Oil Refining Helping Researchers With New Tools For Type 1 Diabetes: In order to control blood sugar, engineering researchers from the Rensselaer Polytechnic Institute are merging automation techniques from oil refining in order to create a closed-loop artificial pancreas.

The reason for this device is so that blood sugar levels can be automatically monitored and insulin can be administered to patients suffering from Type 1 diabetes. After six years of research and studies, Professor B. Wayne Bequette, a member of the Department of Chemical and Biological Engineering at Rensselaer had progressively created more highly advanced control systems for the closed-loop artificial pancreas. Through Professor Bequette work, he hopes to benefit 15,000 children and 15,000 adults who are diagnosed with Type 1 diabetes every single year.

Bequette states: “Every single person with Type 1 diabetes has a different response to insulin and a different response to meals. These responses also vary with the time of day, type of meal, stress level, and exercise. A successful automated system must be safe and reliable in spite of these widely varying responses.”

Like most people, Bequettes fight against type 1 diabetes is very personal to him, given that his little sister developed the disease very early in life. Unfortunately, at that time diabetes wellness was not as advanced as it is today.

A person who had Type 1 diabetes will find themselves with little or no insulin in their pancreas. Due to this, they will have to take insulin injections on a daily basis. Some people who have Type 1 diabetes prefer to use an insulin pump instead. The insulin will help to maintain the blood sugars, for if they do not stay balanced serious life-threatening health problems could occur through hyperglycemic, which means blood sugar is too high and through hypoglycemic, which means blood sugar is too low.

Bequette says, “A key challenge for people living with Type 1 diabetes is the constant monitoring of their blood sugar level. Blood glucose levels are generally measured from a tiny blood sample captured from a finger stick test, prior to eating or sleeping. Another critical challenge is accurately estimating how many carbohydrates they eat. These blood sugar readings, along with the amount of carbs eaten, must be interpreted to decide how much insulin the individual needs to inject. Exercise and fitness also impact the amount of insulin required. Continuous blood glucose monitors are available on the market, but are not yet as accurate as finger sticks tests. There are many judgment calls and best guesses being made on a daily basis by individuals with Type 1 diabetes. And though medical technology for diabetes is very advanced and reliable, he is working on an artificial pancreas that would remove the need for most of this guesswork.”

HbA1C Results Prove Inaccurate For Dialysis Patients: According to a new study at Wake Forest Baptist Medical Center, a test known as the golden standard long-term glucose monitoring test proved to be less valuable in patients who are on dialysis.

The hemoglobin A1C (HbA1c) is administrated to patients over a 3-month period to check blood sugar levels and has become a trusted test in terms of the medical field. It had even been identified as an applicable tool in diagnosing diabetes, according to the American Diabetes Association. However, recently professionals have found that the HbA1c test is not helpful for patients who have been diagnosed with diabetes and are in the advanced stages of kidney failure. Alternatively, the GA assay, aka glycated albumin does appear to be more helpful in that area.

Diabetes is the most common cause of kidney failure worldwide and is associated with high mortality rates — more than 20 percent of dialysis patients die each year. As such, there is an urgent need for accurate blood sugar testing in diabetic dialysis patients.

Barry I. Freedman, M.D., lead investigator of the study and Professor at John H. Felts III said, “Many organs don’t function properly in severe kidney failure. For example, most dialysis patients have anemia with fewer red blood cells than they should, which has a dramatic impact on the accuracy of the HbA1c reading.”

Freedman goes on to say, “Doctors long thought the HbA1c predicted outcomes in diabetes. This test is not predictive of outcomes in diabetes patients with kidney disease on dialysis. Dialysis patients and physicians get a false sense of security because their lower HbA1c actually relates to shorter red cell survival, yet suggests diabetes control is better than it really is.”

This is the way it works. Hemoglobin takes red blood cells through the body, carrying oxygen. Blood sugar will interact with the hemoglobin and come up with HbA1c, which are only accurate when red cells have a regular lifespan. However, dialysis patients have a shorter red cell lifespan, which means the time that sugar is in the blood stream to interact with hemoglobin is reduced and cause less HbA1c values.

During this study, 444 patients suffering from diabetes who also have to undergo dialysis were tested on. While patients continued their normal treatments and were monitored in the amount of HbA1c they also agreed to the GA test every three months for 2.3 years.

Freedman responds the results of the test. “This is the first study showing that a blood sugar test predicts risk of death in diabetic dialysis patients, as well as risk of hospitalization. This test provides the missing link that will allow dialysis patients and physicians to accurately gauge risk. The association is clear: high GA readings predict higher risk.”

More than 24 million Americans suffer from diabetes and being able to monitor blood sugar is one way to manage diabetes. More than 500,000 people are on dialysis in United States alone and diabetes is the cause of almost 50 percent of those with kidney failure. More than 20 percent of patients who suffer from kidney failure die each year.

Master Gene Found To Cause Obesity And Diabetes: According to a study led by a team of King’s College London and the University of Oxford researchers, a “master regulator” gene is being named the culprit of high cholesterol levels and type 2 diabetes in the body.

The regulatory gene has become a lead target in helping to fight off metabolic diseases such as diabetes, obesity and even heart disease. Fat alone is the biggest cause of these diseases.

Through years of continuous study, it had already come to light that the KLF14 gene was linked to type 2 diabetes and cholesterol levels. However, researchers did not know about the role that was being played in which could control other genes positioned further away on the genome.

Over 20,000 genes within subcutaneous fat biopsies in 800 UK female twin volunteers were examined. A connection was found between the KLF14 gene and the expression levels of multiple distant genes that were found in fat tissue. This means that the gene acts as a master switch to control these genes. Six hundred subcutaneous fat biopsies were then confirmed in Icelandic subjects.

These other genes that are controlled by the KLF14 gene are found to be linked to certain metabolic traits like cholesterol, insulin, glucose levels, and BMX (body-mass index).

There are a set of genes that are inherited by the mother and the father, but the KLF14 gene is inherited from the mother. In this instance, the father’s side of the KLF14 for lack of a better world “switched off.” This means that the mother’s gene is the one that is ready and active. This is actually referred to as a process known as imprinting. The KLF14’s ability to control other genes is completely dependent on the mother, as the father’s copy showed nothing.

A professor by the name of Tim Spector who led the MuTHER project to find out what the master gene was capable of had this to say. “This is the first major study that shows how small changes in one master regulator gene can cause a cascade of other metabolic effects in other genes. This has great therapeutic potential particularly as by studying large detailed populations such as the twins we hope to find more of these regulators.”

Another professor, Mark McCarthy also commented. “KLF14 seems to act as a master switch controlling processes that connect changes in the behavior of subcutaneous fat to disturbances in muscle and liver that contribute to diabetes and other conditions. We are working hard right now to understand these processes and how we can use this information to improve treatment of these conditions.”

New System Could Convert Cells Into Making Insulin: Diabetes is a disease of the body that incurs when a person does not have enough pancreatic beta cells, to produce the necessary insulin which is used to regulate their blood sugar levels.

As it stands right now, there is one standard treatment for diabetic patients and that’s insulin therapy. Insulin therapy works by supplying the patient with insulin so that blood sugar levels can be maintained, thereby reducing the risk of high blood sugar levels that cause a number of various diabetic complications such as neuropathy.

With advancements being made all the time in scientific medicine, researchers began to wonder what would happen if they tried to persuade other cells within the body to become pancreatic beta cells. The answer became quite clear when researchers from UCLA’s Larry L. Hillblom Islet Research Center took the scope from asking the question to making it a reality. The researchers found an underlying mechanism that can transform other cells into pancreatic beta cells.

While insulin therapy does work as an effective treatment, pancreatic beta cells are a potential cure for diabetes.

“Our work shows that beta cells and related endocrine cells can easily be converted into each other,” notes study co-author Dr. Anil Bhushan, an associate professor of medicine in the endocrinology division at the David Geffen School of Medicine at UCLA and in the UCLA Department of Molecular, Cell and Developmental Biology.

Throughout history, cells have been construed as being set in place and unable to change or switched to other cells. However, recent studies have proved something much different. This has launched further understanding into what mechanism allows this to happen.

Chemical tags named “methyl groups” are connected to DNA; these chemical tags can turn up and down the activity of different, particular genes. Methyl groups are very important when it comes to understanding how cells can be transformed into pancreatic beta cells. Methyl groups keep a gene called ARX, which triggers the formation of glucagon-secreting alpha cells in the embryonic pancreas, which cannot be seen in beta cells. By deleting an enzyme called Dnmt1 from the insulin-producing beta cells, they can be transformed into alpha cells.

“We show that the basis for this conversion depends not on genetic sequences but on modifications to the DNA that dictates how the DNA is wrapped within the cell,” Bhushan notes. “We think this is crucial to understanding how to convert a variety of cell types, including stem cells, into functional beta cells.”

Artificial Pancreas May Improve Overnight Control of Diabetes in Adults: New trial studies show suggest that an artificial pancreas, also known as closed loop insulin delivery could advance overnight blood glucose control. The studies also show a reduction in nocturnal hypoglycemia, which is a sudden drop of blood glucose levels in the night for patients who have Type 1 diabetes.

Diabetes is a very common illness among the population. Just alone, the United States has more than 26 million diabetic patients. Patients range from women to men, to small children. Diabetes does not pick and choose, it affects everyone. In today’s world, genetics has very little to do with whether or not a person becomes a diabetic. Although the risk factors are greater, with diabetes in an individual’s family history. Diabetes increases yearly and right now the illness stands at a rate of 3 percent of people developing diabetes yearly.

Those who have Type 1 diabetes know that it is no secret that, in order to control diabetes, insulin must be administered. It is a life-long process and while medical science has made some pretty amazing diabetic breakthroughs, it is a pattern that must completed on a daily basis. In order for blood glucose levels to be controlled, a person must use insulin. While this is a common annoyance to those with type 1 diabetes, it is not uncommon for patients to make the best of it and take their insulin. However, when it comes to the night, patients are sleeping. A common problem occurs during the night with many patients, a drop in glucose levels known as hypoglycemia.

Due to the growing issues, researchers have made advances to try and keep those glucose levels maintained. The development of a closed loop insulin delivery, also known as an artificial pancreas has become the answer to so many health issues that result from low blood glucose levels. A closed loop insulin delivery system automatically records insulin dose judging by glucose levels, which are detected by a sensor. Through studies, the system has proven effective on teens and children alike. However, the effect the system has on adults remains unknown.

This trial study was led by Roman Hovorka of the University of Cambridge, who instructed a team of researchers. It consisted of two studies, so that comparison and efficiency of the overnight closed loop insulin delivery with conventional insulin pump therapy in adults with type 1 diabetes could be completed.

Within this trial 24 adults (10 men and 14 women) between the ages of 18 and 65 were studied upon. Every patient has used insulin pump therapy for the previous three months.

Glucose levels increased by 28 percent, with overnight patients who were using the closed loop insulin delivery.

Through this study, evidence was provided that help to prove that an overnight closed loop delivery can work both safely and effectively to help patients sleep better without have their glucose levels drop in the night.

Researchers of this study admit that the closed loop delivery, “may in the future allow more flexible lifestyles in conjunction with improved glycemic control for people with type 1 diabetes.”

Clinical Trial Finds Weight Loss Through An Experimental Drug: Researchers at Duke University Medical Center have found that an investigational combination of drugs that are used to treat epilepsy, migraine and obesity is producing a 10 percent weight loss in patients who were suffering from obesity during a one-year clinical trial.

The treatment was also helpful in other health areas as well. For example, the controlled-release combination therapy, which consists of topiramate and phentermine were also helpful in decreasing blood pressure and hemoglobin A1C levels. Cholesterol, triglycerides and inflammatory markers were also improved during the clinical trial.

“Patients receiving this combination experienced 8.6 percent greater weight loss, on average, compared to those patients receiving placebo,” stated Kishore M. Gadde, M.D., director of Duke’s obesity clinical trials program. “This kind of weight loss, coupled with significant reductions in cardiometabolic risk factors represents a potentially important advancement in the management of obesity.”

Presently, the only drug available for long-term obesity is Orlistat. Orlistat is available over-the-counter known as Alli, and in a prescription strength known as Xenical. During studies, Orlistat, used at its maximum strength has shown a seven pound weight loss over placebos.

“The combination drug achieves about 19 pounds of weight loss relative to placebo at one year,” Gadde says.

During the 56-week trial, 3 studies were conducted in 93 U.S. Centers with more than 2400 patients who all had a BMI of 27-45 kg/m2 and who also had two or more health issues such as heart disease or diabetes. The patients were randomly drawn to either receive either one/two low-dose drug combinations or a placebo. The drugs used in the trial were phentermine, which has been available for treatment of short-term obesity since 1959, and topirmate, which is also known as Topamax. The patients in this study were also offered advice about exercise and diet.

Vivus funded this clinical trial who is also trying to get Qnexa, the name of the combination therapy to be approved by the FDA.  It was first declined in October 2010 because the FDA ruled that the drug could not be approved in its current form. The FDA needed more safety data about the drug. In March of 2011, a warming was issued by the FDA stating that women who were pregnant and taking topirmate were more at risk for having babies that were born with cleft palate or cleft lip. The drug has also been associated with depression, anxiety, mood changes, and memory problems.

During the Qnexa clinical trials, 34 women became pregnant. Gadde states that, “No birth defects were reported for the babies born.” Gadde also stated, “There is no reason for women to use weight loss drugs while they are pregnant or trying to become pregnant.”

Broken down, the study used once-daily doses of the combined drugs listed below.

Phentermine 7.5mg plus Topiramate CR 46mg achieved 7.8 percent weight loss (p<0.0001 vs. placebo).

Phentermine 15mg plus topiramate CR 92mg achieved 9.8 percent weight loss (p<0.0001 vs. placebo). The placebo group experienced 1.2 percent weight loss.

The highest advance in cardiovascular disease and diabetes were seen in high-risk patients among the groups given placebo, phentermine 7.5mg plus topiramate 40mg, or phentermine 15mg plus topiramate 92mg individually:

• Systolic blood pressure: -4.9mmHg, -6.9mmHg, -9.1mmHg
• Diastolic blood pressure: -3.9mmHg, -5.2mmHg, -5.8mmHg
• Total cholesterol: -4.9%, -5.7%, -7.8%
• LDL: -3.6%, 0.7%, -4.3%
• HDL: 2.8%, 9.5%, 10.7%
• Triglycerides: -8.8%, -24.1%, -25.6%
• Hemoglobin A1C in diabetics: -0.1%, -0.4%, -0.4%
• Fasting insulin in pre-diabetics: 6.0pmol/L, -29.2pmol/L, -31.9pmol/LM

The most common side effects in the groups given placebo, phentermine 7.5mg plus topiramate 40mg, or phentermine 15mg plus topiramate 92mg, individually were:

• Dry mouth (2%, 13% and 21%)
• Parethesia (numbness or tingling), (2%, 14%, 21%)
• Constipation (6%, 15%, 17%)
• Insomnia (5%, 6%, 10%)
• Dizziness (3%, 7%, 10%)
• Dysgeusia (distorted sense of taste) (1%, 7%, 10%)

“Although the overall incidence of these events was relatively small,” Gadde says, “clearly there is a dose-related increase in risk.”

“Two thirds of Americans are overweight or obese. For obese patients who have failed to achieve meaningful weight loss with diet and exercise, we have just one treatment before jumping to bariatric surgery. We need more treatment options.”

Possible New Non-Insulin Treatment Found For Type 1 Diabetes: While Type 2 diabetes is more common, many patients find themselves becoming diagnosed with Type 1 diabetes. Through-out many years, Type 2 diabetic patients have been placed on a strict diet and exercise regime while patients with Type 1 diabetes are often treated with insulin injections. In fact, Type 1 diabetes affects more than 1 million people within the U.S. who have to take multiple injections of insulin to metabolize their blood sugar.

Now, thanks to the researchers as UT Southwestern Medical Center, a hormone pathway has been discovered that could be the gateway toward treating Type 1 diabetes without insulin.

Fibroblast growth factor 19 (FGF19) was found with insulin-like features but does not cause an excess of glucose that turns to fat. This means that this FGF19 could help treat patients with Type 1 diabetes and it could help patients who are suffering from obesity.

“The fundamental discovery is that there is a pathway that exists that is required for the body, after a meal, to store glucose in the liver and drive protein synthesis. That pathway is independent of insulin,” said Dr. David Mangelsdorf, Chairman of Pharmacology at UT Southwestern.

Both Dr. Mangelsdorf and Dr. Kliewer, a professor of Molecular Biology and Pharmacology at UT Southwestern are co-senior authors of this study. Dr. Kliewer himself has been researching FGF19 since he discovered its connection with metabolism eight years ago.

The hormone fibroblast growth factors works by controlling nutrient metabolism. These factors are released when bile acid appears in the small intestine. These bile acids are produced by the liver, which are then broken down into fats in the body.

“FGF19 does not make fat, and that’s one of the effects that separates it from insulin. Insulin also does not really have a dramatic effect on bile acid synthesis. So, the two pathways are different even though they both function in glycogen and protein synthesis,” said Dr. Mangelsdorf, a Howard Hughes Medical Institute investigator at the medical center.

While using mice, the two researchers tried to manipulate FGF19 as an alternative to insulin therapy, but some pretty grave side effects occurred. First, this mice’s liver grew in size before developing cancer. Another promising diabetes treatment did appear however. This treatment involves the nuclear acid receptor FXR. Modulators of FXR have been shown to lower cholesterol and triglycerides in preclinical models.

Retinopathy Can Be Identified 10 Years Before It Happens: Diabetes affects more than 24 million people every single day in the United States, men, women and children are all affects. By this time next year, another million will be diagnosed with diabetes while another million walk around unknowable daily without symptoms but still have diabetes. Diabetic patients living with poor control of and high blood glucose levels are more likely to have eye-related complications within ten years.

When a person has diabetes, they are dealing with some very high glucose levels. These high levels are associated with mircovascular complications, which includes retinopathy.

“However, some controversy concerns the actual value of this glycemic threshold for identifying retinopathy,” the authors of states. “It is now well established that the non-diabetic population also has retinopathy, albeit at a lower frequency than patients with diabetes and in a milder form, indicating that there may be factors other than fasting plasma glucose levels that increase the risk of retinopathy.”

The retinas of 700 men and women were examined by Pascale Massin, M.D., Ph.D., of Hôpital Lariboisière, Paris, and colleagues in the Data From an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) Study Group. Nine years of research saw that fasting plasma glucose levels and hemoglobin A1C has also been tracked. During this study, 235 patients were diabetic, 227 patients have impaired fasting plasma glucose levels and 238 have glucose levels within the normal limits. Among the participants, 44 patients had retinopathy which included 19 who were diagnosed with diabetes, 19 who has impaired fasting levels and 6 who has normal glucose levels. When compared with patients that did not have retinopathy, conditions where in higher levels of fasting plasma glucose ten years previous.

“Levels of HbA1c and fasting plasma glucose at baseline were related to the presence of retinopathy 10 years later, and the levels at which the positive predictive values increased provide a rationale for the choice of thresholds for the definition of hyperglycemia associated with 10-year retinopathy,” the authors write. “We propose that thresholds of 108 milligrams per deciliter for fasting plasma glucose concentration and 6.0 percent for HbA1c level could be used to define those who are at risk of retinopathy; this is in agreement with our observation of a risk of retinopathy within the impaired fasting glucose range (fasting plasma glucose level, 110 milligrams per deciliter or higher).”

“Factors other than glucose measures play only a minor role in retinopathy,” they conclude.

Research Shows Safflower Oil Helping Type 2 Diabetics: Safflower oil, which can be found in many kitchens around the world, is finding its name on headlines this week. Thanks to a recent study, a person who takes a daily dose of safflower oil for 16 weeks can improve cholesterol levels, insulin sensitivity and blood sugar. It is also helpful in women who are obese postmenopausal and have type 2 diabetes.

Eighteen months prior, researchers found that safflower was also helpful in decreasing abdominal fat and increasing muscle tissue. It is also in association with increased health in patients suffering from metabolic syndrome, which have a cluster of symptoms from heart disease to diabetes.

With this study, the chief researcher suggested that a person suffering from cardiovascular disease or at risk for the disease could safely lessen their risk or symptoms by taking a daily dose of 1 2/3 teaspoons of safflower oil.

Martha Belury, professor of human nutrition at Ohio State University said, “The women in the study didn’t replace what was in their diet with safflower oil. They added it to what they were already doing. And that says to me that certain people need a little more of this type of good fat — particularly when they’re obese women who already have diabetes. I believe these findings suggest that people consciously make sure they get a serving of healthy oil in their diets each day- maybe an oil and vinegar dressing on a salad, or some oil for cooking. And this recommendation can be extended to everyone.”

When broken down, safflower oil is found to have linoleic acid, a poly saturated fatty acid. In the 1960’s research suggested that dietary oils from plants could help prevent heart disease. However, in recent years Omega-3 fish oils have gained huge popularity of fatty oils like safflower oil.

“The health benefits of omega-3 PUFAs seem convincing, but I think there’s also a place for omega-6 PUFAs. We’ve known for a long time that polyunsaturated oils are very beneficial for cardiovascular disease prevention, and these data we are adding now show that these oils can also help with other aspects of metabolic syndrome, including even glycemic control, we suspect it could be through a mechanism that is not yet identified.” Belury commented.

During the research, scientists performed secondary analysis of the data that has been collected within the trial. They checked to see how long it took for effects to be seen. Every four weeks, blood samples were taken. Sixteen weeks later, a reduction was noted in total body fat and body mass index as well.

“We don’t know the long-term effects of safflower oil from this study alone, but I certainly think it’s possible that the risk for cardiovascular problems could be significantly decreased in this high-risk group if supplementation were continued,” Belury said.