Diabetes Mellitus

Schizophrenia could be linked to increased risk of type 2 diabetes

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People with schizophrenia are at an increased risk of developing diabetes, even when the effects of antipsychotic drugs, diet and exercise are adjusted for, a new study has found.

Schizophrenia is known to be associated with a reduced life expectancy of up to 30 years. This is largely due to physical health disorders such as heart attack or stroke, for which type 2 diabetes is a major risk factor.

People with long-term schizophrenia are three times more likely than the general population to have diabetes, something which has previously been attributed to poor diet and exercise habits in this group, as well as the use of antipsychotic medication.

Researchers from King’s College London examined whether diabetes risk is already present in people at the onset of schizophrenia, before antipsychotics have been prescribed and before a prolonged period of illness that may be associated with poor lifestyle habits – such as poor diet and sedentary behaviour.

They pooled data from 16 studies comprising 731 patients with a first episode of schizophrenia and 614 people from the general population.

They analysed blood tests from these studies and found that patients with schizophrenia showed higher risk of developing type 2 diabetes compared with healthy controls.

Patients had higher levels of fasting blood glucose, which is a clinical indicator of diabetes risk.

 

Researchers also discovered that compared with healthy controls, patients with first episode schizophrenia had higher levels of insulin and increased levels of insulin resistance, again supporting the notion that this group are at higher risk of developing diabetes.

These results remained significant even when analyses were restricted to studies where patients and controls were matched for dietary intake, the amount of regular exercise they engaged in, and ethnic background.

This suggests that the results were not wholly driven by differences in lifestyle factors or ethnicity between the two groups, and may therefore point towards schizophrenia’s direct role in increasing risk of diabetes.

The researchers highlight several factors that could increase the likelihood of developing both conditions, including shared genetic risk and evidence of shared developmental risk factors, such as premature birth and low birth-weight.

It is also thought that the stress associated with developing schizophrenia, which sees levels of the stress hormone cortisol rise, may also contribute to a higher risk of diabetes.

“Our study highlights the importance of considering physical health at the onset of schizophrenia, and calls for a more holistic approach to its management, combining physical and mental healthcare,” said Toby Pillinger from King’s College London.

The study was published in journal JAMA Psychiatry.

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Fighting diabetes through yoga, AYUSH activities focus in 2017

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If 2015 saw a marketing blitzkrieg to showcase yoga to the world, this year was about dedicating it and other AYUSH practices for treatment of diabetes. Quality concern in herbal medicine, however, remains a challenge that needs to be addressed through validation and proper enforcement of regulation. Faced with questions about scientific basis of traditional medicines, the AYUSH Ministry entered into an agreement for improving international acceptability and branding of AYUSH systems.

Benchmarks for training in yoga and practice in ayurveda, unani medicine and panchakarma will help ensure the highest standards in quality, safety and effectiveness of traditional medicines, the ministry said. India also partnered with the US to initiate research efforts on traditional medicines for cancer treatment and the first US-India workshop on traditional medicine was held.

Recently, yoga as an “ancient Indian practice” was inscribed on UNESCO’s representative list of Intangible Cultural Heritage of Humanity. On International Yoga Day celebrations in Chandigarh, Prime Minister Narendra Modi appealed to all that yoga must be devoted to fighting diabetes.

“All people belonging to the field of yoga must continue with their yoga activities but diabetes must be the main focus,” he said. Following which a yoga protocol to fight diabetes mellitus, developed by a committee of experts, was unveiled in October. This protocol includes various exercises and diet regimen that a patient can follow.

Continuing with the theme, a national protocol was also launched for treating diabetes through ayurveda. These guidelines prescribe medicines for different symptoms. The protocol also includes a list of fruits and vegetables a diabetic patient should or should not eat. It also recommends an active lifestyle, physical exercise, yoga in order to avoid falling prey to diabetes.

The emphasis on diabetes also landed the ministry in a major controversy after a misleading advertisement of an ayurvedic medicine, AYUSH-82, for diabetes gave a false notion that diabetics could avoid using insulin after taking the drug for a few months.

This was in contravention of Drugs and Magic Remedies Objectionable Advertisements Act-1954 which disallows advertisements of cure for chronic illnesses like diabetes. The advertisement was subsequently pulled off air in October. Questions have also been raised about research and clinical trial methods for AYUSH-82 before making tall claims.

AYUSH Minister Shripad Yesso Naik admitted that quality concern with traditional medicines was a huge challenge. “Many questions are raised about the scientific basis of traditional medicine, their quality, safety and efficacy. It is true that the facet of the traditional and complex herbal formulation can’t be explained fully on the conventional parameters used for testing of chemical drugs.

“But for the sake of safety and consumers to use these medicines with confidence, it is necessary to ensure quality of products,” he said.

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US FDA approves Drug to reduce Heart Problems for Diabetic Patients

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The U.S. Food and Drug Administration today approved a new indication for Jardiance (empagliflozin) to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and cardiovascular disease.

“Cardiovascular disease is a leading cause of death in adults with type 2 diabetes mellitus,” said Jean-Marc Guettier, M.D., C.M., director of the Division of Metabolism and Endocrinology Products in FDA’s Center for Drug Evaluation and Research. “Availability of antidiabetes therapies that can help people live longer by reducing the risk of cardiovascular death is an important advance for adults with type 2 diabetes.”

According to the Centers for Disease Control and Prevention, death from cardiovascular disease is 70 percent higher in adults with diabetes compared to those without diabetes, and patients with diabetes have a decreased life expectancy driven in large part by premature cardiovascular death.

The FDA’s decision is based on a postmarketing study required by the agency when it approved Jardiance in 2014 as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Jardiance was studied in a postmarket clinical trial of more than 7,000 patients with type 2 diabetes and cardiovascular disease. In the trial, Jardiance was shown to reduce the risk of cardiovascular death compared to a placebo when added to standard of care therapies for diabetes and atherosclerotic cardiovascular disease.

Jardiance can cause dehydration and low blood pressure (hypotension). Jardiance can also cause increased ketones in the blood (ketoacidosis), serious urinary tract infection, acute kidney injury and impairment in renal function, low blood glucose (hypoglycemia) when used with insulin or insulin secretagogues (e.g. sulfonylurea, a medication used to treat type 2 diabetes by increasing the release of insulin in the pancreas), vaginal yeast infections and yeast infections of the penis (genital mycotic infections), and increased cholesterol.

The most common side effects of Jardiance are urinary tract infections and female genital infections.

Jardiance is not intended for patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Jardiance is contraindicated in patients with a history of serious hypersensitivity reactions to Jardiance, severe renal impairment, end-stage renal disease, or dialysis.

Jardiance is distributed by Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.

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USFDA just approved the world’s first ‘artificial pancreas’

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The FDA just approved a device that’s often referred to as an ‘artificial pancreas’. The device, made by Medtronic, is called the MiniMed 670G.

It’s been approved for people with type 1 diabetes over the age of 14. It works by automatically monitoring a person’s blood sugar levels and administering insulin as needed – no constant checking and injecting required.

Diabetes is a condition in which people have a hard time processing sugar. Type 1, in particular, is an autoimmune disease in which the body mistakenly kills cells that are supposed to make insulin, a hormone that helps people absorb and process the sugar in food.

Insulin is produced and released through the pancreas – that’s where the term ‘artificial pancreas’ comes in.

Roughly 1.25 million people in the US have type 1 diabetes. These patients often opt to have an insulin pump that can administer insulin as needed throughout the day.

Some also buy a glucose monitor, which is used to continuously monitor blood sugar levels; that way a diabetic can know if their levels are going too low or too high and find a way to correct it.

In contrast, the MiniMed 670G, referred to as a ‘hybrid closed loop’ system, is what Jeffrey Shoorin of the FDA said in a statement is a “first-of-its-kind technology”: the first approved system that combines both the glucose monitor and the insulin pump in one device.

According to the FDA, the device measures blood sugar every five minutes, then responds by sending insulin into the body, or holding steady. Diabetics can also manually request insulin around mealtimes.

A clinical trial of the MiniMed 670G involving 123 people with type 1 diabetes had no serious adverse events, though the FDA notes that “risks may include hypoglycemia, hyperglycemia, as well as skin irritation or redness around the device’s infusion patch.”

While the device is approved as of today, Medtronic will do additional testing to see how well it works in real-life situations. The company is also conducting additional trials to see if it can be used in children 7 to 14 years old.

“We are committed to preparing for commercial launch as quickly as possible,” Francine Kaufman, M.D., chief medical officer of the Diabetes Group at Medtronic, said in a statement.

Here’s what the device looks like:

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Researchers created a new contact lens to test glucose levels in tears

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Researchers have developed a new technology that could allow non-invasive testing of glucose levels, via a contact lens that samples glucose levels in tears.

Current method to monitor glucose levels involve a medication process along with a painful fingerpick blood test.

Glucose is a good target for optical sensing, and can be used as an alternative approach, the study said.

“It should be noted that glucose is present not only in the blood but also in tears, and thus accurate monitoring of the glucose level in human tears by employing a contact-lens-type sensor can be an alternative approach for non-invasive glucose monitoring,” said Wei-Chuan Shih, Associate Professor at University of Houston in Texas, US.

The researchers developed a tiny device built with multiple layers of gold nanowires and gold film that was produced, using solvent assisted nanotransfer printing.

This component strengthens a technique called surface-enhanced Raman scattering — named after Indian physicist C.V. Raman, who discovered the effect first in 1928 — which gauges how light interacts with a material to determine its molecular composition, the researchers stated.

Further, the device enhances the sensing properties of the technique by creating “hot spots” or narrow gaps within the nanostructure which intensified the Raman signal.

Traditional nanofabrication techniques rely on a hard substrate — usually glass or a silicon wafer — but researchers wanted a flexible nanostructure which would be more suited to wearable electronics, Shih said.

The layered nanoarray was produced on a hard substrate but lifted off and printed onto a soft contact, Shih said in the paper published in the journal Advanced Materials.

Although non-invasive glucose sensing is just one potential application of the technology, it provided a good way to prove the technology, he said.

Moreover, the device is also an effective mechanism for using surface-enhanced Raman scattering spectroscopy.

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