Effect of population screening for type 2 diabetes

Effect of population screening for type 2 diabetes
by Medical Xpress August 24, 2017
"Three large trials published today in Diabetologia (the journal of the European Association for the Study of Diabetes) show that screening for type 2 diabetes and cardiovascular risk factors may not reduce mortality and cardiovascular disease in the general population. However, for individuals diagnosed with diabetes, screening is associated with a reduction in mortality and cardiovascular disease risk. " full text

Articles mentioned in this news:

• Simmons (2017). Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events: a controlled trial among 1,912,392 Danish adults
• Simmons (2017). Effect of screening for type 2 diabetes on risk of cardiovascular disease and mortality: a controlled trial among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009
• Feldman (2017). Screening for type 2 diabetes: do screen-detected cases fare better?
• Simmons (2017). Should we screen for type 2 diabetes among asymptomatic individuals? Yes
• Shaw (2017). Does the evidence support population-wide screening for type 2 diabetes? No

'Big Fat Fix' Film Challenges Mediterranean Diet

'Big Fat Fix' Film Challenges Mediterranean Diet
An Interview With Cardiologist Aseem Malhotra
Editor's Note:  Cardiologist Aseem Malhotra, MBChB, MRCP, talks about his new documentary The Big Fat Fix, which sent him to Pioppi, Italy, the village where Ancel Keys researched diet and cardiovascular health. A regular contributor to the BMJ and major UK newspapers on the topic of dietary health, Dr Malhotra believes that the demonization of fat let sugar off the hook as the real culprit in the diabetes, obesity, and cardiovascular disease epidemic, and that we need to rethink our approach to exercise. ... Full Text.


This article is an another interesting opinion based on facts and viewed from a different angle. This interview reminds me the Michael Pollan's book In Defense of Food published in 2008: Food – Not Nutrients – Is The Fundamental Unit In Nutrition. (PBS Documentary In Defense of Food in Dec. 2015, PBS Newshour and on YouTube).
Food Insight (2015). 4 Food Rules You Won’t Find in Michael Pollan’s ‘In Defense of Food’

Unconventional view of type 2 diabetes causation proposed

Unconventional view of type 2 diabetes causation proposed
Source: MedicalPress

At 85, Nobel laureate James D. Watson, the co-discoverer of the double-helix structure of DNA, continues to advance intriguing scientific ideas. His latest, a hypothesis on the causation of type 2 diabetes, is to appear 7 pm Thursday US time in the online pages of The Lancet, the prestigious British medical journal.
 
Watson's hypothesis suggests that diabetes, dementias, cardiovascular disease, and some cancers are linked to a failure to generate sufficient biological oxidants, called reactive oxygen species (ROS). Watson also argues the case for a better understanding of the role of exercise in helping to remedy this deficiency. ...
 

rule of halves of diabetes

Rule of halves of diabetes
Source: DAWNStudy Diabetic Attitudes Wishes and Needs

Diease or not disease, a diabetic question

Diease or not disease, a diabetic question

Last a few days, I read two diabetic related articles, which both are not my cup of tea; but I am really appreciating their thoughts and contrast.

• The Lie That's Killing Us: Pre-Diabetes (Riva Greenberg) on Huffpost defines the Type 2 diabetes as a diesase into four stages, which includes pre-diabetes as the stage 1.
• No Such Thing As Type 2 Diabetes? (Alice G. Walton) on Forbes is on the another side. The original article is published on Lancet (Is type 2 diabetes a category error? by Edwin AM Gale)

Both of authors are creative and thoughtful. Riva Greenberg is much more on the side of novelty/grassroot side (without enough evidence, to me) and Edwin Gale is much more on the side of classic/ivy tower (with typical theory/evidence, to me). I enjoy reading both articles.

Special issue on lipotoxicity

Special Issue on Lipotoxicity

Source: Biochimica et Biophysica Acta 2010;1801(3)

Editors: A. Vidal-Puig & R.Unger

“It was sometime in March 2009 when our colleague Fritz Spener first proposed a special issue of BBA Molecular and Cell Biology of Lipids focused on the concept of lipotoxicity and its relevance as an integrative pathogenic mechanism of the metabolic syndrome. Although we might have hesitated a little initially, this did not last long as we realised that: a) ours would be a unique, high quality publication addressing the topic in depth and globally; b) this is an important area of research with enormous implications for metabolic disease and, in our opinion, its relevance is underestimated and relatively unknown among both the biomedical community and general public; and c) the great opportunities offered by new technologies and experimental models to understand the role of lipotoxicity in common metabolic diseases makes this a very timely issue. And also, of course, we expected strong support from the “lipotoxic community”. Certainly we have not been disappointed. In fact our colleagues have provided enormous support and their generosity has made this issue viable. Our only regret is that we have not been able to involve as many of the key experts as we wanted due to space constrains and the time scale of the project, and we hope this will not be the cause of any lost friendships!”


Here is the special issue: Special issue on lipotoxicity.

This issue isn’t new. I have got the similar hypothesis after I attended a lecture by J. Denis McGarry in 2001 (In memory of Dr. John Denis McGarry. His article "What if Minkowski Had Been Ageusic?"  is on the wall of my office all the time). I put this special issue on my blog to remind me keeping work on this hypothesis.

Update on the alternative to HOMA-IR and HOMA-b

Update on the HOMA-IR and HOMA-b
Source:  iHOMA2
iHOMA2 is an interactive, 24-variable, HOmeostatic Model of Assessment with the baseline default characteristics of the HOMA2 computer model of fasting insulin:glucose interaction. iHOMA2 enables the mathematical functions describing the organs and tissues involved in the glucose and hormonal compartments to be modified using simple visual analogue controls. The model can be used to evaluate therapeutic agents and predict effects on fasting glucose and insulin and on beta cell function and insulin sensitivity.

Here is the main URL for the iHOMA2 website.

I am not a fan of iHOMA2; I post it here as a future reference.

Joslin's Diabetes Deskbook, A Guide for Primary Care Providers, Updated 2nd Ed., Excerpt 2: Do You Know the Conditions that May Cause Inaccurate Results from the A1C Test?

Joslin's Diabetes Deskbook, A Guide for Primary Care Providers, Updated 2nd Ed., Excerpt 2: Do You Know the Conditions that May Cause Inaccurate Results from the A1C Test?
By Richard S. Beaser, M.D.


"... With respect to the testing methodology, when HPLC laboratory techniques are used to perform measurements, the number of things that can affect the test results is limited. Using this methodology, the most common factors that can affect A1C measurements are:

• Hemolytic anemias Carbamylated and acetylated hemoglobins (rare).
• "Fast" migrating hemoglobins, most commonly hemoglobins D, J, and N, can lower readings.
• Fetal hemoglobin greater than 25% interferes with hemoglobin A1c measurement and cannot be corrected for.
• True beta-thalassemia will interfere with some HPLC methods, but the patient has to be symptomatic at the time for the effect to be significant.
• Severe lipemia in some patients can interfere with measurements. Interference can be reduced by washing red cells and making an offline dilution to report out the A1C value
• Taking medications such as salicylates can have an effect, though rarely ..."

Fatty Liver Disease in Diabetes: Good and Bad?

Fatty Liver Disease in Diabetes: Good and Bad?


When the enzyme called histone deacetylase 3 (HDAC3) was removed, the mice had massively fatty livers, but lower blood sugar, and were thus protected from glucose intolerance and insulin resistance....


The findings demonstrate that fat itself is not necessarily all bad. "It matters a lot how fat is handled and stored," notes Lazar. "It also highlights the importance of complying with our internal circadian clock. For example, since our body does not anticipate food at night and is preparing to generate more glucose, night-time eating is likely to shoot up blood sugar and thus may contribute to diabetes."


The full text here.
The original article here.

Metabolic surgery for type 2 diabetes and obesity related - Nature Medicine

Metabolic surgery for type 2 diabetes

David E Cummings

Clinicians note that bariatric operations can dramatically resolve type 2 diabetes, often before and out of proportion to postoperative weight loss. Now two randomized controlled trials formally show superior results from surgical compared with medical diabetes care, including among only mildly obese patients. The concept of 'metabolic surgery' to treat diabetes has taken a big step forward.

Full Text | PDF

Topic: Guts over glory - why diets fail

Rachel Larder and Stephen O'Rahilly

Losing weight can pose a challenge, but how to avoid putting those pounds back on can be a real struggle. A major health problem for obese people is that diseases linked to obesity, such as type 2 diabetes and cardiovascular disease, put their lives at risk, even in young individuals. Although bariatric surgery[mdash]a surgical method to reduce or modify the gastrointestinal tract[mdash]was originally envisioned for the most severe cases of obesity, evidence suggests that the benefit of this procedure may not be limited to the staggering weight loss it causes. Endogenous factors released from the gut, and modified after surgery, may explain why bariatric surgery can be beneficial for obesity-related diseases and why operated individuals successfully maintain the weight loss. In 'Bedside to Bench,' Rachel Larder and Stephen O'Rahilly peruse a human study with dieters who regained weight despite a successful diet. Appetite-regulating hormones in the gut may be responsible for this relapse in the long term. In 'Bench to Bedside,' Keval Chandarana and Rachel Batterham examine how two different methods of bariatric surgery highlight the relevance of gut-derived hormones not only in inducing sustained weight loss but also in improving glucose homeostasis. These insights may open new avenues to bypass the surgery and obtain the same results with targeted drugs.

Full Text | PDF

Topic: Metabolic insights from cutting the gut

Keval Chandarana and Rachel L Batterham

Losing weight can pose a challenge, but how to avoid putting those pounds back on can be a real truggle. A major health problem for obese people is that diseases linked to obesity, such as type 2 diabetes and cardiovascular disease, put their lives at risk, even in young individuals. Although bariatric surgery[mdash]a surgical method to reduce or modify the gastrointestinal tract[mdash]was originally envisioned for the most severe cases of obesity, evidence suggests that the benefit of this procedure may not be limited to the staggering weight loss it causes. Endogenous factors released from the gut, and modified after surgery, may explain why bariatric surgery can be beneficial for obesity-related diseases and why operated individuals successfully maintain the weight loss. In 'Bedside to Bench,' Rachel Larder and Stephen O'Rahilly peruse a human study with dieters who regained weight despite a successful diet. Appetite-regulating hormones in the gut may be responsible for this relapse in the long term. In 'Bench to Bedside,' Keval Chandarana and Rachel Batterham examine how two different methods of bariatric surgery highlight the relevance of gut-derived hormones not only in inducing sustained weight loss but also in improving glucose homeostasis. These insights may open new avenues to bypass the surgery and obtain the same results with targeted drugs.

Full Text | PDF 

In defence of white rice | BMJ

In defence of white rice
by Kadoch
The finding of an increased risk of type 2 diabetes with higher consumption of white rice1 is not surprising because suboptimal results are to be expected whenever a whole plant food is refined. This is especially true with other poor lifestyle practices. Nevertheless, I worry that we are losing the forest among the trees.
White rice has been the staple of the Asian diet for thousands of years. For most of that time it produced some of the most slender people in history. Western diseases such as diabetes and coronary artery disease were almost unheard of in this region.2 Only after the comparatively recent adoption of high fat Western dietary habits, focused primarily on animal products and highly processed junk foods, have these illnesses become more prevalent in Asia.
Diets centred on white rice have, in fact, produced some of the most dramatic health benefits reported in the medical literature. The rice diet, as pioneered by Walter Kempner, has repeatedly been shown to drastically reduce hypertension, insulin resistance, and obesity.3 Low fat diets emphasising starch have reversed diabetes and coronary artery disease.4 5 These remarkable studies were all inspired by the traditional Asian cuisine.
Encouraging patients to choose intact whole grains such as brown rice is certainly warranted. However, to rescue the Asian population from a mounting epidemic of chronic lifestyle diseases, most effort should be focused on removing the cause-the toxic Western diet. This may even justify promoting a return to white rice, instead of condemning it outright.
Full text of article

Diabetes diet: What to eat when you have diabetes - Chicago Tribune

Decoding the diabetic diet
Source: Chicago Tribune.


"A focus on carb- and portion-control should be top priority, but that doesn't mean the occasional treat is out of the question."


Eat more

• Fish
• Nuts
• Nonstarchy vegetables
• Magnesium-rich foods (spinach, almonds, broccoli, lentils, tofu, pumpkin seeds, sunflower seeds)
• Foods rich in omega-3s (flaxseed, walnuts, salmon, tuna, sardines)
• Whole grains (quinoa, brown rice, wild rice, amaranth)
• Whole fruit (in servings the size of a tennis ball)
• Nonfat or low-fat Greek yogurt
• Olive oil
• Cinnamon
• Vinegar

Eat less

• Stick margarine, butter, shortening or lard
• Fried foods
• Refined grains (white bread, white rice, white flour)
• Sugary drinks (soda, fruit juices, sweetened ice teas, sports drinks)
• Fruity yogurts
• High-fat meats (sausage, bacon, hot dog, scrapple)

Full text here.

When It Comes To A1C Blood Test For Diabetics, One Level No Longer Fits All

When It Comes To A1C Blood Test For Diabetics, One Level No Longer Fits All

by Nancy Shute

Source: National Public Radio

 … If there's one thing that people with diabetes get pounded into their heads, it's that they've got to keep their A1C level under control. That's the blood glucose measure that's used to decide how well a person is managing their diabetes.

But new diabetes management guidelines announced today will cut many people with diabetes some slack.

Where old guidelines from the American Diabetes Association said that people should maintain an A1C of 7, the new guidelines say that patients should work with their doctors to determine an appropriate A1C target. …

Full text: here

Circulation's Diabetes Mellitus Studies

Circulation's Diabetes Mellitus Studies 2009 - 2010
"The following articles are being highlighted as part of Circulation's Topic Review series. This series will summarize the most important manuscripts, as selected by the editors, published in Circulation and the Circulation subspecialty journals. The studies included in this article represent the articles related to diabetes mellitus that were published in Circulation in 2009 and 2010. ..."
full text: here

Role of Environmental Chemicals in Diabetes 1 and Obesity

Role of Environmental Chemicals in Diabetes 1 and Obesity: A 2 National Toxicology Program Workshop Report

By Kristina A. Thayer, Jerry Heindel, John R. Bucher, Michael A. Gallo 

full text: here (pdf)

CHE: Practice Prevention Columns and Fact Sheets 

CHE-Alaska: The Role of Environmental Chemicals in the Development of Diabetes and Obesity 

Diabetes Medication Comparison Table: Benefits and Risks

Diabetes Medication Comparison Table: Benefits and Risks
Source: Diabetes In Control.com
read full article here: http://www.diabetesincontrol.com/articles/features/11666

The 2009 ISPAD Clinical Practice Consensus Guidelines

The 2009 Clinical Practice Consensus Guidelines
By the International Society for Pediatric and Adolescent Diabetes

Here are the PDFs of chapters:

Chapter 1: Definition, epidemiology, diagnosis and classification

Chapter 2: Presentation and phases of diabetes

Chapter 3: Type 2 diabetes

Chapter 4: Monogenic diabetes

Chapter 4b: Management of cystic fibrosis-related diabetes

Chapter 5: Diabetes education

Chapter 6: The delivery of ambulatory diabetes care

Chapter 7: Assessment and monitoring of glycemic control

Chapter 8: Insulin treatment

Chapter 9: Nutritional management

Chapter 10: Diabetic ketoacidosis

Chapter 11: Hypoglycemia

Chapter 12: Sick day management

Chapter 13: Exercise

Chapter 14: Management of children with diabetes requiring surgery or fasting

Chapter 15: Psychological issues

Chapter 16: Adolescence

Chapter 17: Microvascular and macrovascular complications

Chapter 18: Other complications and associated conditions

Recipes and Meal Planning from the American Diabetes Association

Recipes and Meal Planning from the American Diabetes Association

If you are looking for healthy recipes to lose weight, prevent, or manager diabetes, you may like the MyFoodAdvisor – Recipes for healthy Living from the American Diabetes Association. You must register to access these recipes, which I don’t like the way of access, but it’s FREE.

HbA1c: what do the numbers really mean?

The Lancet, Volume 378, Issue 9796, Pages 1068 - 1069, 17 September 2011

Randie R Little a, David B Sacks b

The Comment by Shivani Misra and colleagues (April 30, p 1476)1 addresses the topic of changing the way glycated haemoglobin (HbA1c) is reported from the traditional percentage units (used in the Diabetes Control and Complications Trial [DCCT] and UK Prospective Diabetes Study [UKPDS]) to the International Federation of Clinical Chemistry's (IFCC's) mmol/mol units. This is an important communication. Unfortunately, the Comment contains both misleading and erroneous information.

The remark about “variations of between 3% and 14% being reported” is misleading. The paper cited refers to between-laboratory coefficients of variation obtained from old (1996) data, before implementation of method standardisation by the National Glycohemoglobin Standardization Program (NGSP). Virtually all current methods have coefficients of variation of 5% or less, with some less than 2%.2

Moreover, Misra and colleagues advise clinicians not to convert the IFCC mmol/mol results to DCCT-aligned percentage units and claim that “the DCCT-aligned results are now untraceable and cannot be linked… to the original reference measurement, making them effectively meaningless”. This statement is completely incorrect. An established master equation with documented stability, which describes a linear relation between IFCC and NGSP/DCCT units, permits traceability of DCCT results to the IFCC reference system, and allows direct conversion of numbers between the two systems.3 This is vital to allow health-care providers to compare a patient's HbA1c value to the large body of published outcome data that use DCCT-aligned results.

A third miscommunication is “One untimed… blood sample for diagnosis”. The guidelines4 recommend that, in the absence of unequivocal hyperglycaemia (an uncommon finding), HbA1c be confirmed by repeat testing. It is essential for the medical community to understand these changes in HbA1c clearly to avoid negatively affecting care of diabetic patients.

We declare that we have no conflicts of interest.

References

1 Misra S, Hancock M, Meeran K, Dornhorst A, Oliver NS. HbA1c: an old friend in new clothes. Lancet 2011; 377: 1476-1477. Full Text | PDF(46KB) | CrossRef | PubMed

2 College of American Pathologists. GH2-A glycohemoglobin participant summary, 2011. Northfield, IL: CAP, 2011.

3 Geistanger A, Arends S, Berding C, et al. Statistical methods for monitoring the relationship between the IFCC reference measurement procedure for hemoglobin A1c and the designated comparison methods in the United States, Japan, and Sweden. Clin Chem 2008; 54: 1379-1385. CrossRef | PubMed

4 International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32: 1327-1334. CrossRef | PubMed

The Lancet, Volume 378, Issue 9796, Pages 1069 - 1070, 17 September 2011

HbA1c: what do the numbers really mean? — Authors' reply

S Misra a, M Hancock a, K Meeran a, A Dornhorst a, NS Oliver a

We do not believe that we have misled readers. The stated coefficients of variation refer to figures before the National Glycohemoglobin Standardization Program (NGSP) was implemented and were quoted to illustrate the different coefficients of variation in existence at the time of the Diabetes Control and Complications Trial (DCCT). Furthermore, the next paragraph clearly states that “harmonisation of results to DCCT-based calibrants in the 1990s partly alleviated this variation”. Although effective, the NGSP did not provide a reference measurement system, which has been the underlying driving force behind the International Federation of Clinical Chemistry (IFCC) standardisation.

In quoting “the DCCT-aligned results are now untraceable and cannot be linked… to the original reference measurement, making them effectively meaningless”, Randie Little and David Sacks chose to omit the phrase “through successive calibrations”. This statement referred to the use of DCCT-calibrated analysers, which are not in any way linked to the IFCC reference system. This practice would generate untraceable results. The consensus statement1 clearly indicates that the IFCC reference represents the only valid anchor to standardisation. We acknowledge that the use of the IFCC-NGSP master equation does permit traceability to the IFCC reference system. However, there are some crucial limitations, which underpin our reluctance to encourage physicians to undertake this conversion routinely.

First, although a linear relation exists between the IFCC-standardised and DCCT-aligned results, the latter cannot be considered a “pure” HbA1c measurement.2 Now that a pure HbA1c standard exists, one must question the validity of continuing to report DCCT-aligned results. To suggest that comparisons to outcome data necessitate interconversion is, in our opinion, ill-considered since the master equation can equally convert targets into new units.

Second, the use of the master equation generates further uncertainty in the derived DCCT-aligned values.3 Irrespective of whether this is significant, should the use of an equation to derive values from a reference be considered as robust as a system in which an unbroken chain of calibrations links the reference to the designated comparison method?4

Third, in the UK, DCCT percentage units will cease to be reported from October, 2011. We therefore actively encourage clinicians to familiarise themselves with the new units now. This is a fundamental course of action to avoid confusion later, which would undoubtedly be detrimental to patients' care.

We accept that a single measurement is not proposed; however, Little and Sacks have misunderstood the message being conveyed. Since guidelines5 advise repeat testing of an abnormal result by the same method, a second HbA1c measurement in a patient with an interfering factor will simply duplicate the error. It is important for clinicians to understand the limitations of a test, no matter how many times it is repeated.

References

1 Hanas R, John G. 2010 consensus statement on the worldwide standardization of the hemoglobin A1C measurement. Diabetes Care 2010; 33: 1903-1904. CrossRef | PubMed

2 European Association for the Study of Diabetes. Report of the ADA/EASD/IDF Working Group of the HbA1c Assay. London, UK, 20 January 2004. http://www.ifcchba1c.net/files/2004_Diabetologia2004_46_R53_54.pdf. (accessed Aug 3, 2011).

3 Geistanger A, Arends S, Berding C, et al. Statistical methods for monitoring the relationship between the IFCC reference measurement procedure for hemoglobin A1c and the designated comparison methods in the US, Japan and Sweden. Clin Chem 2008; 54: 1379-1385. CrossRef | PubMed

4 Joint Committee for Guides in Metrology. International vocabulary of metrology—basic and general concepts and associated terms. 3rd edn. http://www.bipm.org/utils/common/documents/jcgm/JCGM_200_2008.pdf. (accessed Aug 31, 2011).

5 WHO. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. http://www.who.int/diabetes/publications/report-hba1c_2011.pdf. (accessed Aug 31, 2011).

a Imperial Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK

Pathway to diabetes through attenuation of pancreatic beta cell glycosylation and glucose transport
http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2414.html