type 2 diabetes

#Type 2 diabetes and #cancer risk: real-world data

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A new study has identified a significantly increased risk for cancers among patients with type 2 diabetes (T2D), with its authors suggesting that strategies for cancer-specific screening and prevention among patients with T2D should be established in clinical practice.

Researchers examined data on 410,191 patients with T2D from the Shanghai Hospital Link database in China, who were identified from July 2013 to December 2016 and followed-up for cancer incidence until December 2017.

Overall, 8,485 cases of cancer were identified. The researchers found men and women with diabetes had a 34 per cent and 62 per cent higher risks of developing cancer than men and women in the general population, respectively.

Among men, the risk of cancer of the prostate, skin, thyroid, kidney, liver, pancreas, lung, colorectum and stomach, and leukaemia and lymphoma, was increased significantly, while there was a decrease in the risk of oesophageal cancer.

In women, there were significantly greater risks of lymphoma, leukaemia and cancer of the nasopharynx, liver, oesophagus, thyroid, lung, pancreas, uterus, colorectum, breast, cervix and stomach, and a decreased risk of gallbladder cancer.

Writing in the Journal of Diabetes, the authors said future studies are needed to distinguish the effects of T2D from those of common risk factors.

#High prolactin may protect against #type 2 diabetes

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  • Noticias Médicas Univadis

New research published in Diabetologia suggests that higher circulating total prolactin concentrations in women are inversely associated with incident type 2 diabetes (T2D).

Researchers analysed data on 8,615 women from the US Nurses’ Health Study (NHS) and the NHS II to examine the prospective relationship between circulating prolactin concentrations and T2D risk.

Across a follow-up period of up to 22 years, 699 cases of T2D were documented. The authors observed an inverse association between total circulating prolactin levels and T2D risk. Women in the top quartile of prolactin levels were 27 per cent less likely to develop T2D than those in the lowest quartile (HR 0.73; 95% CI 0.55-0.95; Ptrend=.02). The authors said the association did not differ by menopausal status, but appeared time-varying, with stronger associations observed within the first 9-10 years of follow-up after blood draw.

“Our epidemiological observations, coupled with previous population data and emerging experimental evidence, support a potential protective role of prolactin within the biologically normal range in the development of type 2 diabetes risk in women,” the authors said. They added that more research is needed to understand the biological mechanisms underlying the association, which may lead to the development of new strategies for early prevention and treatment of T2D.

#Planned intermittent fasting may help reverse #type 2 diabetes

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  • Noticias Médicas Univadis

Therapeutic fasting may help reverse type 2 diabetes (T2D) suggest the authors of a new case series of three male patients who were able to cease insulin therapy after following such a regimen.

All three patients were referred to the Intensive Dietary Management clinic in Toronto, Canada, for insulin-dependent T2D. They attended a six-hour nutritional training seminar before embarking on a fasting regimen. Patients 1 and 3 followed alternating-day 24-hour fasts, while patient 2 followed a triweekly 24-hour fasting schedule for approximately 10 months. On fasting days, the patients consumed dinner only, whereas on non-fasting days the patients consumed lunch and dinner.

All three patients eliminated the need for insulin with a month, with one patient ceasing insulin therapy after five days. Two of the men discontinued all diabetic medications entirely, while the third discontinued three out of four medications following the fasting regimen. There was also a general reduction of haemoglobin A1C (HbA1C) levels for all patients, and all experienced weight loss of at least 10 per cent.

Presenting the findings in BMJ Case Reports, the authors said educating patients on the benefits of fasting in the management of T2D may aid in the remission of the disease and curtail the use of pharmacological interventions.

#Insulin Glargine/#Breast Cancer Link Seen Again in #Type 2 Diabetes

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Marlene Busko

In a large observational study, women with type 2 diabetes who received long-acting insulin glargine (Lantus, Sanofi) had a 1.4-fold increased risk of breast cancer compared with women who were given intermediate-acting neutral protamine Hagedorn (NPH) insulin during roughly 4 years and up to 12 years of follow-up.

In contrast, those who received insulin detemir (Levemir, Novo Nordisk) did not have any increased risk of breast cancer.

Of note, the breast-cancer signal with insulin glargine was only significant among prior insulin users and not new users.

And this signal does not mean clinicians should change clinical practice without a review by regulatory agencies, caution the investigators, led by Jennifer W Wu, MD, of McGill University, Montreal, Quebec, who published their paper in the Journal of Clinical Oncology.

“Despite these findings, the benefits and risk of insulin glargine must be considered by drug regulatory agencies before any changes in clinical practice can be made,” they conclude.

The fact that the increased risk of breast cancer was only seen in women with prior exposure to insulin, “an unusual group of type 2 [diabetes] women,” suggests “the safety signals may be nuanced, with specific types of insulin,” said Craig Currie, PhD, an epidemiologist from Cardiff University, Wales, who was not involved with the study.

Nevertheless the “findings add to an increasing body of evidence that questions the safety of insulin in people with type 2 diabetes more generally,” he told Medscape Medical News in an email.

New Study as Long-Acting Insulins Have Been Available for Longer

The issue of cancer risk associated with insulin, which is a potential growth factor, isn’t new and has reared its head before in relation to insulin glargine in particular.

Several observational studies have looked at whether insulin glargine is associated with an increased risk of breast cancer and have come up with conflicting results, Dr Wu and colleagues explain as background.

Moreover, in the randomized Outcomes Reduction Insulin Glargine Intervention (ORIGIN) trial, which had adjudicated cancer outcomes reported in 2013, only roughly 4000 of the 12,500 patients were women, and there were only 56 cases of breast cancer during follow-up, which was “insufficient power for site-specific cancers such as breast and also…too short a follow-up for the necessary latency.”

Thus “to date, the US Food and Drug Administration finds the evidence is inconclusive and suggests that more epidemiologic data are needed,” they observe.

So they aimed to assess the risk of breast cancer with insulin analogs, “now that these insulins have been on the market for a longer time.”

They identified 22,395 women with type 2 diabetes in the UK Clinical Practice Research Datalink (CPRD) who had not been prescribed insulin before age 40, had not had gestational diabetes or any cancer, but had received at least one prescription of insulin glargine, detemir, or NPH during 2002–2012.

On average, the women received 5.4 to 5.8 insulin prescriptions each year.

During follow-up, 108 of 9549 women who received NPH, 176 of 9575 women who received insulin glargine, and 37 of 3271 women who received insulin detemir developed breast cancer.

The incidence rates of breast cancer were 35.1, 48.7, and 14.8 per 1000 person-years for women who received NPH, glargine, and detemir, respectively.

New Insulin Users Not at Risk?

Those who received insulin glargine for 5 or more years had a roughly twofold increased risk of breast cancer compared with the reference group (women who received NPH) and women who were switched to insulin glargine from another insulin had an approximately 1.5-fold increased risk of developing breast cancer.

#Omega-6 may help prevent #type 2 diabetes

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The risk of developing type 2 diabetes (T2D) could be significantly reduced by eating a diet rich in omega-6 polyunsaturated fats, a new study suggests.

While recent studies have raised concerns that omega-6 may have negative health effects, such as inflammation, this latest research supports clinical recommendations to increase dietary intake of omega-6 rich foods.

For the study, scientists analysed data from 20 studies involving 39,740 adults from 10 countries, in whom 4,347 new cases of diabetes occurred over time. They found that higher proportions of linoleic acid biomarkers as percentages of total fatty acid were associated with a lower risk of type 2 diabetes overall. They also found levels of arachidonic acid were not significantly associated with risk of diabetes.

“Some scientists have theorised that omega-6 is harmful to health,” said lead author Dr Jason Wu, of the George Institute for Global Health in Sydney. “But based on this large global study, we have demonstrated little evidence for harms, and indeed found that the major omega-6 fat is linked to lower risk of type 2 diabetes”.

The findings are published in The Lancet Diabetes & Endocrinology.

#Type 2 diabetes: Can #lifestyle intervention alone improve #glycaemic control?

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New findings suggest intensive diet and exercise interventions may result in modest improvements for patients.

A new study, which set out to determine if an intensive lifestyle intervention results in equivalent glycaemic control compared with standard care in patients with type 2 diabetes (T2D) has determined that while such interventions don’t reach the criterion for equivalence, they result in a modest reduction in blood glucose levels.

For the study, almost 100 adults with non-insulin-dependent T2D, who were diagnosed for less than 10 years, were randomised to a standard care group or a lifestyle group.

All participants received standard care with individual counselling and standardised, target-driven medical therapy. Additionally, the lifestyle group received five to six weekly aerobic training sessions as well as dietary plans aiming for a body mass index of 25 or less.

After 12 month follow up, average haemoglobin A1c (HbA1c) levels changed from 6.65 per cent to 6.34 per cent in the lifestyle group and from 6.74 per cent to 6.66 per cent in the standard care group. Writing in JAMA , the authors said while the change did not meet a prespecified criterion for equivalence between groups, the changes in glycaemic control suggest potential benefit.
Reduction in glucose-lowering medications occurred in 73.5 per cent and 26.4 per cent of lifestyle and standard care participants respectively.

Vegetarian diet almost twice as effective for weight loss

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Even though all participants reduced their calorie intake by 500kcal/day, those who went vegetarian lost more body weight and muscle fat.

Dieters who go vegetarian not only lose weight more effectively than those on conventional low-calorie diets but also improve their metabolism by reducing muscle fat, a new study published in the Journal of the American College of Nutrition has found.

Since losing muscle fat improves glucose and lipid metabolism, this finding is particularly important for people with metabolic syndrome and type 2 diabetes, says lead author, Dr. Hana Kahleová, Director of Clinical Research of the Physicians Committee for Responsible Medicine in Washington DC.

Seventy-four subjects with type 2 diabetes were randomly assigned to follow either a vegetarian diet or a conventional anti-diabetic diet. The vegetarian diet consisted of vegetables, grains, legumes, fruits and nuts, with animal products limited to a maximum of one portion of low-fat yoghurt per day. The conventional diabetic diet followed the official recommendations of the European Association for the Study of Diabetes (EASD). Both diets were restricted by 500 kilocalories per day compared to individual normal calorie intake.

The vegetarian diet was found to be almost twice as effective in reducing body weight, resulting in an average loss of 6.2kg compared to 3.2kg with the conventional diet.

Low gluten diet may be a risk factor for type 2 diabetes

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Gluten-free diets have grown in popularity in recent years, but evidence is lacking regarding gluten intake and long-term health.

A new study which set out to determine if gluten consumption will affect health in people with no apparent medical reasons to avoid gluten has found that doing so may increase a patient’s risk of developing type 2 diabetes (T2D).

After examining data for 199,794 participants in three long-term health studies, researchers found that most participants had gluten intake below 12 grams/day, and within this range, those who ate the most gluten had lower T2D risk during thirty years of follow-up.
Study participants who ate less gluten also tended to eat less cereal fibre, a known protective factor for T2D development. After adjusting for cereal fibre, individuals in the highest 20 per cent of gluten consumption had a 13 per cent lower risk of developing T2D in comparison to those with the lowest daily gluten consumption (approximately fewer than 4 grams).
Commenting on the findings, Geng Zong, research fellow in the Department of Nutrition at Harvard University’s T.H. Chan School of Public Health in the USA said: “People without coeliac disease may reconsider limiting their gluten intake for chronic disease prevention, especially for diabetes.”
The research was presented at the American Heart Association’s Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions

Genetic risk profiling does not improve diabetes prevention

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A new study suggests providing education on personalised risk does not motivate behavioural changes.

Findings from a new study question the benefits of incorporating genetic and phenotypic risk profiling into prevention programmes for type 2 diabetes.

Researchers from the UK’s University of Cambridge School of Clinical Medicine undertook a a randomised controlled trial of more than 569 healthy adults born between 1950 and 1975 who had no previous diabetes diagnosis or other chronic diseases.
Participants were assigned to  either a control group who received only standard lifestyle advice on preventing diabetes, or groups that also received either their genetic risk estimate or phenotypic risk estimate of developing diabetes. Eight weeks later, participants were fitted with a device to monitor physical activity for six days.

They found that compared to the control group, receipt of a genetic or phenotypic risk estimate was not associated with more physical activity.

Writing in PLOS Medicine, the authors said additional research is needed to investigate the conditions under which risk information might enhance preventive strategies. “Approaches targeting individual behaviour change, such as communicating genetic risk, are unlikely to be successful in isolation in an environment in which there are many impediments to being physically active and eating a healthy diet.”

Obesity: NICE publishes new standard assessment and management of the condition

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The standard covers the clinical assessment and management of obesity in children, young people and adults.

Adults with a Body Mass Index (BMI) of 35 or more, who have been diagnosed with type 2 diabetes within the past 10 years, should be offered an expedited referral for bariatric surgery assessment.

That is according to a new quality standard, Obesity: clinical assessment and management, which has just been published by the National Institute for Health and Care Excellence in the UK.

It says the move could improve quality of life and reduce the risk of premature mortality for people with obesity and type 2 diabetes of less than 10 years’ duration by improving glycaemic control and reducing or delaying the need for medication to control diabetes.

In addition, the new quality standard says adults with a BMI of above 50 should also be offered a referral for bariatric surgery assessment.
Healthcare professionals should also discuss the benefits and risks of both bariatric surgery and non-surgical treatment when offering referral for assessment, the guidance states.
It adds, “Patients who have had bariatric surgery should have a postoperative follow-up care package within the bariatric surgery service for a minimum of two years”.