Diet Drinks May Worsen Glucose Control, Making Type 2 Diabetes More Likely

January 12, 2018 · Posted in Risk Factors · Comment 

Many people substitute diet drinks containing artificial sweeteners for sugary drinks in the hopes of reducing their diabetes risk. However, new research suggests that artificial sweeteners alter the gut’s response to glucose in a way that could actually worsen diabetes risk.

At the 2017 meeting of the European Association for the Study of Diabetes, researcher Richard Young described a small study in which he and his colleagues compared the effects of artificial sweeteners to those of placebo in healthy adults. Seventeen participants consumed an amount of artificial sweetener equivalent to what would be found in 1.2 to 1.5 liters of diet beverage per day for two weeks, while 16 participants received placebo.

Young and colleagues determined that glucose absorption and glycemic response increased in the participants who consumed the artificial sweetener. Those who consumed the sweetener absorbed 20% more glucose than those in the placebo group. While before the study the two groups had similar blood glucose levels, these rose by 24% in those who consumed the artificial sweetener.

Consuming artificial sweetener also seemed to affect the gut peptide GLP-1, which limits the rise in blood glucose after meals. The two groups had similar GLP-1 responses before the study, but after consuming artificial sweetener, participants showed a 34% reduction in GLP-1 response to glucose absorbed in the intestines.

Changes like these could increase the risk of type 2 diabetes. Young explained that artificial sweeteners may reduce the body’s ability to control blood sugar levels, leading to high glucose, and possibly predisposing those who consume artificial sweeteners to type 2 diabetes. Young and colleagues have previously found that switching from sugar to artificial sweeteners does not predict a lower risk of type 2 diabetes.

This study was the first of its kind in humans. Larger studies will help to clarify the effects of artificial sweeteners on glucose control.

Liraglutide Decreased Body Weight, Improved Glucose Tolerance and Cardio Health in Schizophrenia

December 18, 2017 · Posted in Potential Treatments · Comment 

weightA 2017 article by Julie R. Larsen and colleagues in the journal Archives of General Psychiatry reported that the drug liraglutide, a treatment for type 2 diabetes, improved certain health measures in people with schizophrenia who were overweight and prediabetic and being treated with the atypical antipsychotics olanzepine or clozapine.

In the 16-week trial, patients received a daily 2 mg injection of liraglutide under the skin or placebo. Liraglutide decreased body weight, improved glucose tolerance, and improved cardio-metabolic measures. Weight decreased by more than 10 pounds on average compared to placebo.

Liraglutide is derived from a human metabolic hormone. It binds to the same receptors as does the metabolic hormone GLP-1, which stimulates insulin secretion.

Giving Infants Vitamin D Can Reduce Type 1 Diabetes

August 10, 2017 · Posted in Potential Treatments · Comment 

babyA 2001 cohort study in Finland showed that giving vitamin D supplements to infants may reduce their risk for type 1 diabetes. The data for the study, by Elina Hyppönen and colleagues in the journal The Lancet, came from 10,366 people born in 1966. Their mothers were part of a medical registry that collected information on vitamin D given to children during the first year of their lives.

Of the 10,366 people in Hyppönen’s study, 81 had been diagnosed with type 1 diabetes by the end of 1997. Those participants who were given vitamin D supplements during their first year of life were less likely to be diagnosed with type 1 diabetes than other participants. Those who regularly took the recommended dose at the time, 2000 IU daily, during their first year of life had significantly lower diabetes rates 33 years later.

Preventing Metformin Side Effects

July 24, 2017 · Posted in Current Treatments · Comment 

metformin tablets

Depression is a risk factor for type 2 diabetes, and the drug metformin is a common treatment for diabetes. In a 2016 article in the Journal of Clinical Psychiatry, researcher Chittaranjan Andrade suggests ways of minimizing side effects from metformin.

Gastrointestinal side effects such as nausea, vomiting, abdominal discomfort, flatulence, and diarrhea are common on metformin. In the article, Andrade writes, “These are less likely to occur with gradual dose uptitration, administration of the drug with meals, and use of a time-release formulation.”

Lactic acidosis, a buildup of lactate in the body that can result in muscle pain, burning, and other symptoms, is a rare side effect of metformin. Avoiding prescribing metformin to people with impaired kidney, liver, or cardiac functioning and other risk factors can prevent lactic acidosis.

Vitamin B12 absorption can also be affected by long-term metformin use. Andrade suggests that rather than waiting for a vitamin deficiency to be identified, a proactive approach should be taken. Long-term metformin users could be given an annual intramuscular shot of vitamin B12.

Bipolar Disorder and Diabetes Linked

July 19, 2017 · Posted in Risk Factors · Comment 

diabetes linked to bipolar disorderA systematic literature review in 2016 showed a definitive link between bipolar disorder and diabetes. Bipolar disorder almost doubles the risk of diabetes while diabetes more than triples the risk of bipolar disorder. The article by Ellen F. Charles and colleagues was published in the International Journal of Bipolar Disorders.

The review included seven large cohort studies. The studies, based on elderly populations only, examined bipolar disorder and diabetes rates. Charles and colleagues suggested that shared mechanisms could cause both illnesses. New disease models that explain the link between bipolar disorder and diabetes could lead to better treatments.

The review also reported that both bipolar disorder and diabetes were independently associated with risk of cognitive decline and dementia in these elderly individuals. People with diabetes had more brain atrophy on average than others who share their age and gender but did not have diabetes. People with bipolar disorder who also had diabetes and either insulin resistance or glucose intolerance had neurochemical changes in the prefrontal cortex that indicated poor neuronal health. In some cases, these patients also had reduced brain volume in the hippocampus and cortex.

Bad Habits May Reduce Brain Volumes, May Cause Dementia

September 26, 2016 · Posted in Risk Factors · Comment 

bad habits can reduce brain volumes

Smoking, alcohol use, obesity, and diabetes aren’t just harmful to the body. They may actually lead to dementia.

Behavioral risk factors for cardiovascular disease like those listed above have been linked to reduced volume in the brain as a whole and several brain regions,  including the hippocampus, precuneous, and posterior cingulate cortex. A 2015 study by researcher Kevin King and colleagues found that these reduced brain volumes are early indicators of cognitive decline.

King and colleagues analyzed data on 1,629 participants in the long-term Dallas Heart Study. Their cardiovascular risk factors were assessed when they began the study, and their brain volume and cognitive function were measured seven years later.

Alcohol use and diabetes were associated with lower total brain volumes, while smoking and obesity were linked to low volumes in the posterior cingulate cortex.

Low hippocampal volume was linked to past alcohol use and smoking, while lower precuneous volume was linked to alcohol use, obesity, and blood glucose levels.King and colleagues suggested that subtle differences in brain volumes  in midlife are the first sign of developing dementia in participants who were still younger than 50 years of age.

Liraglutide FDA-Approved for Obesity

September 12, 2016 · Posted in Current Treatments · Comment 

new drug for obesityThe drug liraglutide (trade name Saxenda) has been approved by the Food and Drug Administration (FDA) as a treatment for obesity. It had previously been approved for the treatment of type 2 diabetes.

Liraglutide is taken as a daily injection and is meant to be used alongside a calorie-reduced diet and increased physical activity. Liraglutide works by mimicking a peptide (GLP-1) that regulates appetite and calorie intake.
Recommended dosage is 3 mg/day, but should begin at 0.6 mg/day for the first week and gradually increase by 0.6mg each week to reduce the likelihood of gastrointestinal side effects.

In three clinical trials, participants who were overweight or obese, some of whom had weight-related conditions such as high blood pressure, type 2 diabetes, or high cholesterol, either received training about following a reduced-calorie diet and increasing physical activity or had already lost up to 5% of their body weight by engaging in these practices.

Among those participants who did not have diabetes or a weight-related condition, 62% lost up to 5% of their body weight after a year of taking liraglutide, compared to 34% of those who were given a placebo injection.

Of the participants who had type 2 diabetes, 49% lost up to 5% of their body weight after a year of liraglutide, compared to 16% of those who received placebo.

Of those who had a weight-related condition other than diabetes, 42% lost up to 5% of their body weight compared to 21.7% who took placebo.

Diabetes Drug Pioglitazone May Improve Depression

July 18, 2016 · Posted in Potential Treatments · Comment 

telomereResearchers believe there is a link between diabetes and depression. Some drugs used to treat type II diabetes and its associated inflammatory symptoms have been found to improve depression as well. These include metformin, rosiglitazone, and pioglitazone. A recent study by Natalie Rasgon and colleagues explored the effects of pioglitazone treatment on people with insulin resistance, insulin sensitivity and/or pre-diabetes and ongoing depression. The researchers hoped to find that adding pioglitazone to the patients’ regular antidepressant regimen might improve depression by reducing inflammation.

The study also touched on the role of telomere length in mental and metabolic disorders. Telomeres are repeated DNA sequences that sit at the end of chromosomes and protect them during cell replication. Telomeres get shorter with aging and with psychiatric illnesses. In the study, telomere length was used to predict whether patients’ depression would improve.

Rasgon and colleagues found that in those patients taking both pioglitazone and antidepressant treatments (compared to those who received a placebo in addition to their antidepressants), longer telomeres predicted better antidepressant response. This suggests that telomere length could be used as a biomarker—that is, measuring a patient’s telomere length could reveal whether that patient’s depression is likely to respond to an anti-inflammatory treatment such as pioglitazone. The research was presented at a 2015 scientific meeting.

Clarifying the Effects of a Diabetes Drug that Improves Bipolar Depression

May 6, 2016 · Posted in Potential Treatments · Comment 
bladder and prostate

Bladder and prostate

Research continues on pioglitazone, a drug typically used to treat diabetes but with other positive effects on depression and stroke risk. Some researchers are working on determining whether the drug increases the risk of developing certain cancers, including bladder, prostate, and pancreatic cancers. A recent study by James D. Lewis and colleagues in the journal JAMA found no statistically significant increase in risk of bladder cancer among patients taking the drug, but the researchers said they also couldn’t rule out that the drug may increase this risk, as has been seen in previous studies. The study by Lewis did show an increase in pancreatic and prostate cancers in patients taking pioglitazone, but the researchers did not determine whether this was caused by the drug.

Another recent study by Walter N. Kernan and colleagues in the New England Journal of Medicine reported that pioglitazone reduced the incidence of stroke and heart attack in patients with a history of stroke or blocked blood vessels in the brain but without a diagnosis of diabetes. Patients who received pioglitazone also experienced side effects including weight gain, edema (an increase in fluids in the body’s tissues) and serious bone fractures.

Pioglitazone has had positive effects in bipolar depression and may one day be used as a treatment for bipolar disorder. For now, it may be worthy of consideration for the treatment of diabetes in patients who also have bipolar depression.

Diabetes Complicates Bipolar Disorder

September 30, 2015 · Posted in Course of Illness, Risk Factors · Comment 

diabetes and bipolar disorder

People with bipolar disorder are three times more likely than the general population to develop type 2 diabetes. Type 2 diabetes typically occurs in adulthood and is associated with insulin resistance, as opposed to type 1, which is usually diagnosed in childhood and is associated with insulin deficiency.

In a talk at the 2015 meeting of the Society of Biological Psychiatry, researcher Tomas Hajek reported that in a large group of bipolar patients, 13% reported a history of type 2 diabetes, 21% were diagnosed with type 2 diabetes upon laboratory evaluation, and 32.2% had pre-diabetes without realizing it. Thus, about half of these patients with bipolar disorder were either affected by diabetes or at risk for it, many without knowing it.

The Bad News

Diabetes complicates the course of bipolar illness. Type 2 diabetes is associated with poorer response to treatment, atrophy of the hippocampus, cognitive impairment, and higher rates of conversion from mild cognitive impairment to full-blown dementia.

The main effect of type 2 diabetes is insulin resistance. The body produces enough insulin, but insulin’s effects at its receptors are impaired. Diabetes also causes deficits in growth factors, increases in the enzyme GSK3B, decreases in mitochondria and brain-derived neurotrophic factor (BDNF, which protects neurons), and glucose toxicity.

Recent research by Hajek and colleagues shows that diabetes has several other detrimental effects on the brain in bipolar disorder. On magnetic resonance spectroscopy (MRS) scans, people with type 2 diabetes had lower levels of NAA, a marker of neuronal integrity, in the prefrontal cortex. This can indicate impaired functioning. People with type 2 diabetes also had lower levels of creatine, indicating impaired energy metabolism. In addition, hippocampal volume decreases with aging, and type 2 diabetes accelerated this age-related decline.

Some of diabetes’ effects on the brain are mediated by other health factors, including obesity, cerebral blood vessel disease (which affects white matter integrity), and side effects from medications.

What You Can Do

Start early with a good diet and exercise, and have regular checkups with a doctor, who can tell you if you have diabetes or are at risk for it. If so, start long-term preventative treatment with the most effective and easy-to-tolerate medications, and periodically have your fasting blood sugar tested. If these tests are abnormal, have your hemoglobin A1c (HbA1c) checked. This is a measure of good glucose control, and should be under 6. If it creeps upward toward 6 (a sign of pre-diabetes), the drug metformin may be able to prevent the onset of type 2 diabetes. If you have type 2 diabetes, there are several types of effective medications that can minimize its effects.

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