December 30, 2005

Early Treatment Of Type 1 Diabetes Lowers Heart Risk

When a woman is giving birth, having a "coach" tell her to push during contractions makes almost no difference in shortening labor, and may actually increase her risk of subsequent problems with her bladder, researchers at UT Southwestern Medical Center have found.

For the most part, it doesn't matter whether the mother is coached or not, the researchers report in the January issue of the American Journal of Obstetrics and Gynecology. And researchers noted that further study must be done to determine if bladder problems were permanent.

"Oftentimes, it's best for the patient to do what's more comfortable for her," said Dr. Steven Bloom, lead author of the paper and interim chair of obstetrics and gynecology at UT Southwestern.

In the study, UT Southwestern researchers focused on second-stage labor - the time in which the cervix is fully dilated and the baby begins to descend. This report follows an earlier one that found a rise in pelvic-floor problems among coached women.

The new study involved 320 women at Parkland Memorial Hospital who were giving birth for the first time, had uncomplicated pregnancies and did not receive epidural anesthesia. They were randomly assigned, with both groups tended by nurse-midwives. Of the two groups, 163 were coached to push for 10 seconds during a contraction, and 157 told to "do what comes naturally".

For women who were randomly assigned to the coaching group, the second stage of labor was shortened by 13 minutes, from 59 to 46 minutes.

"There were no other findings to show that coaching or not coaching was advantageous or harmful," Dr. Bloom said.

The earlier study, reported in the January issue of Obstetrics and Gynecology, involved the same group of women. In it, researchers investigated whether coaching causes long-term problems to the mother's pelvic region.........

JoAnn      Permalink


December 28, 2005

How a High-Fat Diet Causes Type 2 Diabetes?

Howard Hughes Medical Institute scientists have discovered a molecular link between a high-fat, Western-style diet, and the onset of type 2 diabetes. In studies in mice, the researchers showed that a high-fat diet disrupts insulin production, resulting in the classic signs of type 2 diabetes.

In an article published in the December 29, 2005, issue of the journal Cell, the scientists report that knocking out a single gene encoding the enzyme GnT-4a glycosyltransferase (GnT-4a ) disrupts insulin production. Importantly, the researchers showed that a high-fat diet suppresses the activity of GnT-4a and leads to type 2 diabetes due to failure of the pancreatic beta cells.

"We have discovered a mechanistic explanation for beta cell failure in response to a high-fat diet and obesity, a molecular trigger which begins the chain of events leading from hyperglycemia to insulin resistance and type 2 diabetes," said Jamey Marth, a Howard Hughes Medical Institute investigator at the University of California, San Diego (UCSD). Marth and first author Kazuaki Ohtsubo at UCSD collaborated on the studies with scientists from the Kirin Brewery Co. Ltd., and the University of Fukui, both in Japan.

The discovery of the link between diet and insulin production offers new information that may aid in the development of therapys that target the early stages of type 2 diabetes. In its earliest phases, the disease causes failure of insulin-secreting beta cells in the pancreas, which leads to elevated blood glucose levels. As the disease progresses, the insulin-secreting beta cells overcompensate for the elevated blood glucose, and eventually pump out too much insulin. This leads to insulin resistance and full-blown type 2 diabetes.

Worldwide, more than 200 million people have type 2 diabetes, and close to 20 million people in the United States have been diagnosed with the disorder. The new studies suggest that people with an inherited predisposition to type 2 diabetes might have variations in the gene for GnT-4a, said the researchers.........

JoAnn      Permalink


December 28, 2005

Counseling Encourages Exercise

Professional counseling and support can boost physical activity among adults, a new review finds, but scientists aren't sure what kind of professional advice work best to encourage exercise or whether counseling increases physical activity over the long run.

Counseling generally encourages exercise, according to Dr. Melvyn Hillsdon of University College London and his colleagues. However, the scientists found no evidence that counseling can help people reach a specific exercise goal.

"More research is needed to establish which methods of exercise promotion work best in the long term to encourage different types of people to be more physically active," Hillsdon says, noting that most of the studies included in the review lasted less than a year.

The review appears in the recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Hillsdon and his colleagues reviewed 17 studies that included 6,255 healthy adults age 16 and older. All of the studies were randomized controlled trials that compared different ways to encourage sedentary adults to become more physically active.

The studies measured the effects of interventions such as individual and group counseling, telephone calls, written motivational materials and supervised and unsupervised exercise.

Hillsdon and his colleagues say continuing professional support combined with self-directed exercise may provide the most consistent results, but they acknowledge the studies vary too widely to recommend any single approach.........

Janet      Permalink


December 25, 2005, 10:32 AM CT

Merry Christmas To All Our Readers

Medicineworld wishes all our readers merry Christmas.

Oh, jingle bells, jingle bells

Jingle all the way

Oh, what fun it is to ride

In a one horse open sleigh

Jingle bells, jingle bells

Jingle all the way

Oh, what fun it is to ride

In a one horse open sleigh........

Daniel      Permalink


December 16, 2005

Type 2 Diabetes And Depression

Type 2 diabetes and depression can be a fatal mix. Patients whose type 2 diabetes was accompanied by minor or major depression had higher mortality rates, compared to patients with type 2 diabetes alone over the three-year period of a recent study in Washington state. The results appear in the November 2005 edition of Diabetes Care, published by the American Diabetes Association.

Scientists at the University of Washington and at Group Health Cooperative, a large, Seattle-based health plan, conducted the study. The scientists surveyed and followed up 4,154 patients with type 2 diabetes. The patients filled out written questionnaires. With patients' consent, automated diagnostic, laboratory, and pharmacy data were collected from Group Health Cooperative. The scientists also reviewed Washington state mortality data to analyze diabetes complications and deaths.

Depression is common among people who have type 2 diabetes. This high prevalence can have unfortunate repercussions. Both minor depression and major depression among people with diabetes are stongly linked with increased mortality.

"Depression may be associated with increased mortality in patients with diabetes because of both behavioral and biological factors," the scientists noted in their article. More work, they added, is needed to untangle the cause-and effect relationships among depression, behavior, diabetes complications, and mortality.

Dr. Wayne Katon, professor and vice chair of the UW Department of Psychiatry and Behavioral Sciences, and an adjunct professor in the UW Department of Family Medicine, led the recent study. He is a noted researcher on the associations between depression, aging, and chronic diseases, and on the medical costs and personal toll from untreated on inadequately treated depression. The research team included Drs. Carolyn Rutter, Greg Simon, Elizabeth Lin, Evette Ludman, and Michael Von Korff from the Group Health Cooperative Center for Health Studies; Dr. Paul Ciechnowski, UW assistant professor of psychiatry and behavioral sciences; Dr. Leslie Kinder from the Veterans Affairs Puget Sound Health Care System; and Dr. Bessie Young from the UW Department of Medicine.........

JoAnn      Permalink


December 15, 2005, 7:22 PM CT

Mental Stress May Raise Cholesterol Levels

There is good evidence to show that stress can increase a person's heart rate, lower the immune system's ability to fight colds and increase certain inflammatory markers but can stress also raise a person's cholesterol? It appears so for some people, according to a new study that examines how reactions to stress over a period of time can raise a person's lipid levels.

This finding is reported in the recent issue of Health Psychology, published by the American Psychological Association (APA). In a sample of 199 healthy middle-aged men and women, scientists Andrew Steptoe, D.Sc., and Lena Brydon, Ph.D., of University College London examined how individuals react to stress and whether this reaction can increase cholesterol and heighten cardiovascular risk in the future. Changes in total cholesterol, including low-density lipoprotein (LDL) and high-density lipoprotein (HDL), were assessed in the participants before and three years after completing two stress tasks.

Our study found that individuals vary in their cholesterol responses to stress, said Dr. Steptoe. "Some of the participants show large increases even in the short term, while others show very little response. The cholesterol responses that we measured in the lab probably reflect the way people react to challenges in everyday life as well. So the larger cholesterol responders to stress tasks will be large responders to emotional situations in their lives. It is these responses in everyday life that accumulate to lead to an increase in fasting cholesterol or lipid levels three years later. It appears that a person's reaction to stress is one mechanism through which higher lipid levels may develop."

The stress testing session involved examining the participants' cardiovascular, inflammatory and hemostatic functions before and after their responses to performance on moderately stressful behavioral tasks. The stress tasks used were computerized color- word interference and mirror tracing. The color-word task involved flashing a series of target color words in incongruous colors on a computer screen (ex. Yellow letters spelling the color blue). At the bottom of the computer screen, four names of colors were displayed in incorrect colors. The object of the task was to match the name of the color to the target word. The other task used was mirror tracing, which mandatory the participant to trace a star seen in a mirror image. The participants were told to focus more on accuracy than on speed in both tasks.........

Daniel      Permalink


December 14, 2005

Pancreatic Cancer Linked to Insulin Resistance

A new study led by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health, shows for the first time that male smokers with the highest insulin levels are twice as likely to develop pancreas cancer as men with the lowest levels. Similarly, men with glucose levels in the range of clinical diabetes were twice as likely to develop the cancer as men with normal glucose levels. This study examined data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study* of 29,000 male smokers in Finland and appears in the December 14, 2005, issue of the Journal of the American Medical Association.

Study investigators drew blood from enrollees when they joined the ATBC Study in the mid-1980s. This allowed the scientists to determine participants' overnight fasting insulin and glucose levels a number of years ahead of when they might be diagnosed with cancer. Over the course of 17 years, 169 men in the study developed pancreas cancer.

Study results show a two-fold increase in risk of pancreas cancer in the quartile of men with the highest fasting serum insulin levels (greater than 6.1 microinternational units per milliliter) compared to those in the lowest quartile (less than 2.75 microinternational units per milliliter). Increasing concentrations of glucose, insulin, and insulin resistance were also associated with pancreas cancer. Moreover, the risk for pancreas cancer increased with longer follow-up time.

"Some men were in the highest quartile of insulin or had abnormal glucose levels more than a decade before the cancer appeared," noted lead researcher Rachael Stolzenberg-Solomon, Ph.D., of NCI's Division of Cancer Epidemiology and Genetics. "It is important to note, however, that this study was only done in male smokers and that any assumptions about risk in the general population or whether one can determine their own pancreas cancer risk specifically based on insulin levels is premature."........

Daniel      Permalink

No Kidney Benefit for ACE-Inhibitors (December 11, 2005)
The best way to protect kidneys of diabetic patients is to lower blood pressure. Period. So says Juan P. Casas M.D. and his colleagues of the British Heart Foundation Laboratory at University College London, who reported that a meta-analysis of 127 randomized trials did not confirm a renoprotective effect for either ACE-inhibitors or angiotensin receptor blockers.

Joslin Guide to Diabetes (December 6, 2005)

Internet Discussion Group Provides Support To Diabetics (December 6, 2005)

Cell Transplantation Technique Restores Insulin Production in Diabetics (November 29, 2005)