Diabetic Live

Researchers at UCLA demonstrated that the common over-the-counter dietary supplement gamma-Aminobutyric acid (also known as GABA) may aid in inhibiting the development of insulin resistance and glucose tolerance, two conditions that are known to be precursors to the development of both Type 2 diabetes and metabolic syndrome.

In the preclinical study, researchers gave GABA to mice that were obese, had developed insulin resistance, and were in the early stages of Type 2 diabetes. GABA is a naturally-produced compound similar to amino acids that plays an important role in inhibitory processes in the central nervous system of all mammals. When the researchers gave GABA to the mice, they found that the compound worked to suppress the inflammatory immune responses that are associated with the development of Type 2 diabetes.

According to the investigation’s authors, GABA aided in preventing progression of Type 2 diabetes; in addition, it improved insulin sensitivity and glucose tolerance in the mice, even after they had already developed Type 2 diabetes. They also identified regulatory immune cells that play a role in GABA’s inhibition of inflammation.

The research team commented that future studies on the effects of GABA on conditions associated with Type 2 diabetes could provide new medications based on the compound that treat metabolic syndrome and Type 2 diabetes related to obesity.

GABA has become popular in recent years as a dietary supplement promising everything from weight loss to muscle gain to reduced anxiety and depression to better sleep. Since GABA is an inhibitor, it is frequently promoted as a compound that stops excessive brain activity, allowing the individual to relax and eliminate anxiety. “It’s the brakes of your brain. It stops activity,” says Karl Doghramji, M.D., director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia.

It is thought that GABA reduces the effects of glutamate, a neurochemical that increases agitation and excitement. By taking GABA, individuals may be able to silence their overactive thoughts and, for example, get a better night’s sleep. Deficiencies in GABA levels are thought to cause a lack of “delta” sleep — the “deep” stage of sleep that begins about 45 minutes after one falls asleep. Lacking this type of sleep could be damaging to an individual’s mental health, according to Dr. Doghramji; those suffering with depression, anxiety, and other disorders often don’t get enough delta sleep.

Research shows that long-term deficiencies in delta sleep can cause more serious problems. One in three people who suffer with recurrent insomnia has some kind of psychiatric disorder, while 25% of those individuals also have anxiety problems.

However, there isn’t sufficient evidence yet to determine whether GABA supplements have an effect on improving sleep patterns and moods. “We just don’t have any data on them. We do not know how much GABA is really in the supplement or the product’s purity. There are no studies backing up the claims made by the supplement manufacturers.”

According to the New York University Langone Medical Center, there is no evidence that GABA supplements are effective in reducing symptoms from anxiety “presumably because the substance itself cannot pass the blood-brain barrier and enter the central nervous system.” Because they do not actually affect brain chemistry, GABA supplements are most likely ineffective in treating mood disorders, though they may still have some utility in treating hypertension.

Having insects liquefy and digest the dead tissue from your wounds might not be the most appealing idea, but a research team in Hawaii has done just that — using maggots to clean infected and dead tissue from wounds in diabetics — with very positive results.

Doctors typically use scalpels or enzymes to remove dead or infected tissue from wounds in diabetic patients, whose natural wound-healing processes are impaired by a reduction in bloodflow to their extremities. Doctors call this process debridement; however, with traditional tools such as scalpels, it is often ineffective.

“These problem patients with diabetes really need better treatments in order to salvage their limbs,” said Dr. Lawrence Eron with Kaiser Hospital and the University of Hawaii in Honolulu. “Maggot debridement treatment is overwhelmingly effective,” he added. “After just one treatment these wounds start looking better.”

Dr. Eron and his colleagues presented the findings of an investigation into the use of maggots for debridement purposes to their peers at a scientific meeting in Chicago. The results of the investigation have not been reviewed by independent, outside experts.

The investigation was conducted on 37 individuals with diabetes who had artery disease that reduced circulation to the extremities and impaired their wound-healing capacities. All of the patients had wounds that had proven difficult to heal, with some of them lasting for up to five years.

Dr. Eron’s team placed 50 to 100 maggots — species Lucilia sericata — on the patients’ wounds. The insects were left on the wounds for two days and then replaced with new ones; the treatment averaged five days across the group of patients.

“We cage the maggots in a mesh-like material. Nylon panty hose might be used. And then we seal them so they don’t get out,” said Dr. Eron.

Of the 37 patients, 21 had successful outcomes, with success being defined as the eradication of infection, total removal of the dead tissue associated with the wound, formation of new connective tissue in the wound and more than 3/4 closure of the wound.

Among the patients in which the treatment failed, three experienced complications with infected bones, two experienced heavy bleeding, and one had excessive inflammation around the wound.

Five of the wounds were infected with MRSA, a “superbug” known to be extremely resistant to antibiotics; those wounds healed successfully with the use of the maggots. A bacterium called MSSA infected nine other wounds; six of those were successfully treated. Among the patients there were 10 cases of wounds infected with group B streptococci; all of those wounds healed successfully, according to Dr. Eron.

As many patients would understandably be apprehensive about having live maggots inserted into their wounds, Dr. Eron noted that it’s important to explain the process and the mechanisms behind its success to patients. “A lot of patients might be somewhat wary of having live insects placed into their wounds so we explain how it works and what possible problems might occur,” he said.

The maggots secrete a digestive substance into the wounds that break down dead tissue. They feed on this tissue, where it is further digested in the gut of the maggot. The process effectively cleans the dead tissue surrounding the wound; the digestive substance that the maggots secrete also encourages development of granulation tissue, a type of connective tissue that forms when wounds heal.

“After this, we go on to do further treatment with hydrogels, grafts of cell culture tissue, or negative pressure dressings,” said Dr. Eron. “But to get to this point where these techniques will work, you really need to clean up the wound, get rid of dead tissue, and get robust granulation tissue into the wound. And this is where the maggots help.”

A recent preliminary study suggests that people taking the prescription drugs Januvia (sitagilptin) or Byetta (exenatide) to treat Type 2 diabetes may be at an increased risk of developing pancreatitis as well as pancreatic cancer.

In addition, the study discovered that Byetta could potentially increase risk of developing thyroid cancer. The researchers commented noted that the results weren’t conclusive and that further investigation would be necessary before a definite link could be identified.

“We have raised concern that there may be a link, but we haven’t confirmed it,” says Dr. Peter Butler, lead researcher on the project and the director of the Larry L. Hillblom Islet Research Center at the University of California in Los Angeles. “We need to do more work to figure out whether this is real or not,” continued Dr. Butler.

Byetta and Januvia are prescribed to Type 2 diabetics to help keep blood glucose levels in a healthy range. The medications encourage the production of a hormone called glucagon-like peptide 1 (GLP-1).

Although Januvia and Byetta, both relatively new injectable drugs that treat Type 2 diabetes, have some benefits over older medications, Dr. Butler warns that every new medication requires thorough research to determine any complications that could arise from its use. “When new drugs come out, the long-term side effects of these drugs are not well understood,” said Dr. Butler.

Dr. Butler’s team used data from the U.S. Food and Drug Administration’s database of adverse events in patients taking Byetta and Januvia between 2004 and 2009. Any time a patient experiences an adverse event, it is reported by the patient’s physician and recorded in the database.

Dr. Butler’s team found that patients who were being treated with Byetta and Januvia displayed six times more reported cases of pancreatitis. Those taking Byetta showed a 2.9-fold increase in pancreatic cancer while those taking Januvia showed a 2.7-fold increase in pancreatic cancer. The researchers also noted that there was an increase in reported cases of thyroid cancer among patients prescribed Byetta.

However, Dr. Butler stated that the data does not necessarily point to an increase in those complications among patients taking the medications but could be a result of an increase in the number of doctors actually reporting those adverse events.

“It is important to avoid alarmism and have people stop medicines that they may be benefitting from when the risk is not yet defined,” said Dr. Butler. “If the drug and you are working well together, I wouldn’t say there is any reason to stop the drug, based on the evidence we have right now,” he said. “But if you have any concern you should talk to your doctor about it.” Butler also noted that losing weight is the greatest deterrent to pancreatic cancer in patients with Type 2 diabetes.

Dr. Mary Ann Banerji, director of the Diabetes Treatment Center at SUNY Health Science Center Brooklyn, New York City, agrees with Dr. Butler, stating that the data “should not be blown out of proportion.”

Dr. Banerji does not prescribe Byetta or Januvia to patients with a family history of thyroid cancer or pancreatitis, but other drugs such as metformin and insulin come with their own risks. “You prescribe them on an individual basis, because, in the end, all of medicine is individual,” said Dr. Banerji. “We should use these drugs judiciously along with metformin.

A small retrospective study recently presented at the annual meeting of the European Society for the Study of Diabetes has demonstrated that elevated accumulation of fat, inflammation, and fibrosis of the liver are associated with a higher risk of cardiovascular disease. The risks are especially high for those who have been diagnosed with diabetes.

“What we are realizing is that [nonalcoholic fatty liver disease] is adding extra cardiovascular risk to people with diabetes, and to those without, on top of that which is already existing,” says Dr. Christopher Byrne, a lead investigator working on the study.

Dr. Byrne, who is a professor of endocrinology and metabolism at the University of Southampton in England, suggested that the findings of the study demonstrate that patients who have documented liver disease may require more aggressive therapies in response to the additional risk they face. Those therapies should target the liver in addition to the heart.

The study was conducted on 112 patients who had been diagnosed with nonalcoholic fatty liver disease, proven by biopsy. The study showed that the participants’ Kleiner scores were highly-correlated with Framingham Risk Score (FRS) as well as QRISK2 — both indicators of cardiovascular risk. The Kleiner score is a histologic measure of non-alcoholic fatty liver disease severity.

“Nonalcoholic fatty liver disease represents a spectrum of fat-mediated liver conditions causing progressive hepatocellular damage,” says Sarah Hudson, a medical student at the University of Southamptom. “There is increasing evidence of an increased cardiovascular risk associated with progression of nonalcoholic fatty liver disease,” continued Hudson. She also noted that the preferred method of determining the severity of non-alcoholic fatty liver disease was through histopathologic tests.

The primary goal of the study was to determine whether Kleiner score is correlated with risk of cardiovascular disease and whether the score was higher in individuals who were already known to have increased cardiovascular risk, especially those who had also been diagnosed with diabetes.

Kleiner scores provide an assessment of a variety of factors, including steatosis, lobular inflammation, fibrosis, and hepatocyte ballooning. As liver disease becomes more severe, Kleiner score increases correspondingly.
The mean age of participants in the study was 48 years; mean Kleiner score among the patients was 5.3, while median FRS and 13 and median QRISK2 score was 8. Mean body mass index (BMI) of the participants was about 34kg/m2.

Not only were Kleiner scores found to be highly-correlated with cardiovascular risk according to both FRS and QRISK2 models, but they were also higher in a group of 32 participants who had been diagnosed with diabetes versus non-diabetic individuals. It was discovered that the increased risk of cardiovascular disease in correlation with non-alcoholic fatty liver disease was independent of hyperglycemia and increased body weight.

“We need more prospective studies to see what markers may be used to help stratify who requires biopsy and how best to manage people who have got NAFLD,” noted the study’s authors.

“Up until now we’ve been very poor in providing cardiovascular risk reduction treatments for patients with NAFLD,” said Dr. Byrne. “But what we don’t know is whether those lifestyle changes are good at decreasing liver inflammation, or decreasing liver fibrosis.”

Dr. Byrne, along with other members of a research team, are now studying the use of highly-purified omega-3 fatty acid ethyl esters in the treatment of fatty liver disease. This form of fish oil has been available in Europe for at least a decade as Omacor and in the United States as since 2004 as Lovaza.

According to a recent study published in the October 1 issue of the “The American Journal of Cardiology,” percutaneous coronary intervention (or PCI) of chronic total occlusions (CTOs) is associated with reduced mortality in people with diabetes and can also reduce the need for coronary artery bypass grafting.

Headed by Bimmer E. Claessen, M.D., with the Cardiovascular Research Foundation of New York City, the study analyzed the long-term clinical outcomes after PCI of CTOs in patients who were known to be either diabetic or non-diabetic. The study used data from 1,742 patients who were classified according to whether they had been diagnosed with diabetes or not (1,347 were non-diabetic and 395 were diabetic). Study participants who underwent PCI of CTOs in the period between 1998 and 2007 were evaluated for five-year clinical outcomes. Patients were stratified according to several factors, including status of diagnosis of diabetes, successful versus failed CTO PCI, and for the use of drug-eluting (DES) versus bare-metal stents (BMS). The study participants received follow-up examinations for an average of three years.

The researchers identified similar procedural success both in patients who had diabetes and those who didn’t. In all, 96.4% of patients with diabetes and 94% of those without the disease received stent implantation after successful CTO PCI. It was also discovered that successful CTO PCI was associated with a significantly reduced long-term mortality risk in patients with diabetes, at 10.4% compared to 13%, as well as a significant reduction in requirements for coronary artery bypass grafting at 2.4% compared to 15.7%. Usage of drug-eluting stents versus bare-metal stents was associated with a decrease in target vessel revascularization in patients both with and without diabetes (17.6% for the former and 26.5% for the latter). Insulin-dependent diabetes was identified in multivariate analysis as a factor that independently predicted mortality in the cohort that had been diagnosed with diabetes.

“Successful CTO PCI in patients with DM was associated with a reduction in mortality and the need for coronary artery bypass grafting,” wrote the authors of the study.

Three of the researchers announced that they had interests associated with the study. Two of the authors associated with the study disclosed that they had financial ties to Cordis Corporation, while one other author disclosed financial ties to Boston Scientific Corporation.

Percutaneous coronary intervention (PCI), more commonly known as angioplasty, is a surgical procedure used to treat narrowed coronary arteries in the heart due to the buildup of cholesterol plaques. It has been shown to improve quality of life and to be more cost-effective than other procedures such as coronary artery bypass grafting in treating patients who have medically refractory myocardial ischemia.

The procedure is sometimes described as “balloon angioplasty” due to the use of an inflated balloon to crush the cholesterol plaque against the arterial walls and break it down. Although balloon inflation within the artery is generally performed in all angioplasties, the procedure typically includes other operatons such as atherectomy, the implantation of stents, and brachytherapy — the use of radiation to inhibit restenosis.

Stents are small mesh tubes that are implanted into the artery to ensure that it stays open. Stenting has been shown to reduce symptoms related to coronary artery disease in addition to reducing cardiac ischemia. Stents can be made of several different kinds of material. Stainless steel is the most commonly used material but it is not always compatible with the human body and steel stents sometimes result in restenosis and thrombosis.

A study recently reported in the journal “Pediatrics” has demonstrated that pregnant women with well-managed diabetes may not be at increased risk of giving birth to preterm infants or infants with very low birth weight.

“With modern management and adequate glycemic control in pregnancies complicated by diabetes mellitus, the risk of respiratory distress syndrome in near-term and term newborns may not be increased beyond that of a nondiabetic control population,” wrote the authors of the study. The investigation was headed by Yoram Bental M.D., with the Department of Neonatology at Laniado Hospital in Israel and the Israel Institute of Technology in Haifa; also affiliated were researchers with the Israel Neonatal Network. “We hypothesized that maternal …DM increases the risk for mortality, respiratory distress syndrome (RDS), and major complications of prematurity,” continued the authors.

The research team used data collected from the Israel National Very Low Birth Weight Infant Database, covering the years 1995 to 2007. Pregnant woman with diabetes were categorized as either pregestational or gestational; the independent effects of diabetes in pregnant women on infant mortality, RDS, and other complications related to premature birth were analyzed with multivariable logistic regression. The two groups of mothers — those with pregestational and gestational diabetes — demonstrated similar results so their data was pooled together in further analysis.

Mothers with diabetes were more likely to have received a complete course of prenatal steroids compared to women who had not been diagnosed with diabetes. The infants of diabetic mothers showed slightly higher gestational age and birth weight than those of non-diabetic women, but the two groups also demonstrated a similar distribution of birth weight percentiles and mean birth weight z scores. The group of diabetic mothers had higher Apgar scores, enough to be considered statistically significant.

The two groups of mothers did not have significantly different rates of delivery room mortality, RDS, and other complications associated with premature birth. In fact, the group of non-diabetic mothers had a significantly higher rate of total mortality and bronchopulmonary dysplasia. Among the mothers with diabetes, adjusted odds ratios were not significantly increased for risk of mortality, RDS, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity, or intraventricular hemorrhage.

“With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM,” wrote the study authors.

Limitations in the study’s methodology that could potentially affect results include a lack of prospective recording of the degree of glycemic control or the type of diabetes with which the mothers had been diagnosed.

The study’s authors concluded that diabetes should not be considered as an extra risk factor in the development of RDS in infants. “Whenever financial limitations are important in the strategic planning of delivery room care of premature infants, and in particular if the issue of prophylactic surfactant is to be discussed, we suggest that IDM should not be considered as an extra risk of developing RDS,” wrote the authors. “This suggestion is probably strengthened from the fact that safe therapeutic alternatives to prophylactic surfactant exist, such as early nasal continuous positive airway pressure. However, this speculation has not been proved and may not be valid in cases of poor glycemic control.”

The Israel National Very Low Birth Weight Infant Database receives partial support from the Israel Center for Disease Control and the Ministry of Health.

Previous research has suggested the possibility that having diabetes could increase an individual’s lifetime risk of also developing thyroid cancer. A new report, however, has solidified that claim, demonstrating that the association holds true for retirement-age Americans. The findings were published in the journal “Thyroid.”

The study was conducted by epidemiologists affiliated with the National Cancer Institute (NCI) and the National Institutes of Health (NIH). After analyzing the results of the study, the researchers found that patients age 50 to 71 who had been diagnosed with diabetes showed a one-quarter increase in 10-year risk of developing thyroid cancer.

The study used data from nearly 500,000 men and women who had participated in the NIH-American Association of Retired Persons (AARP) Diet and Health Study. The study was conducted in 1995 and 1996.

At the beginning of the study, the researchers collected information about the health of the participants through the use of questionnaires. Questions were related to pancreatic health, body mass index (BMI), the presence of diabetes, and other health factors.

Ten years later, the researchers conducted follow-up examinations on many of the participants. The study used data collected from the follow-up tests.

Researchers found that almost one in 10 volunteers had been diagnosed with diabetes at the time of the initial questionnaire. Upon follow-up examination, those who had diabetes at baseline were noted to develop thyroid cancer at a greater average frequency than those who had not been diagnosed with diabetes.

On average, those who had been diagnosed with diabetes were 25% more likely than non-diabetics to be diagnosed with thyroid cancer. The women in the study showed a particularly high risk of developing cancer.

Diabetic men experienced a 4% increase in their chances of developing thyroid cancer, but diabetic women saw their chances of developing thyroid cancer increase much more dramatically, by 46%.

The results are very similar to findings that were published a decade ago in the journal “Clinical Diabetes.” In an issue of the journal from 2000, endocrinologist Patricia Wu with the University of California in San Diego estimated that 6.6% of the population of the United States has some form of thyroid disease. Diabetics are more likely to experience thyroid problems; about 10.8 percent suffer with thyroid conditions, according to Dr. Wu.

The mechanisms underlying the relationship between diabetes and thyroid cancer are unclear. However, some scientists believe that the diseases are related in that they are both disorders of the endocrine system. Additionally, Thyroid Today notes that both diabetes and thyroid conditions are typically linked to increased body mass, age-related risk, and autoimmune problems.

Scientists have been somewhat baffled in recent years by thyroid cancer, specifically the rate at which is occurs. A paper published in the journal “Cancer” states that thyroid carcinomas are more common than doctors once thought. The National Cancer Institute (NCI) estimates that 11 out of every 100,000 Americans are diagnosed with thyroid cancer each year. However, the report in “Cancer” states that the figure was significantly lower until recently.

From 1988 to 1998, thyroid carcinoma diagnoses rose by an average of 3.5% every year. From 1998 to 2005, that number rose by 6.7% every year. The researchers commented that the reason behind the increase in cancer diagnoses needed to be explored.

“Reasons for this increase, including environmental, dietary and genetic causes, need to be explored. To our knowledge, there is no new evidence to suggest that the exposure of human beings to radiation, a well known environmental risk factor, has increased over time to account for the observed increase in thyroid cancer,” said the researchers.

Patients who have been diagnosed with Type 2 diabetes can demonstrate elevated levels of glucose and glycated hemoglobin (HbA1c) even 10 years before their actual diagnosis, according to Esther van’t Riet, Ph.D., with the Department of Epidemiology and Biostatistics at VU University Medical Center in Amsterdam. Dr. van’t Riet presented the information at a poster session at the 47th annual meeting of the European Association for the Study of Diabetes (EASD). According to Dr. van’t Riet, individuals demonstrate moderate increases and then rapid increases in the few years prior to the diagnosis of diabetes, with increases in Hba1c often preceding elevated glucose.

Dr. van’t Riet and her research team used data from the Hoorn Study, a cohort of 565 Dutch participants, aged 50 to 75 at baseline in 1989 and with follow-ups in 1996 and 2000. None of the 565 participants had been diagnosed with diabetes at the beginning of the study.

At follow-up meetings, incident diabetes was diagnosed with the World Health Organization and American Diabetes Association’s 2011 criteria for the disease: fasting blood glucose levels of 7.0 mmol/L (126.1 mg/dL) or greater, or post-load glucose levels of 11.1 mmol/L (200mg/dL) or higher; and/or HbA1c levels of 6.5% or higher. Participants were categorized according to the status of their development of diabetes at baseline and follow-up.

At the 1996 follow-up, 99 of the study participants had developed incident diabetes; by 2000, an additional 48 had developed the disease. At the 2000 follow-up, 418 participants had still not developed diabetes. According to van’t Riet, the development of diabetes was preceded by elevated glucose and HbA1c levels in the years leading up to the diagnosis. “Those who developed diabetes already had elevated levels of glucose and A1c in 1989. So up to 10 years before diagnosis, we already see an elevation of all 3 glycemic measures,” she said. The third measure that the study analyzed was post-load glucose levels, which were obtained two hours into an oral glucose tolerance test.

“When we look at changes in time, we first compared those who never developed diabetes with those who had insulin diabetes in 1996. We see that all 3 glycemic measures show a steep increase from 1989 to 1996. After the diagnosis in 1996, they stabilize,” said Dr. van’t Riet.

The researchers also compared study participants who didn’t develop diabetes throughout the course of the investigation with those who had developed the disease in 2000. Those who developed diabetes saw increases in fasting glucose and post-load glucose between 1989 and 1996 that was “almost comparable for those who developed diabetes and those who never developed diabetes.” However, by 1996, those levels increased in the group that developed diabetes: “A steep increase is observed, which was not seen in those who never developed diabetes,” said dr. van’t Riet.

Unlike blood glucose levels, HbA1c levels did increase between 1989 and 1996 for those who later developed diabetes. “This might indicate that A1c increases earlier than glucose,” said Dr. van’t Riet.

The researchers performed further analysis on study participants with incident diabetes in 2000 who had increased HbA1c levels but lower glucose, and on those who had high glucose and normal HbA1c due to changes in the diagnostic criteria for diabetes.

“In those with diabetes based on high glucose, A1c levels tend to increase also. But in those with diabetes based on high A1c, glucose levels tend to stabilize in the follow-up period…. It might indicate that there are different developmental patterns according to the type of criteria you use,” continued van’t Riet.

Doctors have long extolled the health values of getting eight hours of sleep every night. Add another benefit to the list: new research shows that getting eight and a half hours of sleep every night could reduce the risk of developing Type 2 diabetes in teenagers who are obese. The findings were published in the journal “Diabetes Care.”

The study was conducted on 62 teenagers. The results demonstrated that insulin and blood sugar levels stayed at optimum levels for those who got between seven and a half and eight and a half hours of sleep at night. Getting more or less sleep increased the chance of elevated blood glucose levels; getting less than seven and a half hours of sleep resulted in lowered insulin levels.

According to the research team, which is affiliated with Children’s Hospital of Philadelphia, the results of the study demonstrate that healthy sleeping patterns could be beneficial in warding off diabetes in the participants of the study, who were all obese. The study was headed by Dr. Dorit Koren, who commented that the results corresponded with previous research showing that sleep-deprived adults were at a higher risk of developing Type 2 diabetes.

The study was conducted over a period of one and a half days. The teenagers’ blood sugar levels were monitored throughout the investigation, while their sleeping patterns were tracked and analyzed by the research team.

“Our study found to keep glucose levels stable, the optimal amount of sleep for teenagers is 7.5 to 8.5 hours per night,” said Dr. Koren.

The research team plans to conduct additional research, this time in the teenagers’ own homes rather than in a laboratory, to back up the results of the study.

“In the meantime, our study reinforces the idea that getting adequate sleep in adolescence may help protect against type 2 diabetes,” says Dr. Koren.

Research has shown that teenagers are not getting enough sleep. Another study previously conducted in 2007 showed that one in three British teenagers is getting just four to seven hours of sleep every night.

Another study conducted at the University of Buffalo and headed by Lisa Rafalson found that participants who were sleep-deprived were 4.5 times more likely to develop impaired fasting glucose, a condition that is considered a precedent to Type 2 diabetes. The study analyzed data from 1,455 volunteers over a period of six years; it measured how long the participants slept on average on weeknights. Participants who got less than six hours a night were four times more likely to develop impaired fasting glucose than participants who regularly got six to eight hours of sleep a night. The study’s findings were presented at the 49th annual Conference on Cardiovascular Disease Epidemiology of the American Heart Association in Palm Harbor, Florida.

“Our findings will hopefully spur additional research into this very complex area of sleep and illness,” said Rafalson. “While previous studies have suggested that there may be many genes that each have a very small effect on the risk of diabetes, there is no known genetic predisposition to sleep disturbances that could explain our study’s results, especially in this limited sample size. It is more likely that pathways involving hormones and the nervous system are involved in the association.”

It is speculated by some researchers that a lack of deep sleep is the source of the increased risk of diabetes: a shortage of slow-wave, or deep sleep, impairs the body’s ability to regulate blood glucose levels and increases risk of Type 2 diabetes.

A longitudinal study conducted in Japan has shown that risk of dementia increases when glucose levels swing out of control, especially directly after meals. The study was conducted by Yutaka Kiyohara, M.D., Ph.D., and colleagues at the Kyushu University in Fukuoka, Japan. The results were reported in the September 20 issue of the journal “Neurology.”

Individuals who had been diagnosed with diabetes were 74% more likely to develop some form of dementia over 15 years of follow-up. The study also adjusted for confounding factors. The study followed 1,017 community-dwelling older adults who did not have dementia at the beginning of the study. The participants had an oral glucose test at age 60 or older; the researchers followed them for 15 years to determine if they developed one of the various forms of dementia.

Patients with diabetes were also 2.05 times more likely to develop Alzheimer’s than individuals with normal glucose tolerance levels, after adjustment for confounding factors. As such, diabetes was specifically associated with a higher risk of developing Alzheimer’s disease later in life.

According to Richard Bergenstal, M.D., with the International Diabetes Center at Park Nicollet in Minneapolis, MN, the study’s results were also interesting in that they displayed a strong risk prediction of Alzheimer’s associated with post-load glucose levels during the oral glucose tolerance test.

Patients who displayed higher blood glucose levels two hours after a meal were shown to be at a higher risk of developing dementia, including Alzheimer’s.

Study participants who showed a post-meal blood glucose measurement of 7.8 to 11.0 mmol/L had a 50% greater chance of developing all-cause dementia. Those with a post-meal blood glucose measurement greater than 11.0mmol/L had 2.47-fold increase in risk of all-cause dementia and a 3.42-fold increase in risk of Alzheimer’s.

According to Kiyohara’s research group, the findings demonstrated that “that postprandial glucose regulation is critical to prevent future dementia.” Individuals with diabetes need to manage their post-meal blood glucose levels carefully since they are at a greater risk of developing dementia later in life. “Our findings emphasize the need to consider diabetes as a potential risk factor for all-cause dementia, Alzheimer’s disease, and probably vascular dementia,” added Kiyohara’s group.

Bergenstal, a previous president of the American Diabetes Association, warned that it’s as yet unclear whether improved control of post-meal insulin levels could lower the risk of dementia for patients who already have diabetes. We need to understand it a lot better before we build this into our clinical practice,” said Bergenstal. “We don’t know yet from these studies how to intervene.”

Among the participants of the study, those who displayed diabetes through an oral glucose tolerance test were 2.07 times more likely to develop vascular dementia compared to those with normal glucose tolerance. The numbers were adjusted for age and sex.

The significantly higher risk of vascular dementia in diabetes patients may be a result of the low number of cases of that type of dementia, or because diabetes is associated with hypertension and other cardiovascular complications that are linked to vascular dementia.

Hyperglycemia may have also had an effect on the development of dementia by way of atherosclerosis, oxidative stress, the accumulation of advanced protein glycation, and changes in insulin metabolism that yield altered amyloid metabolism.

Diabetes and prediabetes accounted for 14.6% of all-cause dementia, 20.1% of Alzheimer’s disease, and 17% of vascular dementia risk. The research team noted that further studies were required before the results could be generalized to other ethnic populations.