Diabetic Live

An ancillary study to the Look AHEAD trial found that intensive lifestyle interventions designed to promote weight loss in obese individuals with Type 2 diabetes also helped reduce obstructive sleep apnea in the same patients.

Over the course of the four year study, patients who underwent intensive interventions demonstrated an approximately four point reduction in apnea-hypopnea index. Meanwhile, the control group saw a four-point increase in the same metric, according to Gary Foster Ph.D., with Temple University in Philadelphia. Dr. Foster reported the findings of the study at a meeting of the Obesity Society.

Patients with the more severe obstructive sleep apnea at the beginning of the study also saw the greatest benefit and reported the largest gains. However, Dr. Foster commented that intensive interventions would not be a replacement for other sleep apnea therapy: the patients in the study had a mean apnea-hypopnea index of 20, which means that a four-point reduction would not be enough to eliminate symptoms without the help of other treatments.

“I don’t want to give you the impression that this is an alternative treatment to [continuous positive airway pressure treatment],” said Dr. Foster. “It’s probably a complementary treatment.”

The study, called Sleep AHEAD, was an ancillary of the Look AHEAD trial, which studies the benefits and effectiveness of intensive lifestyle interventions for obese individuals with Type 2 diabetes. The interventions are designed to promote weight loss in those individuals through education and diabetes support.

The Sleep AHEAD study aimed to determine whether the patients’ weight loss would also reduce the severity of sleep-related breathing disorders such as obstructive sleep apnea. It had been previously demonstrated in smaller studies that weight loss did have a positive effect on sleep apnea.

The study participants were given a questionnaire which aided researchers in identifying the severity of each individual’s sleep apnea. Patients who were already receiving treatment for sleep apnea or who had received surgery to treat the condition were not included in the pool of participants; researchers wanted to study patients who were not receiving current treatment for sleep apnea.

In all, 305 patients participated in the study, undergoing polysomnograms at their homes to measure symptoms of sleep apnea. Researchers rated participants on the severity of sleep apnea. Those with an apnea-hypopnea index of 5 or less were classified as free of sleep apnea; a score of 5 to 15 was diagnosed as mild; a score of 15 to 30 was moderate, and a score of 30 or more was severe.

Mean score among the participants was 20.5, with 13.4 percent of patients classified as not having sleep apnea. Participants with mild sleep apnea made up 33.5 percent of the study group while moderate patients made up 30.5 percent and severe patients made up 22.6 percent.

A year into the intensive intervention, patients had lost an average of 24 pounds while patients in a control group did not demonstrate any weight loss. Additionally, patients undergoing lifestyle interventions saw a reduction in apnea-hypopnea index of about six points while control patients had an increase of four points.

Four years into the study, intervention patients were more likely to have seen an improvement in their sleep apnea severity classifications (40 percent versus 15 percent) and were also more likely to experience a remission of symptoms (20 percent versus 3 percent).

Though weight loss seemed to be associated with reduction in sleep apnea, Dr. Foster commented that a healthier lifestyle in general could be more responsible for the positive changes.

“The likely hero, I think, is fitness,” said Dr. Foster, citing that previous research has shown that increased fitness levels even in the absence of weight loss can lead to improved sleep apnea.

New research has demonstrated that a type of sugar extracted from buckwheat, called D-fagomine, could help diabetics keep their blood glucose levels well-managed and may offer prebiotic activity in small doses.

A group of Spanish researchers reported in the journal “British Journal of Nutrition” that ingestion of the sugar along with sucrose or starch resulted in a less-severe blood sugar spike and did not stimulate the secretion of insulin. Data from animal studies also showed that ingestion of the D-fagomine sugar was associated with a reduction in levels of potentially harmful bacteria in the gut and a promotion of beneficial bacteria called Lactobacili.

“Based on all this evidence, d-fagomine may be used as a dietary ingredient or functional food component to reduce the health risks associated with an excessive intake of fast-digestible carbohydrates, or an excess of potentially pathogenic bacteria,” wrote the study’s authors.

The D-fagomine sugar is currently under development by Bioglane, a Barcelona-based biopharmaceutical company associated with the Spanish Research Council (CSIC). Bioglane funded the study into the properties of d-fagomine. Bioglance has previously reported that is has developed enzymatic processes that can be used to produce natural iminosugars on a large scale suitable for commercial use. It has focused on developing D-fagomine up to this point and has scaled up its production of the sugar under the name FDA-GMP. Bioglane was formed in 2007 and is also associated with the Genoma Espana Foundation and Caja Navarra. The company is devoted to finding new iminosugars that would allow humans to eat carbohydrate-rich diets without the negative effects sometimes associated with them.

D-fagomine is an iminosugar that occurs naturally in buckwheat grain and traditional buckwheat-based foods, according to Bioglane. The compound was first isolated in 1974 and is usually considered to be a glucose analog.

In the new study, lab rats were fed a combination of D-fagomine along with either starch or sucrose. The results of the experiments showed that the rats taking D-fagomine demonstrated lower levels of blood glucose, depending on the size of the dose. When they were given a dose of 1 to 2 milligrams per kilogram of body weight along with one gram of sucrose, they showed a 20 percent reduction in blood glucose levels after the meal. The maximum blood glucose level took longer to occur as well. According to the researchers, insulin levels also decreased along with the decrease in blood glucose.

The researchers also noted in their report that D-fagomine had significant prebiotic effects, preventing certain harmful bacteria from adhering to mucus membranes in the gut of test animals while having a positive effect on good bacteria.

“We also disclose here an activity of D-fagomine that had never been suggested before: the modulation of bacterial adhesion. We observed that D-fagomine selectively agglutinated potentially deleterious Enterobacteriaceae and prevented their adhesion to pig intestinal mucosa,” they reported. “The adhesion of Lactobacillus spp. was promoted by D-fagomine while that of Bifidobacterium spp. was not affected.”

However, they reported that additional research would be necessary to determine if D-fagomine could provide prebiotic health benefits from long-term use: “As the intestinal microbiota clearly influences the physiological status of the gut and even the health of the whole organism, further studies will determine whether this activity of D-fagomine results in long-term effects related to the reduction of health risk factors,” they said.

The research team was affiliated with Bioglane, Institut de Quimica Avancada de Catalunya, CSIC, Barcelona Science Park, the Universitat de Barcelona, and the Universitat Autonoma de Barcelona.

A team of scientists reported on October 5 that they had successfully utilized cloning technology to create embryonic stem cells that contained genetic information from specific individuals. The success of the project could mark an important step in the development of stem cell cloning techniques, which could be used to treat diseases since they are not rejected by the patient’s body.

The cells produced in the experiment were genetically abnormal and would not be suitable for use in humans, say the researchers. But the discovery could still pave the way for future cloning techniques that could heal a variety of terminal illnesses.

The use of embryonic stem cells is controversial throughout several fields, including ethics, morality, and politics. Scientists paid women to donate eggs, which were used in the research. The study created concern about the exploitation of women for research and the health risk involved in donating eggs. The researchers used the eggs to produce and destroy embryos, from which the stem cells were extracted. The research caused controversy because scientists grew mutant human embryos specifically for use in the extraction of stem cells.

“They have created human embryos. They are abnormal, but they are still human embryos,” says Daniel P. Sulmasy, professor of medicine and ethics at the University of Chicago. “Anyone who is opposed to the deliberate creation and destruction of human embryos, as I am, would be opposed to this research.”

However, other scientists, bioethicists, and advocates of embryonic stem cell research praised the scientists for their meticulous attention to detail and for the advances in the fields of medicine that the research could bring.

“I think it will teach us a lot of how to control the generation of all the different cell types that we would like to study and use for therapy,” says Lawrence Goldstein, director of the stem cell research program at the University of California at San Diego. “I think it’s a really exciting development,” Goldstein continued.

Those who support embryonic stem cell research feel that it is one of the most promising fields of biomedical research. Embryonic stem cells are thought to have the ability to become any type of cell, tissue, or organ in the body. Such cells could be used to regrow defective organs such as kidneys, hearts, and livers, and new research could result in a cure for several serious diseases such as diabetes, paralysis, and Alzheimer’s disease. However, stem cell research is not without its opponents: scientists must grow and eventually destroy embryos to extract the stem cells, and some opponents believe that destroying an embryo is equivalent to ending a life.

Stem cells were first isolated in 1998 and researchers have been working ever since to create new stem cells that could be used to generate new tissue such as organs or even limbs. Since stem cells would contain the DNA of the individual who is receiving the treatment, the patient’s body would not reject the new tissue.

“Therapeutic cloning,” as it is sometimes called, is the process that was used to clone the sheep Dolly in 1996. The process implants genes from an adult individual into an egg that has been stripped of its own genetic material. Scientists then use other genetic processes to stimulate the egg to grow into an embryo with the new genetic information, which allows scientists to extract the embryonic stem cells.

A team of United States-based scientists are hopeful that new research on a natural chemical found in body cells could set the stage for the development of a vitamin-like pill that could prevent diabetes or perhaps even reverse the disease completely.

The chemical is called nicotinamide mononucleotide (also known as NMN) and it serves an important purpose in the way body cells utilize energy. The U.S.-based researchers tested the compound by injecting diabetic mice with it. After the injections, the mice showed normalized blood glucose levels in addition to lowered triglyceride blood fat and cholesterol levels.

The next step for the research team is to develop a method of administering the NMN compound to mice directly through their drinking water instead of through injections. In the future, the team’s long-term goal is to develop a “nutriceutical” pill, similar to a normal daily vitamin, that can be taken to reverse or prevent Type 2 diabetes.

“Once we can get a grade of NMN that humans can take, we would really like to launch a pilot human study,” said Dr. Shin-ichiro Imai, M.D., Ph.D., from the Washington University School of Medicine in St. Louis; Dr. Imai also headed the study. Since mice share a similar genetic code with humans, medications meant for human use are often tested on mice first. However, even when a medication appears safe when used on mice, it must be extensively tested on humans as well before being approved for prescription and sale. According to Dr. Imai, the effect of NMN was “remarkable,” and it was more pronounced in female mice: “After giving NMN, glucose tolerance goes completely back to normal in female diabetic mice,” said Dr. Imai.

The researchers triggered the onset of Type 2 diabetes in the mice by feeding a high-fat diet to young, otherwise healthy mice. All of the mice displayed decreased levels of a molecule called NAD, which is responsible for extracting energy from nutrients in food and turning it into a form that cells can use to operate. In mice as well as humans, NAD is derived from NMN and is created by cells through a series of metabolic reactions.

One important effect of NAD is the activation of SIRT1, a protein that has been the subject of much study and which has been demonstrated to encourage well-functioning metabolism throughout the body and to increase insulin sensitivity. SIRT1 — or NAD-dependent deacetylase sirtuin-1 — is encoded by a gene also called SIRT1. Since NAD is toxic when administered directly to organisms such as mice and humans, researchers injected mice with NMN instead, which leads to an increase in NAD levels. After they were treated with the compound, the mice displayed significantly improved glucose response. NMN is produced naturally by the body but its levels decrease as the individual ages. High-fat diets also discourage the production of NMN.

According to Dr. Imai, NMN exhibits very similar behavior in mice and humans. However, the further testing will be required before it can be determined whether a lack of the compound is equally responsible for Type 2 diabetes in humans. “Whether this mechanism is equally compromised in human patients with Type 2 diabetes is something we have to check,” said Dr. Imai. “We have plans to do this in the very near future.”

A study published in the October issue of the journal “Diabetes Care” has demonstrated that, in patients with Type 1 diabetes who receive intensive insulin therapy through the use of a pump, a new algorithm based on the food insulin index is more effective at improving acute postprandial glycemia — or blood sugar levels after a meal — than a carbohydrate counting plan.

The study was headed by Jiansong Bao of the University of Sydney in Australia. Bao’s research team compared the effectiveness of a new food insulin index (FII) algorithm, which is used to estimate the dose of insulin that should be given at mealtimes, with counting carbs. The study consisted of 28 adult participants who had been diagnosed with Type 1 diabetes and were users of insulin pumps.

Study participants randomly ate two breakfast meals over the course of three consecutive days. The two separate meals were similar in factors such as total energy, fiber, glycemic index, and calculated insulin demand, but one meal had approximately twice the carbohydrate content of the other meal. For the meal with higher carbohydrate content, the proper insulin dose for the participants was determined by counting the amount of carbohydrates in the meal — 75g. On the other two mornings, participants received the less carb-heavy meal (41g carbohydrate) and used the new FII algorithm to determine proper insulin dosage. Researchers used continuous glucose monitors to determine postprandial blood sugar levels in the participants for the three hours following the meals.

Upon analyzing the results, the researchers discovered that the new FII algorithm had a significant effect in decreasing peak glucose excursion and glucose incremental area under the curve for the three hours after a meal. Participants spent significantly more time after a meal in normal blood glucose ranges when using the FII algorithm, although hypoglycemia was not significantly different between the two groups.

“An insulin algorithm based on physiological insulin demand evoked by foods in healthy subjects may be a useful tool for estimating mealtime insulin dose in patients with type 1 diabetes,” wrote the authors of the study.

Carbohydrate counting is a popular method of ensuring that insulin levels remain under control in both Type 1 and Type 2 diabetics, who must plan their meals to avoid excessive intake of carbohydrate in a single meal. Foods containing carbohydrates increase blood glucose levels, which can prove dangerous for diabetics. By planning their meals carefully and setting a maximum amount of carbohydrate in a single meal, diabetics can ensure that their blood sugar levels will remain well-managed. Most diabetics are advised to start at about 45-50 grams of carbohydrate per meal, though the number varies according to the plan of treatment and the severity of the disease. Doctors can help diabetics establish guidelines for the amount of carbohydrate they should be consuming at every meal.

Not only are diabetics advised to count carbohydrates to better manage blood glucose levels, but they can also use food nutrition labels to determine the total number of calories in the food and to avoid undesirable ingredients such as trans fats and saturated fats. Such fats are especially harmful to patients with heart disease or who are at risk for heart disease; doctors also advise against the consumption of excessive sodium, especially in those who are already hypertensive.

A recent randomized trial showed that increasing the intensity of weight loss interventions only in patients who do not succeed in reaching their goals may be an effective alternative to typical approaches.

According to John Jakicic, Ph.D., with the University of Pittsburgh, the findings did not demonstrate a significant difference in the number of patients who achieved a 10 percent reduction in weight after 18 months between a group that received stepped care and a group that received normal treatment (26 percent versus 32 percent). The two groups also reported similar average weight loss — 5.8 percent loss for the stepped care group versus 6.8% for the normal care group. “So the stepped-care approach may present an effective alternative to standard behavioral weight loss interventions,” said Jakicic.

Jakicic continued to note that 30 to 40 percent of the patients who received stepped care stayed at the first two steps, involving monthly group meetings, lessons mailed to the patients weekly, feedback from doctors on a weight loss diary that the patients completed, and one phone call every month.

Behavioral interventions that promote lifestyle changes have been previously shown to be effective in helping patients lose weight. However, the intensity of the intervention generally remains the same whether or not the patients are responding to the treatment.

Stepped approaches use feedback from the patient’s success with the program to determine its intensity. When a patient does not respond to the intervention, the intensity of the approach is increased. These types of intervention had not been previously compared to standard behavioral interventions for weight loss through the use of a randomized trial.

Jakicic and his team designed the Step Up study, an investigation of 364 overweight and obese men and women that randomly assigned stepped care or standard intervention to each participant. The participants’ mean age was 42.2 and mean body mass index was 33kg/m2. A significant majority of the participants were female (82.7 percent).

Both the standard and stepped care groups were given dietary goals intended to reduce total calorie intake as well as fat intake. Participants were also given targets for engaging in physical activity, increasing in duration to 300 minutes of moderate-to-vigorous exercise each week.

The stepped care group also attended a group session every month throughout the duration of the study and received weekly mailed lessons. They also kept diaries on their progress and received feedback from doctors on those diaries. Participants who failed to achieve their goals — 5 percent of the participants at three months, 7 percent at six months, and 10 percent at nine months — were contacted more frequently by researchers and saw the intensity of their interventions increased. The more high-intensity measures included two phone calls per month instead of one, two individual sessions per month to discuss weight loss, and meal replacements provided to the participants.

Participants in both the standard and stepped care groups lost weight. However, absolute weight loss was significantly higher in the standard care group for the first six months (22 pounds versus 17.6 pounds). For each follow-up beginning at six months from baseline, however, participants did not exhibit a significant difference in weight loss between the two groups.

According to Jakicic, more research is needed to determine the effectiveness of stepped care interventions. Factors that need to be addressed include: the effectiveness of each of the steps as compared to other steps; who responded to the stepped care approach; the possible effect of diet and physical activity; and different approaches that may be more useful in stepped care.

A new study warns that eating food too quickly more than doubles an individual’s chance of developing impaired glucose tolerance, also known as pre-diabetes and the precursor to Type 2 diabetes. It appears that eating quickly is the only mechanical eating practice that can promote the onset of pre-diabetes; people who engaged in snacking and eating late at night were not an increased risk of developing the disease. The study appeared in the journal “Diabetes Research and Clinical Practice” and was conducted at the Institute of Clinical Medicine at the University of Tsukuba.

The Japanese study found that eating food quickly was the only eating pattern that caused a significant increase in risk of developing pre-diabetes. The results were adjusted for factors that may have skewed the results, including age, sex, weight, smoking, alcohol, blood pressure, cholesterol, and whether the individual had a family history of diabetes.

The investigation followed 172 Japanese men and women who were diagnosed as healthy at the beginning of the study for three years. They were asked to self-report various aspects of their eating habits, such as whether they were fast eaters, ate late at night, snacked frequently, skipped meals, or ate out frequently. Throughout the three-year period of the study, 39 participants developed impaired glucose tolerance and two of those went on to develop Type 2 diabetes.

Scientists aren’t sure exactly why eating faster makes an individual more likely to develop pre-diabetes and Type 2 diabetes, but one hypothesis states that eating rapidly results in higher postprandial blood glucose levels — the level of sugar in the blood after a meal. Some doctors also speculate that eating too quickly results in an overall increase in the amount of calories eaten since it takes about 20 minutes for the brain to receive the signal that the stomach is full; thus, those who eat quickly will consume more calories before realizing that they’re finished eating.

Previous research has also confirmed that eating quickly results in increased weight gain, which is associated with pre-diabetes and Type 2 diabetes. One study presented to the North American Association for the Study of Obesity found that overweight men and women consumed fewer calories overall when they slowed their eating pace. Another study conducted in Japan found that among 1,700 young women, eating slowly resulted in feelings of fullness occurring sooner, which meant that the women consumed fewer calories throughout the meal. Additionally, a recent study conducted in New Zealand found that women who were fast eaters were at an increased risk of obesity.

It is thought that there are 2.8 million people throughout the United Kingdom with undiagnosed Type 2 diabetes. The disease reduces or eliminates the body’s ability to produce insulin, which helps shuttle sugar in the bloodstream into cells to be used as energy. Since a Type 2 diabetic’s body does not produce enough insulin on its own, diabetics require insulin supplements in the form of injections or other delivery methods.

Impaired glucose tolerance (IGT), or pre-diabetes, is a sign that the individual will soon develop diabetes if blood sugar levels are not more tightly controlled. In pre-diabetes, those blood glucose levels are elevated, but not high enough to cause diabetes.

Preventative measures such as a healthy diet and regular exercise can help those with pre-diabetes keep their glucose levels under control so that they do not develop Type 2 diabetes. However, 40 to 50 percent of individuals with pre-diabetes will be diagnosed with Type 2 diabetes within ten years.

A study recently published in the journal “Cancer” has discovered that therapy with the drug tamoxifen — an oral medication used in women with breast cancer — is linked to a significant increase in development of diabetes in older survivors of breast cancer.

The study was headed by Lorraine L. Lipscombe, M.D., with the Women’s College Hospital in Toronto. Dr. Lipscombe’s team studied 14,360 women over the age of 65 who had been diagnosed with early-stage breast cancer and had survived. The women had received treatment for breast cancer with tamoxifen therapy. The study used data collected from 1996 to 2006; the patients who were diagnosed with diabetes through March 31, 2008 were matched with control subjects who had not developed diabetes. The research team adjusted for other risk factors and compared the risk of developing diabetes in participants who received tamoxifen and aromatase inhibitor therapy compared to women who were not treated with those drugs.

According to the study’s findings, 10 percent of the patients received a diagnosis of diabetes over a mean follow-up of 5.2 years. Women who were currently receiving tamoxifen therapy had a significantly higher chance of developing diabetes (1.24 adjusted odds ratio) over women who were not being treated with tamoxifen. Treatment with aromatase inhibitors, on the other hand, was found not to be linked to an increased risk of developing diabetes.

“Current tamoxifen therapy is associated with an increased incidence of diabetes in older breast cancer survivors. These findings suggest that tamoxifen treatment may exacerbate an underlying risk of diabetes in susceptible women,” wrote the authors of the study.

Tamoxifen, marketedd as Nolvadex, Istubal, and Valodex in the U.S., is an orally-administered tablet that disrupts the female body’s production of estrogen, which is known to promote breast cancer in women. Tamoxifen binds to the estrogen receptor proteins, effectively blocking additional binding at the site that would cause cancerous growth. Tamoxifen is approved by the FDA for the treatment of breast cancer and other types of cancer and has been used for over 30 years in the treatment of early-stage breast cancer.

The drug has also been used to reduce the risk of breast cancer in women who are at increased risk of developing the disease. It works by blocking the effects of estrogen on breast cancer cells with estrogen receptor-positive proteins, preventing the growth of the cancerous cells. However, the medication is only useful in treating cancer cells that are specifically estrogen receptor-positive. Doctors must determine whether the tumor will respond to tamoxifen treatment before prescribing the drug.

Tamoxifen therapy is known to be associated with several serious side effects, including stroke, blood clots, uterine cancer, and cataracts. It may also cause symptoms similar to menopause such as hot flashes, irregular menstrual periods, headaches, nausea, and fatigue. Though tamoxifen therapy does cause blood clots or stroke in a small number of women, the chances of developing such complications are similar to those associated with estrogen replacement therapy.

Additional adverse side effects associated with tamoxifen therapy include an increased risk of thromboembolism and fatty liver as well as mental effects such as reduced cognition and degraded memory, though memory loss with tamoxifen therapy is not as severe as with aromatase inhibitor therapy. Tamoxifen has also been associated with reduced libido.

However, not all the side effects of tamoxifen therapy are negative; it is known to improve bone health, especially in women, by inhibiting osteoclasts and preventing osteoporosis.

Doctors and scientists have long known that people with Type 2 diabetes are at an increased risk of developing certain types of cancer. Until recently, the mechanisms behind the link between the two diseases have been unclear to medical professionals.

However, the mystery may finally be solved: researchers with the Harvard Medical School have reported that variations in levels of two different proteins are present in both diabetics and cancer patients. The findings were reported in the journal “Cell.”

The study demonstrated that mice who were engineered to have increased levels of the proteins Lin28a and Lin28b had a lower chance of developing diabetes when they were fed a high-fat diet. In contract, mice who are fed the same diet with those proteins functioning at normal levels are apt to become obese and develop Type 2 diabetes. The two proteins have also been proven to be related to an individual’s risk of developing some types of cancer, underscoring a relationship between cancer and diabetes in the activity of these two proteins.

“This highlights the overlap in the biology of these disorders,” says George Daley, M.D., Ph.D., a researcher who was involved with the study. Daley is also director of Stem Cell Transplantation and head of the Stem Cell Research Program at Children’s Hospital Boston. “It may be the same kinds of metabolic shifts that allow cancer cells to grow are also related to [whole-body] glucose metabolism.” Cancer and diabetes appear to both be caused by certain metabolic processes that may be signified by elevated levels of the two proteins.

“The results were startling,” says Daley. “Previously we had considered these molecules only as regulators of cell growth and cancer. But in these mice we discovered remarkable effects on sugar processing and diabetes.”

Daley commented that these findings have provided scientists with a molecular pathway related to diabetes and cancer that could be used in reducing the risk of those diseases. With new knowledge of the pathway in hand, scientists may be able to develop medications that target the processes and lower the risk of developing diabetes and cancer.

In addition, the findings of the study demonstrate that elevated blood sugar levels associated with diabetes are not the cause of higher rates of cancer, as was once hypothesized. This knowledge allows scientists to focus their research in other directions that may prove more fruitful. Researchers have already conducted many investigations on the link between high blood sugar levels and complications related to diabetes.

While diabetes is associated with an elevated risk of various types of cancer, it’s likely that the link between diabetes and pancreatic cancer is the most-researched one. Since the two diseases affect the same organ, it can be difficult to understand the causes and effects of one disease independently of the other. Other types of cancer that commonly follow diabetes include colorectal, prostate, endometrial, breast, liver, renal cell, and non-Hodgkin’s lymphoma. Previous research commonly stated that the strongest link between diabetes and cancer was probably elevated insulin levels, which cause Type 2 diabetes and which are believed to also promote growth of tumors.

While further research is required before scientists can fully understand the link between the two diseases, previous research has made it clear that diabetes typically precedes cancer, not the other way around.

A large meta-analysis of genetic data has discovered previously unknown genes related to Type 1 diabetes. The new information supplements existing knowledge about the genetic networks responsible for the complex range of processes that cause the disease. Type 1 diabetes affects 200 million people around the world; those diagnosed with the disease must use insulin injections to ensure that their blood sugar levels remain under control. The study was published in the journal “Public Library of Science Genetics,” also known as “PLoS Genetics.”

“Genome-wide association studies, as we used here, have been extremely powerful in identifying gene locations involved in the pathogenesis of complex, common diseases,” said Hakon Hakonarson, M.D., Ph.D., head of the study and director of the Center for Applied Genomics at The Children’s Hospital in Philadelphia, Pennsylvania. Dr. Hakonarson noted that the size of the study provided a large pool of data from which the team could draw conclusions. “The larger the cohort used, the more discoveries we can make, and the more we find intriguing biological pathways offering insight into causes of disease.” said Dr. Hakonarson, who collaborated with Constantine Polychronakos, M.D., the director of Pediatric Endocrinology at McGill University.

Called a “genome-wide association study” (GWAS), the study was a meta-analysis that pooled data from six large, existing databases of information about Type 1 diabetes patients. The six studies together comprised information on about 10,000 individuals with Type 1 diabetes in addition to 17,000 control subjects. Information in the databases included single nucleotide polymorphisms (SNPs — pronounced “snips”), single-base alterations in our genetic code that can tip off scientists to the mutations with which they are associated.

The SNPs themselves do not actually cause mutations; they simply appear in regions of the genetic code associated with mutations and allow for more in-depth DNA sequencing studies that can uncover the genes that do actually cause mutations. Hakonarson and his team have conducted studies over the past four years that found SNPs believed to be related to Type 1 diabetes.

Not only did the meta-analysis reinforce previous findings, but it also identified three new SNPs that are located in regions of the genetic code known to have influence on interactions between proteins, cell signaling activity, and inflammation. “Our study found SNPs that we had not expected to have any connection to type 1 diabetes,” says Hakonarson. “The strongest association among the three SNPs was in the region of the LMO7 gene on chromosome 13. We previously associated another member of the LMO gene family with the childhood cancer neuroblastoma. This gene family plays an important role in protein-protein interactions, but it would not have occurred to anyone that it may be active in type 1 diabetes. GWAS continues to turn up surprising biological associations.”

Hakonarson commented that the team would be conducted future studies intended to sequence entire regions of the genetic code which are related to the SNPs. Such a thorough sequencing would provide a better picture of specific mutations which are responsible for the processes that result in Type 1 diabetes.

SNPs have been used for a variety of functions, from predicting an individual person’s response to certain medications to risk of developing certain diseases to breeding livestock. SNPs are single-nucleotide modifications, meaning that they change a single nucleotide; for example, changing a thymine (T) nucleotide to a cytosine (C) nucleotide. Scientists hope that further research will allow SNPs to be used to discover the exact genes responsible for diseases such as diabetes and cancer.