Early diet modification may prevent type 1 diabetes in children

Within the next 10 years the EU-funded Diabetes Prevention study, part of an international study called TRIGR (Trial to Reduce IDDM in the Genetically at Risk), coordinated at the University of Helsinki, Finland, will generate a definite answer to the question whether early nutritional modification may prevent type 1 diabetes later in childhood.

Type 1 diabetes is a growing health problem among European children. European data indicate that the disease incidence has increased five-six-fold among children under the age of 15 years after World War II, and there are no signs that the increase in incidence is levelling off. The most conspicuous increase has been seen among children under the age of 5 years.

The TRIGR study is the first study ever aimed at primary prevention of type 1 diabetes. The study is designed to answer to the question whether excluding cow’s milk protein from the infant’s diet decreases the risk of future diabetes. All subjects are followed for 10 years to get information on whether the dietary recommendations for infants at increased genetic risk of type 1 diabetes should be revised.

Starting in May 2002, 76 study centres from 15 countries (Australia, Canada, the Czech Republic, Estonia, Finland, Germany, Hungary, Italy, Luxembourg, the Netherlands, Poland, Spain, Sweden, Switzerland and USA) have been recruiting families for the study. To be eligible the newborn infant has to have at least one family member (mother, father and/or sib) affected by type 1 diabetes and carry a HLA genotype conferring increased risk for type 1 diabetes. The initial recruitment target of 2032 eligible infants was reached at the be-ginning of September 2006, but the Study Group has decided to continue recruitment till the end of December 2006 (when the EU contribution will finish) to make the study even more powerful statistically.

A majority of the study participants (52%) have been recruited in Europe. The International Coordinating Cen-tre (ICC) is located at the University of Helsinki, Helsinki, Finland and the Data Management Unit (DMU) at the University of South Florida, Tampa, Florida, USA. The trial has logistically been a true challenge for both the ICC and DMU. DMU has been successful in establishing a secure, real-time, web-based, interactive data management system that works extremely well. This system can be directly applied to future international mul-ticentre studies.

The TRIGR study is generating a wealth of information on breast-feeding practices, infant nutrition and growth in young children in various countries. At 2 weeks of age almost all the participating infants were breast-fed. Exclusive breast-feeding continued longer in Europe than in North America. More than one third of the infants (35 %) received other foods in addition to breast milk and/or infant formulas at the age of 4 months, while WHO recommends that supplementary food should be introduced at the earliest by the age of 6 months. In Europe the first foods to be introduced are typically vegetables and fruits, whereas gluten-free cereals are most commonly introduced in North America.

Newborn infants in Northern Europe (NE) had a higher birth weight but a shorter birth length than infants in Central and Southern Europe (CSE). The NE children remained heavier than those from CSE at least up to the age of 18 months. The NE children were also taller than the CSE children starting already from the age of 3 months up to the age of 18 months. Accelerated growth in infancy has been identified as a risk factor for type 1 diabetes later in childhood. Accordingly the observed growth pattern may contribute to the higher incidence of type 1 diabetes in NE compared to CSE.

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Article adapted by MD Only Weblog from original press release.
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Contact: Hans K. Åkerblom
University of Helsinki

More information:
Study websites: http://www.trigr.org

Herbal medicine silymarin shown to help lower blood sugar in type II diabetes

Diabetes is a growing health problem. Giving antioxidants is recognised as one way of helping people with diabetes to control their blood sugar levels.

The herbal medicine extracted from seeds of the Milk Thistle, Silybum marianum (silymarin) is known to have antioxidant properties and research published this week in Phytotherapy Research shows that this extract can help people significantly lower the amount of sugar bound to haemoglobin in blood, as well as reducing fasting blood sugar levels.

Silymarin contains a number of active constituents called flavolignans which are also used to help protect the liver from poisoning.

“We don’t know the exact mechanism of action for this effect, but this work shows that silymarin could play an important role in treating type II diabetes,” says lead author Fallah Huseini, who works at the Institute of Medicinal Plants, which is based in Tehran, Iran.

The data came from a randomized double-blind clinical trial involving 51 people who had had type II diabetes for at least 2 years. One group of 25 patients received 200 mg of silymarin three times a day for 4 months, while the remaining 26 received a placebo treatment. All of the patients continued to use conventional oral hypoglycaemic treatment during the trial. Patients were examined at monthly intervals.

Compared with the beginning of the trial, the treatment group had a significant reduction in fasting blood glucose levels (p<0.001), and a reduction in glycosylated haemoglobin (p<0.001). Both of these measures rose significantly in the placebo group (p<0.0001). There were also non-significant decreases in blood lipids in the treatment group.

“The results are very encouraging, and we now need to do further large multi-centre studies,” says Huseini.

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Article adapted by MD Only Weblog from original press release.
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Huseini, H.F: The Efficacy of Silybum marianum (L.) Gaertn. (Silymarin) in the Treatment of Type II Diabetes: A Randomized, Double-blind, Placebo-controlled, Clinical Trial

Phytotherapy Research is an international journal for the publication of original medicinal plant research, focussing on pharmacology, toxicology and the clinical applications of herbs and natural products in medicine. Papers concerned with the effects of common food ingredients and standardised plant extracts, including commercial products, and mechanistic studies on isolated natural products are particularly welcome. Papers and communications range from case studies to full clinical trials, including studies of herb-drug interactions and other aspects of the safety of herbal medicines. Phytotherapy Research can be accessed online at: http://www.interscience.wiley.com/journal/ptr

John Wiley & Sons Ltd., with its headquarters in Chichester, England, is the largest subsidiary of John Wiley & Sons, Inc. Founded in 1807, John Wiley & Sons, Inc., provides must-have content and services to customers worldwide. Its core businesses include scientific, technical, and medical journals, encyclopaedias, books, and online products and services; professional and consumer books and subscription services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley has publishing, marketing, and distribution centres in the United States, Canada, Europe, Asia, and Australia. The company is listed on the New York Stock Exchange under the symbols JWa and JWb. Wiley’s Internet site can be accessed at http://www.wileyeurope.com/
Contact: Polly Young
John Wiley & Sons, Inc.

Hope for Diabetics at risk of blindness

Brand new research launched at the British Pharmaceutical Conference in Manchester is bringing hope to hundreds of people with diabetes who lose their sight each year as a side-effect of the disease.

People with diabetes commonly experience blindness, or a reduction in sight, when a lack of oxygen at the back of the eye causes tiny blood vessels to overgrow into the vitreous humour, which is a jelly like substance. This jelly like substance is removed during surgery to treat this problem.

Pharmaceutical researchers at the University of East Anglia have revealed that they are developing an artificial form of this vitreous humour so that it can be replaced following surgery or if it has been damaged or degenerated for other reasons.

Biologist Janine Morris working with Pharmacist Susan Barker and Biologist Julie Sanderson at the School of Chemical Sciences and Pharmacy, University of East Anglia, is identifying the essential characteristics of the human and pig vitreous humour so that they can be mimicked artificially.

She says: “I am currently making a gel that imitates the vitreous humour and which is non-cytotoxic to the human eye. The substance will also include anti-angiogenic drugs to prevent the blood vessels re-growing and the original damage re-occurring.”

Placing this artificial jelly into the damaged eye should certainly improve and potentially restore lost sight. Janine Morris says that the research, which is in the preliminary stages, is good news for diabetes sufferers who will be protected against recurring damage. “The idea that we can potentially improve and maintain sight for diabetes sufferers by replacing the vitreous humour is amazing,” she says.

The vitreous humour is a clear gel-like substance that fills the space between the lens and the retina of the eye. It is 99% water but also contains collagen fibres, inorganic salts, acids and sugar.

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Article adapted by MD Only Weblog from original press release.
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For further information please visit:
The University of East Anglia

Diabetes is the leading cause of blindness among people aged 20-74 in Minnesota. Each year, according to the Minnesota Department of Health (MDH), between 400 and 700 Minnesotans go blind due to diabetes complications. Even when blood sugar is controlled, 60% of those having diabetes for more than 15 years will experience some form of diabetic eye disease in their lifetime.November is American Diabetes Month. This is a good time to schedule your annual dilated eye exam, urges the Minnesota Optometric Association (MOA), because type 2 diabetes can be caught early with this exam, and treated. MDH statistics show that of the 276,000 Minnesotans who have diabetes, 96,000 are unaware that they have it.

Currently, only eight in 10 Minnesotans with diabetes have a dilated eye exam every two years. “Most people do not realize that diabetics are twice as likely to suffer from cataracts, diabetic retinopathy and glaucoma. People may have these diseases before they are aware of it,” said Dr. Dirk Colby, president of the MOA and a doctor of optometry with West Metro Ophthalmology, Golden Valley and Plymouth, Minnesota. “It is critical for diabetic patients to come in every year,” said Dr. Colby. “Waiting two years or even worse, not coming in at all, can have a catastrophic effect.”

Diabetes is taking its toll on Americans and Minnesotans with eye diseases and type 2 diabetes is increasing rapidly due to the increase in obesity and decrease in exercise. These two risk factors are the leading causes of type 2 diabetes.

Diabetic retinopathy, the most common diabetic eye disease, is the leading cause of blindness in Minnesota, and overall in the United States. Diabetic retinopathy is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid; in others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

Cataracts occur when the normally clear lens in the eye becomes cloudy, impairing vision. Clouded vision may make it more difficult to read, drive, or see clearly. Glaucoma, an increase in fluid pressure inside the eye, leads to optic nerve damage and vision loss.

To help prevent diabetic eye diseases, the American Diabetes Association recommends people suffering from diabetes should:

• Keep your blood sugar under good control. People who keep their blood sugar levels closer to normal are less likely to have retinopathy.
• Bring high blood pressure down. High blood pressure can make eye problems worse.
• Get a dilated eye exam by a family eye doctor every year. Your optometrist will use drops to enlarge your pupils to look inside your eyes.

The Minnesota Optometric Association (MOA) recommends you see your family eye doctor right way if you have any of the following problems:

• Your vision is blurry.
• You see double, spots or floaters
• One or both eyes hurt
• You feel pressure in your eye
• You can’t see things at the periphery as well as before
• You have trouble reading

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Article adapted by MD Only Weblog from original press release.
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Contact:
Jim Meffort-Nelson
minnesota.aoa.org

Plant pigment in cherries helps lower sugar levels

Perhaps George Washington wouldn’t have chopped down his father’s cherry tree if he knew what chemists now know. They have identified a group of naturally occurring chemicals abundant in cherries that could help lower blood sugar levels in people with diabetes. In early laboratory studies using animal pancreatic cells, the chemicals, called anthocyanins, increased insulin production by 50 percent, according to a peer-reviewed study scheduled to appear in the Jan. 5 issue of the American Chemical Society’s Journal of Agricultural and Food Chemistry. ACS is the world’s largest scientific society.Anthocyanins are a class of plant pigments responsible for the color of many fruits, including cherries. They also are potent antioxidants, highly active chemicals that have been increasingly associated with a variety of health benefits, including protection against heart disease and cancer.

“It is possible that consumption of cherries and other fruits containing these compounds [anthocyanins] could have a significant impact on insulin levels in humans,” says study leader Muralee Nair, Ph.D., a natural products chemist at Michigan State University in East Lansing. “We’re excited with the laboratory results so far, but more studies are needed.” Michigan is the top cherry producing state in the nation.

Until human studies are done on cherry anthocyanins, those with diabetes should continue following their doctor’s treatment recommendations, including any medicine prescribed, and monitor their insulin carefully, the researcher says. The compounds show promise for both the prevention of type 2 (non-insulin-dependent) diabetes, the most common type, and for helping control glucose levels in those who already have diabetes, he adds.

While fresh cherries and fruits containing these anthocyanins are readily available, medicinal products may be the most efficient way to provide the beneficial compounds, according to Nair. It’s possible that anthocyanins eventually could be incorporated into new products, such as pills or specialty juices that people could take to help treat diabetes. Such disease-specific products may take several more years to develop, he notes.

Scientists in Nair’s laboratory have even developed a unique process, patented by the university, for removing sugar from fruit extracts that contain anthocyanins. This could lead to “sugar-free” medicinal products for people with diabetes.

The current study, partially funded by the U.S. Department of Agriculture, involved tart cherries (also known as sour cherries or pie cherries), a popular variety in the United States, and the Cornelian cherry, which is widely consumed in Europe. Nair and his associates, B. Jayaprakasam, Ph.D., L.K. Olson, Ph.D., and graduate student S. K. Vareed, tested several types of anthocyanins extracted from these cherries against mouse pancreatic-beta cells, which normally produce insulin, in the presence of high concentrations of glucose.

Insulin is the protein produced by the pancreas that helps regulate blood sugar (glucose) levels. Compared to cells that were not exposed to anthocyanins, exposed cells were associated with a 50 percent increase in insulin levels, the researchers say. The mechanism of action by which these anthocyanins boost insulin production is not known, Nair says.

Nair and his colleagues are currently feeding anthocyanins to a group of obese, diabetic mice to determine how the chemicals influence insulin levels in live subjects. Results of these tests are not yet available.

Although other fruits, including red grapes, strawberries and blueberries, also contain anthocyanins, cherries appear to be the most promising source of these compounds on the basis of serving size, according to the researcher. The compounds are found in both sweet and sour (tart) cherry varieties.

The potential benefits of cherries extend beyond diabetes. Previous studies by the researcher found that certain anthocyanins isolated from cherries have anti-inflammatory properties and may be useful in fighting arthritis. Nair’s colleagues have found that cherries also may help fight colon cancer.

But people with diabetes are encouraged to use caution when it comes to consuming maraschino cherries, the bright red candied version that adorns ice cream and cocktails, Nair points out. Many of the beneficial cherry pigments that were present in the fresh fruit have been removed during processing, replaced with food coloring, and extra sugar has been added.

The American Chemical Society is a nonprofit organization, chartered by the U.S. Congress, with a multidisciplinary membership of more than 159,000 chemists and chemical engineers. It publishes numerous scientific journals and databases, convenes major research conferences and provides educational, science policy and career programs in chemistry. Its main offices are in Washington, D.C., and Columbus, Ohio.

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Article adapted by MD Only Weblog from original press release.
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Contact: Michael Bernstein
American Chemical Society

Adding Vitamins C and E to diet improves effectiveness of insulin

Adding antioxidants to therapy improves drug’s ability to reduce blood sugar

Boosting insulin with vitamins C and E may improve the drug’s effectiveness for treating diabetes.

A UC Irvine College of Medicine study has found that the popular antioxidant supplements not only enhance insulin’s ability to reduce blood sugar, but also lower the risks of organ damage that can occur despite insulin treatments. The study appears in the January issue of Kidney International.

Dr. Nick Vaziri, professor of medicine, and his team found that untreated diabetes raised blood pressure and increased the production of damaging oxidizing agents called free radicals. The free radicals converted sugars and proteins into harmful chemicals, increasing the risks of tissue damage often seen in untreated diabetes.

Treating the rats with insulin alone improved high blood pressure somewhat and partially spared the sugars and proteins from the free radicals’ assault. But it also added a new problem, as the free radicals turned their attack on nitric oxide, a ubiquitous molecule that usually protects the body from free radicals. This new attack results in yet more toxic chemicals, with the potential to inflict damage to tissues.

Adding vitamins C and E to insulin, however, spared the sugars, proteins and nitric oxide from attack.

“Blood pressure was lowered to normal, and free radicals were not in sufficient numbers to degrade the sugars, proteins and nitric oxide,” Vaziri said. “We think this shows that a diet rich in antioxidants may help diabetics prevent the devastating cardiovascular, kidney, neurological and other damage that are common complications of diabetes.”

Diabetes affects nearly 17 million Americans. Insulin is the predominant treatment, but patients eventually develop complications, like various forms of heart disease and nerve, liver and kidney damage. Studies would still have to be tested in humans, but Vaziri believes that adding vitamins C and E to an insulin-dependent diabetic’s diet should help treat the disease and perhaps prevent future organ damage.

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Article adapted by MD Only Weblog from original press release.
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Contact: Andrew Porterfield
University of California – Irvine

Ginseng extract fights diabetes, lowers cholesterol and decreases weight

An extract from the ginseng berry shows real promise in treating diabetes and obesity, reports a research team from the University of Chicago’s Tang Center for Herbal Medicine Research. In the June issue of the journal Diabetes, they show that the extract completely normalized blood glucose levels, improved sensitivity to insulin, lowered cholesterol levels, and decreased weight by reducing appetite and increasing activity levels in mice bred to develop diabetes.For more than 2000 years, traditional Chinese medicine has used ginseng root to treat a variety of ailments. This study focused instead on substances found in the ginseng berry, which has very different concentrations of ginsenosides, the substances thought to be medically useful.

“Ginseng berry has a distinctive chemical profile and has not previously been used for therapy,” said Chun-Su Yuan, M.D., Ph.D., assistant professor of anesthesia and critical care at the University of Chicago and director of the study. “We were stunned by how different the berry is from the root and by how effective it is in correcting the multiple metabolic abnormalities associated with diabetes.”

Yuan’s team, which included researchers from the Tang Center, anesthesia, clinical pharmacology and medicine, studied the effects of the extract, made from the pulp of the berry. They also studied one particular substance known as ginsenoside Re, which is concentrated in ginseng berries but quite scarce in the root.

They tested the extract by injecting it once a day into mice with a gene defect that causes weight gain and type 2 diabetes. They found that —

• Daily injections of 150 mg/kg of the ginseng berry extract restored normal blood-sugar levels in diabetic mice. Blood-glusoce levels fell from 222 mg/dl (quite high for a mouse) to 137 mg/dl (normal) within 12 days. Treated mice also had better scores on a glucose tolerance test, which measures how quickly the mice could remove excess glucose from the blood.
• The extract caused diabetic mice, which were also obese, to lose more than 10 percent of their body weight in 12 days. Untreated mice gained five percent of their weight in 12 days. The treated mice ate 15 percent less and were 35 percent more active than untreated mice. Once the injections stopped, weight gain gradually resumed.
• The extract improved insulin secretion and insulin sensitivity, both of which were abnormal in mice with diabetes.
• Treated diabetic mice had 30 percent lower cholesterol levels than untreated diabetic mice (117mg/dl versus 169mg/dl).

The extract had no detectable effect on normal mice.

Tests using a ginsenoside Re alone found that it had all of the anti-diabetic but none of the obesity-fighting activities of the extract.

“This novel compound could serve as the basis for a whole new class of anti-diabetic medications,” said Yuan, who is also working to isolate other substances from the extract that contributed to the weight loss.

There is a pressing need for new and more effective drugs for both diabetes and obesity. Diabetes is the seventh leading killer in the U.S. Type 2 diabetes affects almost six percent of the U.S. population and 18.4 percent of those over 65. The cost of the disease is estimated at $105 billion each year.

The U.S. Surgeon General estimates that 61 percent of adults are overweight or obese. Obesity — wieghing more than 20 percent over your maximum recommended body weight — contributes to an estimated 300,000 deaths each year. The economic cost of obesity in the U.S. was about $117 billion in 2000. The rising rate of obesity also contributes to the growing prevalence of type 2 diabetes.

“Since this berry contains agents that are effective against both obesity and diabetes, the ginseng fruit has enormous promise as a source of new drugs,” said Yuan, who has worked with the University to apply for a patent on the development of ginsenoside Re as a diabetes medication.

“The next step is to isolate the other substances in the extract, find out whether they also effect glucose regulation or weight gain, learn how they work and determine the safe and effective dose.”

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Article adapted by MD Only Weblog from original press release.
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Contact: John Easton
University of Chicago Medical Center

Additional authors of the study were Anoja Attele, Yun-Ping Zhou, Jing-Tian Xie, Ji An Wu, Liu Zhang, Lucy Dey, William Pugh and Paul Rue of the University of Chicago and Kenneth Polonsky, now at Washington University in St. Louis. The research was funded by the Tang Family Foundation and the National Institutes of Health.