Is there a link between climate change and diabetes?

From cnn.com

Scientists have long warned that rising global temperatures may impact public health in a devastating way because climate change is associated with deadly weather events, the spread of infectious diseases and even food shortages.

Now, researchers are looking at whether climate change might be linked to another public health concern: Type 2 diabetes.

Between 1996 and 2009, as outdoor temperatures rose across the United States, so did the prevalence of diabetes, according to a study published in the journal BMJ Open Diabetes Research & Care on Monday.

"We were surprised though by the magnitude of the effect size," said Lisanne Blauw, a researcher at Leiden University Medical Centre in The Netherlands and lead author of the study.

"We calculated that a 1-degree Celsius rise in environmental temperature could account for more than 100,000 new diabetes cases per year in the USA alone," she said. "Future research into the effects of global warming on our health status is therefore of great importance."

However, this observational study simply reveals an association between climate and diabetes, not a causation. Among the factors known to cause Type 2 diabetes are being overweight or obese and having a family history of the disease.

"I think calorie consumption and weight are probably the biggest by a country mile," said Dr. Adrian Vella, an endocrinologist who has researched Type 2 diabetes at the Mayo Clinic. He was not involved in the new study.

"I think the general message always should be that association studies do not actually imply causation," he said of linking climate change and diabetes.

Currently, about one out of every three Americans will develop Type 2 diabetes, according to the Centres for Disease Control and Prevention.

For the new study, researchers analysed data on the incidence of Type 2 diabetes in the United States, including the territories of Guam, Puerto Rico and the Virgin Islands, between 1996 and 2009. The data came from the CDC's Behavioural Risk Factor Surveillance System.

The researchers also analysed data on the mean annual temperature per state using data from the National Centres for Environmental Information.

Global data were analysed, too. Information on fasting blood glucose levels and obesity was gathered through the World Health Organization's Global Health Observatory online database.

The researchers found that for every 1-degree Celsius increase in outdoor temperature, there was about a 4% increase of the total diabetes incidence in the United States per year between 1996 and 2009, Blauw said. An increase of 1 degree Celsius is equivalent to an increase of 1.8 degrees Fahrenheit on the Fahrenheit temperature scale.

The worldwide prevalence of glucose intolerance rose by 0.17% per 1-degree Celsius increase in temperature, the researchers found.

"To the best of our knowledge, this study is the first to assess the association of outdoor temperature with diabetes incidence and the prevalence of raised fasting blood glucose on a national and global level," the researchers wrote.

Although more research is needed to determine why -- and how -- this correlation even exists, the study posed one hypothesis that involves the way cooler temperatures can activate a type of body fat called brown fat, or brown adipose tissue.

"The function of brown fat tissue is to burn fat to generate heat, which is important to prevent a decline in body temperature during cold exposure. Therefore, we hypothesize that brown fat plays a role in the mechanism underlying the association between outdoor temperature and diabetes," Blauw said. "In warmer climates, brown fat may be less activated, which may causally lead to insulin resistance and diabetes."

On the other hand, Vella said that brown fat doesn't have that much of an impact on metabolism in humans.

"In humans, brown adipose tissue likely explains about 1% or 2% of energy expenditure in cold situations, and shivering explains far more, so it's an exaggeration," he said.

"Between 1996 and 2009, I believe the environment has changed," he added. "Lots of things changed that might change diabetes incidence, right? The actual population composition changed a little bit. The caloric consumption of that population likely changed. We don't know about physical activity."

In 2012, an International Diabetes Federation report indicated that Type 2 diabetes and climate change may be interconnected public health concerns.

Climate change threatens the fresh food supply, which may negatively impact the diets of those with diabetes, according to the report. Also, deadly heat waves may weaken overall health due to dehydration.

"In hotter temperatures, dehydration and heatstroke increases morbidity and mortality in people with diabetes. People with diabetes are predisposed to cardiovascular events during heat waves and higher mortality from heart attack on days of high air pollution," according to the report.

Meanwhile, an increased prevalence of diabetes may lead to more carbon emissions being generated by the health care systems treating those patients.

"Diabetes-related complications -- such as (cardiovascular disease), stroke and renal failure -- cost lives and money. Hospitalizations from such complications are also energy-intensive and increase (greenhouse gas) emissions," according to the report.

Last week, the Medical Society Consortium on Climate & Health released a "medical alert" report titled "Climate Change Is Harming Our Health".

The report outlined how, across the country, climate change may lead to deadly heat waves; worsened outdoor air quality; hazardous extreme weather events; food-related infections; water-related infections; mosquito- and tick-borne infections; wildfires; and higher levels of depression, anxiety and PTSD among flood victims and farmers.

In the executive summary, the authors wrote, "We -- physicians in medical societies representing over half of the nation's doctors -- see a need to share our growing understanding and concern about the health consequences of climate change with all Americans."

http://edition.cnn.com/2017/03/20/health/climate-change-type-2-diabetes-study/

Open your bedroom window at night to prevent obesity and type 2 diabetes, says Oxford prof

From telegraph.co.uk

Opening your bedroom window at night to allow in a cool breeze could be simple, if chilly, way of preventing obesity and Type 2 diabetes, an Oxford University academic has suggested.
Professor of Endocrinology Ashley Grossman said there was mounting evidence that cooling the body even by just a couple of degrees was beneficial for health.
His comments were made after a new study by Dutch scientists appeared to find a link between global warming and diabetes.
The researchers suggested that a one degree centigrade rise in environmental temperature could lead to 100,000 new cases of diabetes in the US each year because the body needed to burn less brown fat to keep warm, leading to insulin sensitivity and weight gain.
Prof Grossman said the research supported the ‘keep cool’ theory of decreasing diabetes and obesity.
“There is some rather encouraging evidence that cooling the body, even by a few degrees, may improve or reduce diabetes,” he said.
“Living in a cool environment may be useful to increase insulin sensitivity and ward off diabetes.
“Together with work indicating that adequate sleep can also help avoid obesity and diabetes, maybe we should all aim have a good night’s sleep in a cool bedroom with the windows open to the night breeze.”
A recent study by Maastricht University Medical Centre in the Netherlands advised turning the thermostat down to between 15 C and 17 C for a few hours a day to keep weight down.
The experts claimed that because we spend so much time indoors, often in overheated homes and offices, our bodies do not naturally burn calories to keep warm. Temperatures closer to what it is like outside might be more beneficial to health.
Simply being colder raises the metabolic rate - the speed at which calories are burnt - by 30 per cent, and shivering can burn around 400 calories an hour as it increases the metabolic rate fivefold.
The new research Leiden University Medical Centre, which was published in BMJ Open Diabetes Research & Care,  set out to investigate if global increases in temperature were contributing to the type 2 diabetes epidemic.
Nearly two thirds of Britons are overweight or obese and some 3.6 million people have diabetes, most of which is Type 2.
They looked at temperature data and diabetes incidence in 50 US states as well as the territories of Guam, Puerto Rico and the Virgin Islands.  They found that on average, per one degree centigrade increase in temperature, type 2 diabetes incidence increased by 0.314 per 1,000.
The human body stores two types of fat, white and brown. While white fat stores calories, brown fat is converted into energy and heat so keeping cool is thought to stimulate brown fat, and bring weight loss.
However although the link between a cold body and diabetes is fairly well established, researchers said the idea that it might be linked to climate change was unlikely.
Dr Louise Brown, Senior Statistician at the Medical Research Council Clinical Trials Unit at University College London, said: “Overall, the uncovering of this association is interesting but I do not feel that is of great help in our fight against the increasing global incidence of diabetes, unless they are suggesting that we all move to colder climates.
“If they have stumbled across a useful pointer that leads to appropriate metabolic research on the role of brown fat in the development of diabetes then great, but their claims are too strong at this stage.”
Prof Sir David Spiegelhalter, Winton Professor for the Public Understanding of Risk at the University of Cambridge, added: “Even if these estimates were true, it would mean a 2 degrees rise in average temperature was associated with an increased incidence of diabetes of 0.7 per cent.
“In those circumstances I don't think this would be the biggest concern."

http://www.telegraph.co.uk/science/2017/03/20/open-bedroom-window-night-prevent-obesity-type-2-diabetes-says/

Exercise, diet better than medicine for treating Type 2 diabetes, says UBC group

From vancouversun.com

Taking medication to tightly control and lower blood glucose levels is the advice frequently given by doctors to the 400,000 B.C. residents with Type 2 diabetes — but it’s a “misguided” approach, according to the University of B.C. Therapeutics Initiative.
More than $1 billion is spent annually on diabetes drugs in this province, but in its latest bulletin to doctors, the TI says a growing body of research casts doubt on the effectiveness of Type 2 diabetes treatment. Doctors should focus instead on prescribing lifestyle modifications such as weight loss, exercise and healthier diets instead of medications to many patients, it says.
Type 2 diabetes, characterized by resistance to insulin, is largely caused by obesity, lack of exercise, high-carbohydrate diets and aging.
With the exception of a drug called metformin, many glucose-lowering medications like insulin can lead to weight gain or potentially cause low blood sugar (hypoglycemia), which can lead to falls, driving accidents or even loss of consciousness, the TI says. More than half of Type 2 diabetes patients take such medications. (Insulin is an essential medication for those with Type 1 diabetes, which accounts for less than 10 per cent of all diabetes cases in B.C.).
The TI, an independent body that provides advice to doctors, said the optimal blood glucose level target is actually unknown in Type 2 diabetics, and there’s still no conclusive evidence that taking medications to lower blood glucose levels will decrease complications of the condition. Such complications include kidney disease, blindness, cardiovascular disease, strokes and amputations.
Dr. Tom Perry, a Vancouver internist and clinical pharmacologist with the TI, said doctors tend to minimize harms when prescribing drugs to patients.
At the same time, he says that he’s had few “star” diabetic patients willing to put in the hard work to shrink waistlines, exercise and change diet patterns.
“It’s kind of frightening because we don’t really have the right evidence for treating the Type 2 epidemic. What we’ve been doing is not very scientific,” he said, adding that publicly funded (as opposed to pharmaceutical industry-sponsored) research trials are needed to study the best treatment approaches.
Vancouver endocrinologist Dr. Tom Elliott said he’s in general agreement with the TI that some doctors may be over-treating Type 2 diabetics.
“But there are lots of patients we may be under-treating too. The problem is we don’t know how low the glucose levels should go in order to reduce the risk of bad things happening to patients.”
In an article he wrote last fall, Elliott discussed the growing controversy, saying it is true that in borderline patients, there is little high quality evidence regarding glucose lowering drugs for preventing long-term complications.
“What’s clear is that a concerted effort needs to be made to help high-risk groups to achieve better blood sugar control,” Elliott wrote.
Lawrence Leiter, a professor of medicine and nutritional sciences at the University of Toronto and a specialist in the division of endocrinology at the city’s St. Michael’s Hospital, was critical of the TI bulletin. He said the TI group has been overly selective in choosing which studies to base its recommendations upon.

“In the past two years, we have evidence from large, well-conducted, randomized controlled trials that three different medications for the management of diabetes — empagliflozin (Jardiance), liraglutide (Victoza) and semaglutide (not yet approved) — significantly reduced the risk of cardiovascular events in patients with a history of diabetes and cardiovascular disease, and that empagliflozin also reduced the risk of kidney problems.

“Canadian Diabetes Association clinical practice guidelines have for many years emphasized that we must not just lower blood glucose levels but also improve all risk factors, including blood pressure and cholesterol (and) the most recent update to our guidelines, published in November 2016, now recommend the use of empagliflozin and liraglutide to reduce the risk of complications in appropriate patients.”

http://vancouversun.com/news/local-news/exercise-diet-better-than-medicine-for-treating-type-2-diabetes-says-ubc-group

Can whole-body vibration stave off obesity and diabetes?

From medicalnewstoday.com

An intriguing study, published this week in the journal Endocrinology, compares the benefits of whole-body vibration with regular exercise. Could this innovative intervention help to stave off obesity and diabetes? Preliminary findings suggest that it could.
It is difficult to ignore the obesity crisis currently sweeping across the United States and the rest of the West. As the Centres for Disease Control and Prevention (CDC) write: "Obesity is common, serious, and costly."
More than a third of U.S. adults are obese and, in some states, over 35 percent of adults fall into the obese category.
It is now well documented that obesity brings with it a range of negative health consequences, not least of which is diabetes.
One of the best ways to combat obesity is physical activity, but many people struggle to exercise regularly for a number of reasons. Anything that can either replace or add to the benefits of exercise could be hugely beneficial for a large proportion of the population.

Investigating WBV

WBV involves standing, sitting, or lying on a machine with a vibrating platform. As the machine vibrates, it transmits energy through the body, resulting in muscles contracting and relaxing many times per second.
First tested for its therapeutic benefits in the late 19th century, WBV has been studied for use in a range of situations. For instance, the European Space Agency is investigating it as a potential way to maintain muscle mass on long space flights.
Over recent years, WBV has also been assessed for use in a number of medical conditions. For example, a study in 2009 concluded that WBV might be beneficial for increasing muscle strength in the knees of females with osteoarthritis. Another study from the same year showed that WBV improved cardiorespiratory fitness and muscle strength in older adults. Similarly, an investigation in older adults found that WBV could help to improve balance.
The current project set out to understand whether WBV could mimic the benefits of regular exercise on muscle and bone. McGee-Lawrence and her team studied the effect in a mouse model.

Obesity, diabetes, and WBV

Five-week-old male mice were used in the study: half were normal mice, and the rest were genetically unresponsive to leptin. Leptin is a hormone that helps to generate a sense of fullness; animals without a leptin response are predisposed to overeating and are therefore more likely to develop obesity and diabetes.
Both types of mice were split into three experimental groups:

• WBV group - 20 minutes per day
• treadmill exercise group - 45 minutes of walking daily
• sedentary - no exercise

For the first week, the mice were allowed to get used to their equipment. Then, a 12-week exercise regimen began. They were weighed each week.
At the end of the trial, the genetically obese, diabetic mice showed similar benefits from both treadmill exercise and WBV. The obese mice gained less weight following WBV and exercise than the obese mice in the sedentary group, although they were still heavier than the normal mice.
Both exercise and WBV increased muscle mass and improved insulin sensitivity in the obese mice.

Although WBV is not intended to entirely replace exercise, it could play an important role for individuals who either cannot exercise or cannot exercise enough. However, although the results are encouraging, they should be reinterpreted with caution; as McGee-Lawrence says, "because our study was conducted in mice, this idea needs to be rigorously tested in humans to see if the results would be applicable to people."

http://www.medicalnewstoday.com/articles/316383.php

How Managing Diabetes Can Protect Your Kidneys

From futureofpersonalhealth.com

Do you have diabetes or high blood pressure? Are you African-American, Hispanic, Native American or Asian? Do you have a family member with kidney disease? If you said yes to any of these questions, it is especially important to learn about your kidneys and how to maintain good kidney health.
In talking to people who have had kidney failure and also have diabetes, I have heard it said, “I had never even heard of kidney disease and had no idea how important my kidneys were.”

The blood link

The kidneys filter the blood and rid the body of waste products. They reabsorb needed fluid, electrolytes and minerals, and regulate hormones responsible for red blood cell production and bone health. Some ways to prevent kidney disease include controlling blood pressure and cholesterol, maintaining a healthy weight and quitting smoking.
One of the major ways to prevent kidney disease is by managing diabetes. Goals for management of diagnosed kidney disease include all of the above as well as adjusting medications if your blood sugar is not at goal, avoiding low blood sugar levels, and making needed dietary adjustments.
It is important to become educated in diabetes self-management to decrease your risk of developing kidney disease, blindness, foot or limb amputations, and other complications. People often say that they cannot tolerate blood sugar levels below 200 mg/dL, or that an elevated level is “normal for me.” Intolerance of acceptable blood sugar levels occurs when the levels have been running too high for too long. Avoid symptoms and further complications by slowly lowering your blood sugar to the appropriate level.

Taking control

Diabetes is a self-managed disease. That means that choices you make or do not make affect how well you can manage your diabetes. However, less than seven percent of people with diabetes receive proper education. The best way to learn about diabetes is to find a diabetes educator. Diabetes educators can be nurses, dietitians, pharmacists and other healthcare professionals who are experts in the art of diabetes education and management. They assist you in setting and achieving goals, problem solving, and establishing healthy behaviours that work for you; ultimately leading to improved health.
Organizations like the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) offer resources on diabetes education and self-management. You can find a diabetes educator near you at diabeteseducator.org. By taking a few steps to manage your diabetes, you can prevent and preserve kidney function for a healthier and happier life.

http://www.futureofpersonalhealth.com/prevention-and-treatment/how-managing-diabetes-can-protect-your-kidneys?utm_source=propeller

Types of diabetes

From telegraph.co.uk

Type 1 diabetes

Occurs when the pancreas (a small gland behind the stomach) doesn’t produce insulin – the hormone that regulates blood glucose levels. If the amount of glucose in the blood is too high, it can, over time, damage the body’s organs.
Just 10 per cent of all diabetes is type 1 but it’s the most common type of childhood diabetes.

Type 2 diabetes

The body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. This means that glucose remains in the bloodstream and isn’t used as fuel for energy.
90 per cent of adults with diabetes have type 2, and it tends to develop later in life

Gestational diabetes

Around one in 20 pregnant women experience such high blood sugar that their bodies are unable to produce enough insulin to metabolise it. This needs to be managed during pregnancy but almost always clears up after giving birth.

Source: NHS Choices

Type 2 diabetes can be reversed in just four months, trial shows

From telegraph.co.uk

Type 2 diabetes can be reversed in just four months by cutting calories, exercising and keeping glucose under control, a trial has shown.
Although the condition is considered to be chronic, requiring a lifetime of medication, Canadian researchers proved it was possible to restore insulin production for 40 per cent of patients.
The treatment plan involved creating a personalised exercise regime for each trial participant and reducing their calories by between 500 and 750 a day. The participants also met regularly with a nurse and dietician to track progress and continued to take medication and insulin to manage their blood sugar levels.
After just four months, 40 per cent of patients were able to stop taking their medication because their bodies had begun to produce adequate amounts of insulin again.
The researchers at McMaster University in Ontario, Canada, said the programme worked because it gave the insulin-producing pancreas ‘a rest.’
"The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for any signs of relapse," said the study's first author, Dr Natalia McInnes, of McMaster.
"The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes.
“This likely gives the pancreas a rest and decreases fat stores in the body, which in turn improves insulin production and effectiveness."
"The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes.
The number of people in the UK with type 2 diabetes has trebled over the last two decades, rising from 700,000 in the 1990s to 2.8 million today, according to new figures from Cardiff University. The condition costs the NHS around £14 billion a year, but if the intervention worked at the same level for Britons, then more than one million people could benefit.

The condition occurs when an individual does not produce enough insulin, the hormone that allows cells to absorb glucose into the blood, or when the insulin that is produced does not work properly.
As a result, blood sugars build up in the body and the cells do not receive the energy they need. Over time type 2 diabetes can lead to damage to the blood vessels, nerves and organs and trigger kidney disease and blindness. It also increases the risk of a heart attack and stroke.
The increased number of people with the disease has been linked to rising levels of obesity.  Between 1993 and 2010 the proportion of obese people in the UK went from 13 per cent to 26 per cent for men and from 16 per cent to 26 per cent for women.
The charity Diabetes UK is currently funding a large trial to find out if a low-calorie diet can put type 2 diabetes into remission in the long term.
Emily Burns, the research communications manager of Diabetes UK said: “We’re looking forward to seeing the results in 2018. In the meantime, we encourage people with Type 2 diabetes to follow a healthy diet that is low in sugar, saturated fats and salt.
“We know that diet, exercise and medications can help people with Type 2 diabetes to manage their condition. We’re starting to see mounting evidence that putting Type 2 diabetes into remission is feasible as well.”
Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, said: "We know now that intensive diet changes – with calorie restriction over period of few weeks to few months can reverse diabetes in many patients but what we need to determine are ways to keep the weight off and keep people in diabetes 'remission'.

"What happens with weight loss per se is that fat is sucked out of key organs relevant to the efficient metabolism of sugar so this means liver, muscles and pancreas lose fat and start to restore their normal functions leading to lower sugar levels. 
"The present trial is unusual in that it also uses drugs to help get to low glucose levels in the short term with the hypothesis that getting sugars to normal may also help reduce toxic effects on pancreas and kick starts its function.
"However, this is a very controversial hypothesis.  Most researchers think that in order to have diabetes undergo proper 'remission' it’s about more substantial weight loss, without use of drugs and to sustain benefits required keeping most of the weight lost off.   I tend to agree with latter notion." 
The research was published in the Journal of Clinical Endocrinology & Metabolism.
Elsewhere researchers from Copenhagen University Hospital in Denmark warned that ibuprofen should not be sold over the counter after finding that it raised the risk of a heart attack by 31 per cent.

http://www.telegraph.co.uk/science/2017/03/15/type-2-diabetes-can-reversed-just-four-months-trial-shows/