was conducted on 73 middle-aged women in their 40s and 50s. The women fasted for a night and were given muffins from a local bakery the next day. The researchers measured blood glucose levels two hours after the muffins were given. Another 12 women were given standard oral glucose tolerance tests with glucose drinks.

Eight of the group of 72 women demonstrated impaired glucose tolerance. The researchers reported that a standard glucose drink test would have missed more than half the cases of impaired glucose tolerance. The glucose drink test identified one woman as having impaired glucose tolerance; the muffin test identified another individual who the glucose drink test had missed.

A muffin is much cheaper than a glucose beverage test, according to Dr. Traub, at one dollar versus five dollars. None of the women appeared to have stomach problems from the muffins either, unlike the glucose drinks.

Answering Dr. Herman’s criticisms, Dr. Traub’s team commented that even though muffins might vary from area to area, the test should still provide consistent results. Still, they noted that additional research would be required to determine that the test is reliable.

Two former graduate students at MIT’s George R. Harrison Spectroscopy Laboratory have developed new spectrograph technology that could allow diabetics to monitor their blood glucose levels without pricking their fingers to draw blood for testing. Kong and Barman significantly reduced the size of the spectrograph, allowing the technology to be used in much more convenient spaces.

The spectrograph equipment would have previously required too much space to be practical for every day use. Kong and Barman reduced the size of a significant component of the spectrograph and brought the prototype equipment down to about the size of a shopping cart. Tests can be conducted quickly, taking only about a minute.

The Raman spectrograph developed by Kong and Barman tests blood glucose levels by aiming a low-powered laser through the thin area of skin between the thumb and forefinger of the patient being tested. The test has previously been conducted with the use of a compound parabolic concentrator (CPC). The test requires a high degree of collimation, however, which necessitated the use of a very large CPC.

Kong and Barman reduced the size of the equipment by using a smaller mirror—a compound hyperbolic concentrator (CHC)—which focuses the light into a narrow beam through the use of a lens.

“The new design is from five to 20 times smaller than if we used a CPC to achieve the same performance,” said Kong.

Ramachandra Dasari, associate director at the MIT lab, stated that the new smaller Raman spectrographs could have uses beyond simply testing blood glucose levels. They could also identify diseases through the presence of other chemical markers in the bloodstream and to study biopsies to determine if they contain cancerous cells.

“Our next step is to miniaturize this and make it portable,” stated Dasari. The team expects that a portable prototype of the spectrograph equipment will be built within the next couple of years.

The use of spectroscopy technology to diagnose diseases was first envisioned by Michael Feld, a professor of physics at MIT and former director of the Spectroscopy Laboratory. The Raman spectroscopy technique studies the frequency of vibrations that hold molecules together to identify chemical compounds that indicate certain diseases or conditions. The technology has been in development for about 15 years and may someday remove the need to prick fingers to obtain samples for blood glucose testing.

Kong and Barman have worked together in the past: they previously developed a new calibration method for the Raman spectrograph called Dynamic Concentration Correction, which corrects the inaccurate results that can occur in a blood glucose test due to the presence of glucose in the interstitial fluid, or the fluid that surrounds skin cells. The project had been facing difficulties because the spectrograph technology only seemed to penetrate about a half a millimeter under the skin, meaning that the glucose content of the interstitial fluid instead of the blood was being measured. Kong and Barman tested the technology in 10 volunteers, using the newly-calibrated Raman spectrograph to significantly improve the accuracy of blood sugar readings by an average of 15 percent and up to 30 percent in some of the participants.

Regular blood glucose testing is an unavoidable part of life for most diabetics. Elevated blood sugar levels over long periods of time can damage organs and cause other complications while low blood sugar levels can cause fatigue and fainting.

Researchers located in the United Kingdom say that levels of a hormone called B-type natriuretic peptide could have a role in reducing risk of Type 2 diabetes. The study was published online in the journal “PLoS Medicine.”

According to the research team, B-type natriuretic peptide, also called BNP, provides a variety of functions in the cardiovascular system: it mediates vasodilation, antifibrotic effects, and natriuresis. The researchers wrote that the hormone also has lipolytic activity and cross-sectional studies have indicated that BNP levels, or levels of the inactive fragment of its pro-hormone, N-terminal fragment of pro-BNP (NT-proBNP), are decreased in individuals who are obese or have Type 2 diabetes or insulin resistance.

The researchers conducted a prospective case-cohort study, using data from three case-control studies that involved patients who had been diagnosed with Type 2 diabetes. They used this data to determine if a connection existed between Type 2 diabetes and NT-proBNP in the bloodstream. The research team also genotyped the variant rs198389 within the BNP locus and used those results in a meta-analysis that used data from 11 case-control studies in all.

The multivariable analysis from the case-cohort study suggested that higher levels of NT-proBNP were correlated with decreased risk of Type 2 diabetes. For every increase of one standard deviation in blood levels of NT-proBNP, patients demonstrated a 21 percent reduction in risk of developing type 2 diabetes. The researchers adjusted for confounding factors, including age, sex, body-mass index, use of tobacco, hereditary history of Type 2 diabetes, hypertension, systolic blood pressure, and cholesterol levels (HDL, LDL and triglyceride).

The researchers stated that their estimates regarding the correlation between Type 2 diabetes and rs198389 were accurate.

“The association between rs198389 and type 2 diabetes observed in case-control studies (OR=0.94 per C allele; 95% CI, 0.91-0.97) was similar to that expected (OR=0.96; 95% CI, 0.93-0.98) based on the pooled estimate for the log-NT-proBNP level to type 2 diabetes association derived from a meta-analysis of our study and published data (HR=0.82 per SD; 95% CI, 0.74-0.9) and the difference in NT-proBNP levels (HR=0.22 per SD; 95% CI, 0.15-0.29) per C allele of rs198389,” wrote the team.

Additionally, there appeared to be no association between the rs198389 genotype and factors that may have confounded results, such as age, sex, and BMI. The researchers wrote that the findings demonstrate there may be a causal relationship between BNP and Type 2 diabetes, and the issue warrants further research. If a link is proven, it may open the door for therapeutics involving the manipulation of BNP activity to reduce risk of Type 2 diabetes. However, additional research will be needed before a definite causal link is established.

“The evidence for a potential causal link between the BNP hormone system and type 2 diabetes also promotes BNP as a potentially interesting target of preventive interventions. Influencing BNP activity by pharmaceutical interventions has been proven to be feasible in the context of CV medicine,” they wrote.

BNP is secreted by the ventricles of the heart as a response mechanism to excessive stretching of cardiomyocytes—the cells that make up heart muscle tissue. Secretion of BNP is related to several physiological processes, including the reduction of central venous pressure and systemic vascular resistance. Secretion of BNP also promotes natriuresis, the process by which the kidneys excrete sodium through urine. Natriuresis reduces the sodium content of the blood by expelling it through urine.

The American Diabetes Association recently released a position statement which stated that, in helping young people transition into more responsible roles for managing their own diabetes, parents should gradually transfer the responsibilities associated with the disease to their children.

However, the ADA also noted in its “Diabetes Care for Emerging Adults” position statement that most of the work in preparing young individuals for proper diabetes care in adulthood falls to health care professionals. Doctors should begin preparing young people with diabetes and their families for the transfer to an adult clinician at least a year before the switch occurs.

The ADA’s statement arrived through the ADA Transitions Working Group, a multidisciplinary group involving representatives from the American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, and the American Academy of Pediatrics. The panel of representatives reviewed issues that occur as a result of the transition from pediatric diabetes care to adult diabetes care, which affect both the patients and their health care professionals. The statement focused on individuals age 18-30 years old—an age group that the statement described as “emerging adults”—and covered both Type 1 and Type 2 diabetes. The statement was authored by Dr. Anne Peters of the University of Southern California in Los Angeles and Dr. Lori Laffel with Joslin Diabetes Center and Harvard University in Boston.

According to the statement, the transition from pediatric to adult care is a tumultuous one for diabetics; it’s described as a “high risk period” and “a perfect storm during which interruption of care is likely for multiple reasons.”

“This is a critical time when patients not only assume responsibility for their diabetes self-care and interactions with the health care system but when they become more independent,” wrote the authors. Individuals may be moving away from their parents’ homes at the time of the transition and the lack of supervision and increased independence puts them at risk for mismanaging their diabetes. The statement noted that tens of thousands of individuals in the United Sates are currently estimated to be moving from pediatric to adult diabetes care every year.

Other factors that may contribute to difficulties in managing diabetes include the loss of health insurance or inadequate coverage. There may also be a lack of professionals who are specifically trained to meet the needs of the age group. According to the statement, additional research and improved training would help health care professionals meet the medical and psychological needs of those transitioning.

The statement identified eight factors relevant to diabetes treatment that this age group faces, including poor glycemic control; higher risk of acute complications; use of alcohol, tobacco, and drugs; and the differences between adult and pediatric diabetes care. The authors noted that these factors, along with other factors that can cause gaps in diabetes treatment, can lead to increased risk of diabetes-related complications in both the short term (hypoglycemia) and long term (retinopathy and nephropathy). Young adults with diabetes also face a higher relative risk of death than those without diabetes.

The authors recommended that health care professionals providing pediatric diabetes care should offer information about medications, diabetes-related comorbidities, and the patient’s self-assessing abilities to the physicians who will be providing adult care for their patients. The preparations for the patient should be individualized and developmentally-appropriate, requiring the patient to take on responsibilities in glucose monitoring and appointment scheduling.

The statement concluded that, throughout the next decade, they expect the growth of “evidence-based strategies that support best practice for the growing numbers of young adults with type 1 and type 2 diabetes who will be making this important transition.”

A recent investigation found that U.S. adults who have been diagnosed with diabetes are about two times more likely to contract hepatitis B infections. The findings prompted a recommendation to the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices that individuals with diabetes should be vaccinated for hepatitis B.

According to Meredith L. Reilly, an epidemiologist with the CDC, inadequately cleaned blood glucose monitors are one of the major causes of hepatitis B infection among diabetics. Reilly presented the findings at a poster at the CDC Advisory Committee meeting.

Dr. Trudy V. Murphy is head of the vaccine unit of the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta. Dr. Murphy made the suggestion of vaccination to the CDC, stating that “over the past several years, we’ve observed outbreaks of hepatitis B among patients with diabetes in places where they undergo assisted blood glucose monitoring, with more than one person using the monitor.” Out of 28 outbreaks of hepatitis B at long-term care facilities, 24 were traced back to equipment and practices involved in different aspects of blood glucose monitoring.

Dr. Murphy’s recommendations to the CDC Advisory Committee include hepatitis B vaccinations for patients with both Type 1 and Type 2 diabetes. The CDC will place more emphasis on transmission prevention methods such as avoiding needle or lancet sharing and more thorough cleaning of equipment. Dr. Murphy stated that vaccinations will work in concert with other methods as an “additional measure to ensure protection.”

Individuals with diabetes must take extra care to avoid exposure to blood since other blood-borne pathogens can threaten their health. Hepatitis B, in particular, poses a threat to diabetics since it is highly infectious in residual blood and can remain infectious on a surface for seven days. According to Dr. Murphy, a drop of blood small enough to be invisible could still contain enough hepatitis B virus to infect an individual who has diabetes. Additionally, the design of blood glucose monitors makes them difficult to clean thoroughly, and an especially thorough cleaning can damage the equipment.

After conducting investigations into the hepatitis B outbreaks, the CDC reviewed the cases of the disease reported in 2009 and 2010 at sites involved in the CDC’s Emerging Infections Program. The CDC reviewed data from 865 people who had contracted hepatitis B; 95 of those individuals also had diabetes. An analysis showed that individuals age 23-59 with diabetes were 2.1 times more likely to be infected with hepatitis B compared to those without diabetes. The analysis also adjusted for gender, age, ethnicity, and other risk factors for the disease. Individuals age 22 or younger with diabetes were 1.9 times more likely to contract hepatitis B, a statistically significant number, while those 60 or older were 50 percent more likely—which was not statistically significant, according to Ms. Reilly.

The hepatitis B (HBV) virus causes an inflammation of the liver and is spread through contact with body fluids of another individual who has a hepatitis B infection. The disease is commonly spread through needles such as those used for taking blood work or testing blood sugar, which makes it common among individuals with diabetes and health care professionals who perform such tests.

Both Dr. Murphy and Meredith L. Reilly had no disclosures.

New research suggests that drinking less than a couple of glasses of water every day increases an individual’s risk of having elevated blood sugar levels in an unhealthy range.

The study found that adults who drank half a liter of water per day (about two glasses) were more likely to demonstrate blood sugar levels in the pre-diabetes range than those who drank more water. Pre-diabetes is a condition in which blood sugar levels are elevated but not high enough to be characterized as being related to diabetes.

The study does not prove, however, that drinking water directly lowers the risk of developing diabetes. According to Lise Bankir of the French research organization INSERM, the findings demonstrated a correlation between water intake and blood glucose levels but did not show a cause and effect relationship between the two. Bankir did comment that a causal relationship is possible.

“There are good arguments to suggest that there could be a real cause-and-effect relationship in the association we have found,” she said. “But this is not a proof.”

The research team stated that vasopressin, sometimes called diuretic hormone, is the link that may tie reduced water consumption to increased blood sugar levels. The hormone regulates water retention levels, causing the kidneys to retain water when we’re dehydrated. The research suggests that elevated vasopressin levels could also result in elevated blood glucose levels.

According to Bankir, vasopressin receptors can be found in the liver, which produces sugar. The study demonstrated that vasopressin injections in healthy individuals caused blood sugar levels to spike temporarily.

Researchers studied 3,615 French adults, age 30 to 65, who had normal blood sugar levels at baseline—the beginning of the study. Around 19 percent of the study participants stated that they drank less than half a liter a day; the rest of the participants drank a liter or more.

Researchers followed up with the participants for nine years, finding that 565 of the participants developed elevated blood glucose levels while 202 developed Type 2 diabetes. The research team found that the individuals who drank at least a half a liter of water per day were 28 percent less likely to develop elevated blood glucose levels than those who drank less than a half a liter of water every day.

Still, the findings did not demonstrate a definite statistical link between consumption of water and the risk of developing diabetes. Bankir stated that the sample size was “too small to get a significant results” and a larger cohort would be required before a causal relationship could be proven.

Individuals who drink less water are more likely to drink high-sugar drinks such as soda and juice in replacement. Such beverages are often the culprit for high blood glucose levels. However, Bankir’s team adjusted for several factors that could influence results, including the consumption of sugary drinks, exercise levels, and body weight. Even after the adjustments, individuals who drank less water still had higher blood sugar.

One explanation is that individuals who drink more water are more likely to engage in other healthy habits. “Healthier behaviors correlating with higher water drinking could account for the observed association,” said the research team.

Even though the study was unable to prove a direct relationship between drinking more water and lowering one’s blood sugar, Bankir suggested that increasing water intake is always a good idea. “In Western countries, the consumption of sugar is surely too high and contributes to obesity,” she said. “Drinking less of them and more pure water can only be good in my view.”