Type 2 diabetes is the fifth leading cause of death in most developed countries and there is growing evidence that it has reached epidemic proportions in many developing and newly industrialized countries.
The prevalence of diabetes is rapidly rising all over the globe at an alarming rate.
WHO estimates that the total number of diabetic patients over half a billion in the world, of which a quarter live in two populous countries in the world, China and India.
This number does not include pre-diabetics which include those with impaired glucose tolerance (IGT). There are 318 million people in the group (IGT) who are likely to reach diabetic conditions.
Over the past 30 years, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle-aged people.
Diabetes has been recognized to cause several pathophysiological conditions, besides consistently high blood glucose levels.
Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose, and other risk factors contribute to increasing the risk of cardiovascular complications.
Diabetic nephropathy, kidney disease is more common in people with diabetes than in those without diabetes.
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For the first time, the Indian Council of Medical Research (ICMR) has come out with the national ethical guidelines separately for biomedical research involving children. These guidelines cover the ethical and legal issues that researchers need to consider when carrying out biomedical research in neonates and children.
The aim of the guidelines is to set out general principles that can be applied in most situations rather than to cover every possible situation. These guidelines need to be used in conjunction with the current National Ethical Guidelines for Biomedical Research involving Human Participants issued recently by the ICMR, and are meant for use by researchers, ethics committees and other involved stakeholders. While these guidelines cover general biomedical research involving children, the definition of ‘child’ has been variable according to various legal and social contexts. As per the National Commission for Protection of Child Rights, a child is defined as a person from 0 to 18 years of age.
As per the document, for research in children certain guidelines should be followed when conducting research in children. They include research proposals should be scientifically sound; the equation between the potential benefit and the risk or potential harm should be at least as favourable for the proposed research procedure as for the alternatives available to the children; there should be benefit to children in general and, in most cases, to the individual child subject; the need for the study should be justified by a thorough review of literature; and the research should be conducted by a team of investigators who have the requisite expertise.
Besides, one or more members of the team should be a paediatrician and/or have prior experience of conducting research involving children; research involving children should take into consideration the unique physiology, anatomy, psychology, pharmacology, social situation and special needs of children and their families; and research involving children must be conducted in a child-friendly environment, as far as possible. In general, drugs should be tested for safety, pharmacokinetics, and at least initial indications of efficacy in adults established before they are tested in children. It may often be appropriate to defer paediatric testing until adult testing has reached phase III or beyond, when substantial data are available on the safety and efficacy of a drug in adults. However, there may be situations where studies involving children would be needed without prior adult studies, for example, surfactant use in premature babies with respiratory distress syndrome.
According to senior ICMR officials, biomedical research involving children is needed for the benefit of future generations of humanity. It leads to advances in medical care which can potentially improve the health and quality of life of children. As we near the end of the second decade of the 21st century, we have numerous opportunities to develop interventions to promote health, and prevent and treat diseases that affect children. This can only be achieved through experimentation. Research and innovation is therefore the core of the endeavour to generate and translate knowledge into clinical care. However, at the same time, we cannot expose children to undue harm by participating in research studies.
In 2006, ICMR had developed an updated, third version entitled “Ethical Guidelines for Biomedical Research on Human Participants”. These guidelines contain only a small section pertaining to research in children, which does not address in detail several ethical perspectives of conducting biomedical research in neonates and children. This monograph is intended to accomplish this important task and serve as the reference manual for ethical committees in the national context. These consensus recommendations were formulated through a rigorous and robust methodology including review of pertinent national and international guidelines, multiple stakeholders’ input and public scrutiny.
The Indian Council of Medical Research (ICMR) has released the revised national guidelines for biomedical research involving human participants which are aimed at protecting and safeguarding the interests of individuals, communities and society as a whole.
This document is expected to address the ethical challenges involved in a variety of biomedical and health research areas and will be a useful document for the researchers, ethics committees, institution and sponsors engaged in the conduct of biomedical and health research involving human participants across the country.
These guidelines are applicable to all biomedical, social and behavioural science research for health conducted in India involving human participants, their biological material and data. The purpose of such research should be directed towards enhancing knowledge about the human condition while maintaining sensitivity to the Indian cultural, social and natural environment; conducted under conditions such that no person or persons become mere means for the betterment of others and that human beings who are participating in any biomedical and/or health research or scientific experimentation are dealt with in a manner conducive to and consistent with their dignity and well-being, under conditions of professional fair treatment and transparency; and subjected to a regime of evaluation at all stages of the research, such as design, conduct and reporting of the results thereof.
The new guidelines have many new sections added up and many changes incorporated in the existing sections. There are now a total of 12 sections including Responsible Conduct of Research, Informed Consent Process, Vulnerability, Public Health Research, Social and Behavioural Sciences Research for Health, Biological materials, Biobanking and Datasets and Research during Humanitarian Emergencies and Disasters. Many new issues have been added up as subsections e.g. sexual minorities (LGBT), multicentric studies, research using datasets etc. The section on ethics review process has been elaborated to help the many ethics committees who have doubt about the various procedures to be followed.
ICMR first brought out the ‘Policy Statement on Ethical Considerations Involved in Research on Human Subjects’ in 1980 under the chairmanship of Justice H R Khanna. These guidelines were revised in 2000 as the ‘Ethical Guidelines for Biomedical Research on Human Subjects’ under the chairmanship of Justice M N Venkatachaliah. In view of the new developments in the field of science and technology, another revision was carried out as Ethical Guidelines for Biomedical Research on Human Participants in 2006. Bioethics is a dynamic area and over the last 10 years many new concerns and issues have evolved internationally over the ethical dilemmas faced by the scientific and ethics committees in the conduct and review of biomedical research. Hence, an exercise was taken up over a period of one year with national and international consultation to come up with this new set of state of art guidelines.
A new type of non-invasive cancer test has just delivered promising results in an early-stage feasibility study, paving the way for a future when we’ll be able to get highly accurate cancer screening with a simple blood test.
The technology, which involves scanning the blood for bits of DNA shed by tumours, is also referred to as a ‘liquid biopsy’, and these new results are getting us one step closer to a major upgrade in cancer diagnostics.
Right now, our best method for detecting cancer is a biopsy – cutting out a small piece of the tumour tissue for lab analysis. But biopsies are often painful and invasive, and you need to already have a tumour or at least a suspect tumour to cut something out of it.
That’s why scientists have been working on devising blood tests that can do the same thing without any surgery, and with the promise of delivering a diagnosis much earlier.
Finding cancer in the blood is possible when scientists focus on DNA fragments shed into the bloodstream by tumours. This is called circulating tumour DNA (ctDNA).
In recent years, scientists have been working on finding the best method for detecting ctDNA, using samples from patients who already have diagnosed cancer.
The latest study, which was just presented at the 2017 meeting of the American Society of Clinical Oncology (ASCO), has turned up the dial on what scientists can find when they scan for ctDNA.
“Our findings show that high-intensity circulating tumour DNA sequencing is possible and may provide invaluable information for clinical decision-making, potentially without any need for tumour tissue samples,” says lead researcher Pedram Razavi from Memorial Sloan Kettering centre.
The team used blood and tissue samples from 124 metastatic breast cancer, lung cancer, and advanced prostate cancer patients.
They scanned the samples for 508 different gene mutations, going over the specific regions of the genome up to 60,000 times. According to the scientists, this method generates 100 times more data than other sequencing approaches.
To see whether the method could catch any tumour DNA floating around in the blood, the team compared the results with those from tissue samples and genetic material from the patients’ own white blood cells.
“Our combined analysis of cell-free DNA and white blood cell DNA allows for identification of tumour DNA with much higher sensitivity, and deep sequencing also helps us find those rare tumour DNA fragments,” says Razavi.
The researchers detected 864 genetic changes across all three types of cancers in the tissue samples, and found 73 percent of those in the blood tests as well.
A huge benefit of having sensitive ctDNA tests is the chance of finding cancer years earlier than is possible with a biopsy, catching it before it has time to spread through the body.
The new method was developed with researchers from Grail, a genomics company dedicated to early cancer detection, backed by philanthropic funding from people like Jeff Bezos and Bill Gates.
Grail’s Mark Lee, who was one of the study co-authors, told Reuters that the company is now planning to use this new test to gather large-scale data from hundreds of thousands of people, both with and without cancer.
While the results are promising so far, the team will be needing a lot more research before this technology becomes an early detection tool that we all can benefit from in a routine check-up.
“It’s an important first step. We show that what we call a high-intensity approach works,” Razavi told Reuters.
The study was carried out by researchers from the University of California, San Diego State University, the State University of New York at Buffalo, the University of Washington, the Fred Hutchinson Cancer Research Centre, George Washington University, the University of Florida and Northwestern University, all in the US.
It was funded by the US National Heart, Lung and Blood Institute.
All of the UK media outlets that covered the study implied that a direct cause and effect relationship between sitting down and cell ageing had been proven.
For example, the Mail’s headline stated that, “Women who spend at least 10 hours on their backsides each day speed up their aging process.”
This is untrue. While there certainly seems to be an association worthy of further research, no causal link has been established.
What kind of research was this?
This cross-sectional study used data from women taking part in a much bigger study of health called the Women’s Health Initiative.
Cross-sectional studies can find correlations between different factors – in this case, sitting time and telomere length.
But because this type of study only looks at one point in time, researchers can’t say which factor happened first, so it’s not very useful for telling us whether one causes the other.
What did the research involve?
Researchers used information about 1,481 women aged over 65 who’d taken part in various sub-studies of the Women’s Health Initiative.
They used information from women who’d had their physical activity measured using accelerometers (devices that measure movement) and had also given DNA samples that had been tested for telomere length.
After accounting for other factors, they looked at whether telomere length was linked to the amount of time spent sitting.
The information about physical activity was measured over one week, during which time women wore their accelerometer all the time, except when bathing or swimming.
Women taking part also completed a questionnaire about their physical activity and kept a record of their sleep. Telomere length was measured from DNA in blood cells.
hours of moderate to vigorous physical activity each day
use of hormone medicines
They also redid their calculations to divide the women into those who did more or less than the average amount of physical activity (about 40 minutes).
They then looked at the link between time spent sitting and telomere length for women who did more or less than 40 minutes physical activity a day.
They also looked at the link between sitting and telomere length for women who did 30 minutes or more a day, the recommended activity level for all adults.
It’s unclear whether these additional calculations were planned from the start of the study, or whether the researchers decided to do them because the initial findings did not show a link between time spent sitting and telomere length.
What were the basic results?
The length of time spent sitting was not linked to telomere length for women who did 30 minutes or more of moderate physical exercise a day.
For women who did less than the average amount of moderate physical activity each day, time spent sitting did show a link to telomere length.
Among these women, those who spent more than about 10 hours a day sitting had shorter telomeres than those who spent less than about eight hours a day sitting. The average difference was 170 base pairs (95% confidence interval [CI] 4 to 340).
Women who spent the most time sitting were more likely to be older, white, obese and have long-term illnesses.
How did the researchers interpret the results?
The researchers said their results suggest that, “Prolonged sedentary time and limited engagement in moderate to vigorous physical activity may act synergistically to shorten leukocyte telomere length among older women.”
In other words, being both sedentary for long periods and not getting much physical activity may act together to shorten telomeres in blood cells.
They speculated that causes of the link might include insulin resistance, lack of the anti-inflammatory responses the body has to exercise, or obesity.
They also acknowledged women who have long-term illnesses are more likely to have a sedentary lifestyle, and the illness rather than the lack of exercise may cause shortened telomeres.
It’s not news to anyone that being more physically active and spending less time sitting around is likely to keep people in better health.
But this study has many limitations that make it difficult for us to rely on its results.
While they are used as a marker for ageing cells, telomeres are not a direct measure of ageing. Although shortened telomeres have been linked to certain diseases, everyone’s telomeres shorten over time.
Saying shorter telomeres make someone “biologically older” doesn’t mean much. This hasn’t stopped the emergence of private companies offering to measure your telomeres – but it’s unclear what exactly you could usefully do with that information.
And the only cells studied in this research were blood cells, so we don’t know whether the results would have held for brain cells, muscle cells or any other cells in the body.
Doctors have tried to disentangle the effects of physical activity from the effects of being sedentary before without much success.
Generally, as in this study, research seems to show that if you get plenty of moderate to vigorous physical exercise, the amount of time you spend sitting or lying down doesn’t make much difference.
The researchers carried out a lot of comparisons and used multiple models to try to show sedentary time was linked to telomere length.
In most of these models, once you take account of women’s age, ethnicity, body mass index and long-term illnesses, there was no link.
Only when the researchers stratified the results by how much physical activity women did could they show a link in one category: those who did the least physical activity.
That suggests sedentary behaviour is not the strongest factor to affect telomere length.
Another problem with the study is it only looked at telomere length and physical activity at one point in the women’s lives.
We don’t know how much physical activity they’d done throughout their lives, or whether their telomeres had shortened faster than other women recently or at an earlier stage in life.