Category: Diabetes 101

New findings from the Alpha Omega Trial suggest that low-dose omega-3 fatty acid supplementation could play a role in preventing ventricular arrhythmia-related events in patients who have both diabetes and a history of myocardial infarction.

The trial was conducted by a team headed by Daan Kromhout, MPH, Ph.D., from the division of human nutrition at Wageningen University in the Netherlands. Kromhout and colleagues used a sample of 1,014 patients from the age of 60 to 80, who consumed margarine fortified with recommended daily doses of omega-3 fatty acids. Participants were randomly assigned to three groups, which consumed either placebo or one of three types of margarine fortified with omega-3 fatty acids: 400mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); 2g alpha-linolenic acid (ALA); or a combination of EPA, DHA, and ALA. All patients had a history of myocardial infarction within the past ten years. The trial was conducted over a period of 40 months.

Patients across all the groups consumed an average of 18.6g margarine daily, which included an average additional intake of 223mg EPA, 149mg DHA and 1.9g ALA. The median follow-up period was 40.7 months; during that time, 29 patients experienced a ventricular arrhythmia-related event. Another 27 died of myocardial infarction. According to the researchers, their data suggested that supplementation with omega-3 fatty acids in any combination reduced the patients’ chances of ventricular arrhythmia-related events when compared to the rates associated with placebo. Patients who received a combination of EPA, DHA and ALA supplementation had the lowest incidence at 84 percent less than with placebo. Supplementation with EPA, DHA, and ALA had similar benefits over placebo in reducing cardiac arrest, sudden death, and the placement of cardioverter defibrillators.

The groups receiving supplementation did not appear to differ significantly in rates of fatal myocardial infarction compared to the placebo group. However, after adjusting for potential confounding factors, the researchers found that the group receiving a combination of EPA, DHA and ALA saw a reduced endpoint for ventricular arrhythmia-related events as well as fatal myocardial infarction.

Kromhout pointed out in a press release that, although the findings suggest omega-3 fatty acid supplementation has benefits for patients with both diabetes and a history of myocardial infarction, additional research will need to be conducted before the mechanism underlying the benefits is understood.

“While more research is needed to definitively determine the role of these fatty acids in protecting people from ventricular arrhythmias, they seem to provide a benefit to the heart attack patients who also had diabetes,” said Kromhout. “This is the first study that showed a significant protective effect of omega-3 fatty acids in high-risk patients with diabetes who were on state-of-the-art drug treatment for their heart attack,” he continued.

Myocardial infarction, more commonly known as heart attack, is more common among patients with diabetes and is more fatal. Although the processes that cause heart attack are not different among diabetes patients, scientists believe that the procoagulant and prothrombotic characteristics of diabetes are responsible for the increased rates of heart attack. It is also more difficult to ensure proper blood flow through blood vessels in patients who have diabetes after heart attack than in patients without the metabolic disease. Among patients experiencing myocardial infarction, 10 to 30 percent have Type 2 diabetes. Rates of heart attack are expected to rise in the future along with the increasing rate of Type 2 diabetes.

In addition to Type 1 and Type 2 diabetes, there is another variant of the disease: cystic fibrosis-related diabetes. It differs in some important ways from Type 1 and Type 2 diabetes and it requires different treatment methods.

Patients with cystic fibrosis experience decreased nutritional and pulmonary health several years before they’re diagnosed with cystic fibrosis-related diabetes (CFRD). According to Amanda Leonard, a senior pediatric clinical dietician at the Johns Hopkins Cystic Fibrosis Center, early diagnosis and treatment can significantly improve life expectancy in patients who develop CFRD.

“Screening early and knowing which patients are at risk is really important,” said Leonard at a pediatric nutrition meeting sponsored by Johns Hopkins University.

CFRD does “share some components” with Type 1 and Type 2 diabetes, says Leonard, but it’s also different in some important ways. Patients with CFRD typically experience decline in lung function, protein catabolism, weight loss, and an increased rate of mortality. Ketones rarely appear in patients with CFRD, and the development of the disease does not appear to be related to autoimmune function.

In cystic fibrosis patients at the age of 40, the rate of CFRD is over 50 percent. According to Leonard, more patients develop CFRD in the 20-24 year old range than any other age; meanwhile, Type 1 diabetes usually develops in childhood and Type 2 diabetes usually develops in mid-to-late adulthood.

“In CFRD there is a severe insulin deficiency, but it’s not as complete as in type 1,” said Leonard. Physicians define CFRD as the presence of at least two of the following criteria on at least two occasions: hemoglobin A1c of at least 6.5 percent; fasting glucose level of at least 126 mg/dL; and a two-hour oral glucose tolerance test of plasma glucose at least 200 mg/dL.

Leonard says that CFRD isn’t quite as easy to identify as other types of diabetes. In patients with CFRD, a two-hour oral glucose tolerance test (OGTT) can range from 140 to 199 mg/dL while fasting glucose can range from 100 to 125 mg/dL. According to Leonard, it’s “not quite diabetes, but it’s not quite right either.” The disease is “not an all or nothing kind of thing. It’s not that either you have it or you don’t. It can be transient in nature, and there’s a spectrum,” she continued.

Outpatient OGTTs are the best option for routine CFRD testing in clinically stable patients. Cystic fibrosis patients are recommended to begin OGTT screening for diabetes when they reach 10 years of age.

While HbA1c alone cannot be used as to screen for CFRD due to a high rate of false positives, a low HbA1c can confirm a diagnosis from other symptoms.

Patients who are hospitalized due to pulmonary exacerbation and/or treatment with corticosteroids should be tested with both fasting and two-hour post-meal blood glucose monitoring. The patient is diagnosed with CFRD when fasting or post-meal hyperglycemia lasts longer than 48 hours.

Patients with CFRD are treated with insulin; other treatment methods have not shown benefits for patients and are not recommended over insulin. “Insulin is the treatment of choice. Oral agents do not seem to work as well,” said Leonard.

CFRD patients have the same blood glucose goals as other diabetes patients, with an HbA1c goal of less than 7.0 percent. However, goals are adjusted for each individual patient.

Nutritional recommendations for patients with CFRD are based on those for patients with cystic fibrosis. CFRD patients may also benefit from counting carbohydrates to ensure safe blood glucose levels.

New research conducted at the University of Glasgow, Scotland, suggests that thrombolytic drugs—also called “clot-busting” drugs due to their use in dissolving blood clots—improve outcomes in patients who have suffered from strokes, even when they have a past history of stroke or diabetes. In fact, outcomes were similar to those demonstrated by patients who had experienced neither stroke nor diabetes.

The study was conducted by Kennedy Lees, MD, and colleagues at the University of Glasgow. According to Lees, there is “no statistical justification” for denying such clot-busting medications to patients who have a history of stroke or concomitant diabetes. The research was reported in the November 22 issue of the journal “Neurology.”

The use of clot-busting drugs in patients with a history of stroke or diabetes has been controversial, mainly due to restrictions on the approval of intravenous alteplase (Activase) in Europe. Lees said in a statement that therapy with clot-busting drugs “can limit damage and disability due to blood clots” but that “current guidelines can keep people from receiving the therapy if they have a history of stroke and diabetes.” However, physicians often ignore the restrictions when prescribing thrombolytic drugs to these patients.

Lees and his colleagues analyzed data from two registries of stroke victims. One group (the “T” group) consisted of 23,334 patients from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. The other group (the “C” group) consisted of 6,166 patients who had not received treatment with thrombolytic drugs. That data was pulled from the Virtual International Stroke Trials Archive.

The researchers measured outcomes using the 90-day modified Rankin Score, which measures stroke-related death and disability.

In total, the researchers used data from 29,500 patients: 5,411 (18.5 percent) had diabetes; 5,019 (17.1 percent) had a previous stroke; and 1,141 (5.5 percent) had a history of both diabetes and stroke.

Upon analyzing the data, the researchers found that 43.2 percent of the diabetes who received thrombolytic drugs demonstrated a modified Rankin score of 2 or less, which is considered, at worst, a slight disability. Meanwhile, 34.8 percent of patients with diabetes who had not received thrombolytic treatment had a score of two or lower.

Among patients who had a history of stroke and received clot-busting drugs, 48.4 percent showed a modified Rankin score of two or less, compared to 34.5 percent who did not receive the drugs.

Among patients who had a history of both stroke and diabetes, 37.7 percent who received thrombolytic drugs showed a score of two or lower compared to 34.5 percent who did not receive the drugs.

The findings demonstrated that, on average, patients showed improved modified Rankin Scores when they received treatment with clot-busting drugs.

“Better outcomes with therapy show that people with prior stroke or diabetes should not be excluded from receiving thrombolytic therapy,” said Lees. The researchers noted that the study was not randomized; however, they believed that they “attained a reliable statistical result” after adjusting for confounding factors.

According to Bart Demaerschalk, MD, of the Mayo Clinic Hospital in Phoenix, Arizona, noted in an editorial accompanying the study that up to 15 percent of people who arrive at the emergency room with a stroke have a history of previous stroke or concomitant diabetes. Issues surrounding the treatment of these patients with thrombolytic drugs include whether physicians should consider transient ischemic attacks or glucose tolerance in prescribing the drugs. Still, Demaerschalk concluded that “there appears to be no justification for the continued restriction of these patients from receiving thrombolytic therapy.”

A new study found that an enzyme called IKKbeta was linked to increased metabolism in lab mice. When researchers engineered the mice to express the IKKbeta enzyme in their fat tissue, the mice ate more food yet gained less weight, with their bodies using fat and sugar more effectively than mice who had not been treated. The study was published in the online edition of the journal “Endocrinology.”

The researchers working on the study reported that the expression of the enzyme had several positive benefits, including improving the efficacy of insulin, reducing weight gain, and improving metabolism. The mice were also less likely to become obese, though in exchange they experienced significant inflammation. Still, the researchers say that the findings could lead to new discoveries regarding the effect that inflammation and obesity have on insulin sensitivity and insulin resistance.

“Turning on this molecule has a very dramatic impact on lipid metabolism,” says Haiyan Xu, an assistant professor of medicine at the Warren Alpert Medical School of Brown University and a researcher at the Center for Diabetes and Endocrinology of Rhode Island Hospital.

In this study, scientists sought to explore the effects of obesity and inflammation on insulin resistance. Both obesity and inflammation appear to cause insulin resistance, but obesity plays a larger role, and the most popular hypothesis among scientists is that obesity causes inflammation, which contributes to insulin resistance. By expressing the IKKbeta hormone in the fatty tissue of lab mice, the researchers reduced inflammation before they mice were obese; the mice then showed increased metabolism, significantly higher than control mice that did not have the enzyme expressed.

The mice who expressed the enzyme still put on weight, but at a significantly reduced rate. When the mice were fed high-fat diets, altered mice weighed less than 38 gram; control mice weighed over 45 grams. The difference was less pronounced when the mice were fed a healthier diet—called “chow”—but it was still statistically significant. Both male and female mice showed improved metabolism and less weight gain when the enzyme was expressed.

The altered mice actually ate more food, but gained weight more slowly, which demonstrated to the researchers that their metabolic rates were increased over the control mice. Altered mice also displayed lower blood sugar levels after being injected with glucose, and they maintained their lower blood sugar levels after an injection with insulin, which suggests that insulin was more effective for them as well. The altered mice expended more energy than the control mice, which suggests that they successfully metabolized the glucose injections.

The researchers stated that they were not sure about the mechanism by which IKKbeta improves metabolic performance. However, according to Xu, it appears that obesity is a greater factor in causing insulin resistance than inflammation.

“Lower body weight is always a beneficial thing for influencing insulin sensitivity,” said Xu. “Reduced adiposity wins over increased inflammation.”

Previous research has explored the effects of IKKbeta by activating it in the liver, where it seemed to have no effect on weight gain, and in the hypothalamus, where it actually increased weight gain. The findings of the study suggest that IKKbeta’s improvements to metabolic processes are dependent on its expression within fatty tissue.

The study was funded by Brown University as well as the American Heart Association, with a scientist development grant to Xu.

The latest statistics of the International Diabetes Federation predict that diabetes rates will continue to rise in the coming years. By 2030, the IDF predicts, 552 million people could have the disease, or at least one in 10 adults worldwide.

The November 14 report from the IDF used factors such as demographic changes and aging to predict the increasing rates of the disease. According to the IDF, about one in 13 adults worldwide now has diabetes.

The number includes both variants of diabetes in addition to undiagnosed cases. The IDF predicts that the number of diabetes cases will jump significantly—about 90 percent—in Africa, where infectious diseases have typically claimed more lives than diabetes. The predictions may even be conservative, since increasing rates of diabetes due to obesity were not taken into account.

Today, the World Health Organization estimates that there are 346 million people living with diabetes around the world; over 80 percent of deaths from diabetes occur in developing countries. The WHO predicts that diabetes deaths will double by the year 2030 and that the International Diabetes Federation’s numbers are possible.

According to Gojka Roglic, the head of the diabetes unit at the WHO, the predictions are “a credible figure.”

“But whether or not it’s correct, we can’t say,” continued Roglic. She noted that the increasing rates of obesity were linked to the aging of the population rather than the obesity epidemic, although most people with diabetes have the Type 2 variant of the disease, which is related to obesity, poor diet and lack of exercise.

The good news is that many cases of Type 2 diabetes are preventable. “It’s worrying because these people will have an illness which is serious, debilitating, and shortens their lives,” said Roglic. “But it doesn’t have to happen if we take the right interventions.”

Such interventions could include counseling on healthy eating and getting regular exercise. Research has demonstrated that interventions which improve or reverse obesity and sedentary lifestyles are also helpful in controlling blood glucose levels in diabetes. In patients who receive both bariatric surgery and interventions to reduce risk factors of diabetes, the disease is almost completely eliminated.

The number of Type 2 diabetes cases has grown by leaps and bounds over the past several decades. In 1985, the IDF estimated that about 30 million people around the world had diabetes. By 2000, that number had increased to 150 million, and today estimates place the number around 366 million people. Half of those with diabetes are between the ages of 20 and 60, and the disease is expected to grow exponentially. About 4.6 million people die from diabetes each year; the disease also takes an immense financial toll due to health care costs, which run about $465 billion each year in treatment for the disease.

“The data from the latest edition of the IDF Diabetes Atlas show that the epidemic is out of control,” said Professor Jean Claude Mbanya, President of the IDF. “We are losing ground in the struggle to contain diabetes. No country is immune and no country is fully equipped to repel this common enemy.”

The International Diabetes Federation is an association of over 200 diabetes organizations, spanning over 160 countries around the world. Since 1950, the IDF has promoted awareness of the disease, proper care and prevention, and the search for a cure for both Type 1 and Type 2 diabetes.

Diabetics around the world are familiar with the routine of blood glucose testing that requires a prick on the finger to draw blood. Though the inconvenience of drawing blood is a small price to pay for accurate blood sugar control, some diabetics require several tests a day and the frequent pricks can be tiring.

For decades, scientists have pursued alternate methods of blood glucose testing, which could help diabetics improve their control over the disease. Some researchers have targeted tears as a vessel for testing blood glucose, and a recent study published in the journal “Analytical Chemistry” has demonstrated that this may be a viable option.

A research team at the University of Michigan developed a sensor that detects dilute glucose levels in animal tears. They conducted a study using 12 rabbits, demonstrating that the results of glucose tests using tears had similar results to testing using blood samples.

Doctors have made it known that an alternative to the finger-prick blood sugar test would likely be highly successful among diabetics.

“This is an incredibly hot area,” says Dr. George Grunberger, a member of the board of the American Association of Clinical Endocrinologists.

According to Dr. Grunberger, previous research into finding alternative blood sugar testing methods has been enthusiastic, though not always successful.

“People have been trying to read glucose through skin, through measurements attached on the earlobe. There have been machines on the market that got taken off the market because of unreliability and poor reproducibility,” said Dr. Grunberger.

According to the American Diabetes Association, about 25.8 million people in the United States have diabetes; about 7 million of those cases are undiagnosed. Diabetes is characterized by excessive levels of glucose in the bloodstream, which may be caused by a lack of production of the hormone insulin (as in Type 1 diabetes) or a resistance to insulin (as in Type 2 diabetes). Insulin’s job is to transport glucose out of the bloodstream; in diabetics, the body’s inability to use insulin effectively means that glucose remains in the blood.

To combat the effects of chronically elevated blood sugar levels, diabetics must monitor those levels to ensure that they stay in a normal range. For some diabetics, this means testing blood glucose levels “two, three, four or even 10” times a day, says Dr. Grunberger. Since blood sugar levels vary due to diet and physical activity, enough measurements must be taken to ensure proper monitoring.

A team of researchers headed by Jeffrey LaBelle at Arizona State University has previously worked with researchers from the Mayo Clinic to develop blood glucose testing technology that uses tears instead of blood. According to LaBelle, the idea of testing tears dates as far back as 1937, but the fluidity of the liquid makes glucose testing difficult. Tears also contain much less glucose than blood, which means that sensors must be sensitive to small amounts of glucose.

“Levels of glucose in tears have been found to be typically 30-50 times lower than in blood,” wrote the authors on the University of Michigan Study. They noted that physicians would need to establish guidelines for each individual using tears for blood glucose monitoring: “The use of tears as an alternate sample to assess blood glucose in human subjects will likely require that the ratio of glucose in tears and blood be established first for a given individual.”

“The major challenges are evaporation, lower concentration in glucose in tears than blood, lower volume—there’s a lot more blood than tear fluid—and not stimulating the eye; not rubbing it,” says LaBelle.

“Glucose is also a stress responder, so if you stress the eye you can get an inaccurate reading,” he continued.

Medtronic, Inc., the world’s largest medical technology company, recently announced that it received approval from the U.S. Food and Drug Administration for its Investigational Device Exemption (IDE) in conducting a pivotal clinical trial in the ASPIRE study, an investigation of the in-home efficacy of the Low Glucose Suspend feature of Medtronic’s MiniMed Paradigm insulin pump system. The FDA’s approval means that the ASPIRE study will be the first in-home pivotal trial of a closed loop system for treating Type 1 diabetes.

According to David Klonoff, Medical Director of the Diabetes Research Institute at Mills-Peninsula Health Services, the ASPIRE (Automation to Stimulate Pancreatic Insulin Response) study is leading the way in ensuring that hypoglycemia does not get out of control when patients are unable to respond to their low blood glucose conditions, such as when they’re asleep.

“This study leads an industry-wide effort to close the diabetes treatment loop by tackling the important challenge of reducing the risk of hypoglycemia even when a person is asleep or unable to react,” said Klonoff. “The new Low Glucose Suspend integrated system is designed to help improve patients’ ability to manage nocturnal hypoglycemia, which can be one of the most frightening aspects of living with Type 1 diabetes. Until now, we have never had a therapy designed to automatically intervene when blood glucose becomes severely low.”

Francine Kaufman, Chief Medical Officer and Vice President of Global Clinical Affairs at the diabetes division of Medtronic, said that the FDA’s approval is “an important milestone toward bringing Low Glucose Suspend technology to the U.S. market.

“It’s also a critical step toward our ultimate goal — the development of an artificial pancreas,” continued Kaufman. “We believe this innovation has the potential to provide patients with added protection by lowering the risks associated with nocturnal hypoglycemia.”

According to Kaufman, Medtronic worked closely with the FDA to ensure that approval for the study was reached as quickly as possible. “FDA review of the ASPIRE IDE application was conducted through an interactive review process that involved frequent communication with the FDA review team, allowing issues to be resolved quickly and avoiding any unnecessary delays during the review.  We appreciate the valuable input provided by members of the FDA’s Artificial Pancreas Working Group,” said Kaufman.

The ASPIRE study is now in its second phase, with the first phase—an in-patient clinical study—now complete. ASPIRE is a randomized, pivotal in-home study spanning several investigational facilities. The study is intended to test the MiniMed Paradigm insulin pump developed by Medtronic, specifically the efficacy and safety of the equipment, which uses sensors to monitor blood glucose and deliver insulin when necessary. Medtronic has developed a blood glucose sensor called Enlite which will also be tested in the ASPIRE study.

Researchers will study data on hypoglycemic events from two groups of individuals: one with the Low Glucose Suspend feature switched on and the other with the feature switched off. The data will be provided by patients using the system at home to ensure that the results are accurate where the system will ultimately be used. The research team plans to demonstrate that the use of the Low Glucose Suspend feature is safe and will not result in glycemic deterioration; HbA1c levels will be used to determine the efficacy of the system. Additionally, the researchers intend to demonstrate that using the Low Glucose Suspend feature in-home will decrease nocturnal hypoglycemia when patients cannot respond to their own low blood sugar.

Findings from a new study suggest that people who have previously suffered from kidney stones could have a higher risk of developing Type 2 diabetes later in life. Previous research has shown that kidney stones appear to be more common in individuals who have diabetes, but scientists have been unsure as to whether the reverse is true as well.

The new study was conducted at Taipei Medical University in Taiwan. Dr. Herng-Ching Lin and his colleagues analyzed medical records from over 94,000 Taiwanese adults and found that individuals with a history of kidney stones demonstrated a 30 percent increase in their chance of being diagnosed with diabetes over five years than were individuals who did not have kidney stones.

The medical records showed that out of 23,000 adults who had received treatment for kidney stones, 12.4 percent later developed Type 2 diabetes. Of the 70,700 adults who did not have kidney stones, only 9.6 percent developed diabetes.

According to the researchers, some of the overlap between kidney stones and diabetes could be caused by common risk factors between the two conditions. Older age and obesity are commonly listed among the risk factors for both.

However, the researchers accounted for age, obesity, and other health risks when investigating the relationship between kidney stones and diabetes, and they still found that individuals with kidney stones had a one-third higher risk of developing diabetes.

The researchers stated that they were uncertain about the mechanism that causes the relationship. They hypothesized, however, that both kidney stones and diabetes could be caused by some of the same processes.

Kidney stones are formed due to the presence of excessive amounts of crystal-forming substances, such as uric acid, calcium, and oxalate. The minerals cannot be diluted by the available fluid and form small stones which typically do not cause long-term damage but can be very painful when they pass through the urine.

According ot Lin’s research team, there is evidence suggesting that insulin, the hormone responsible for regulating blood glucose levels, could be associated to the formation of kidney stones in some way. Previous research in both animals and humans has suggested that elevated insulin levels can alter the chemical composition of urine, making the formation of kidney stones more likely. Since Type 2 diabetes is associated with high insulin levels due to the body’s inability to use it correctly, the two conditions could be related through the actions of insulin.

Lin’s team noted that their own study had limitations, namely the fact that they used existing medical records—which can be inaccurate—to arrive at their findings. The researchers also did not have access to information about the diet, exercise habits, and family history of the conditions due to the lack of that information in the medical records. Such data could have helped the researchers determine the source of the association between kidney stones and diabetes.

According to the research team, it’s still possible that the formation of kidney stones could be a warning sign that the individual could have an increased risk of developing diabetes. Those who find themselves diagnosed with kidney stones may also benefit from making lifestyle changes that reduce the chances of developing diabetes, including eating a healthy diet and getting more exercise.

Previous research has showed that people with diabetes and insulin resistance have highly-acidic urine, which is a risk factor for developing kidney stones, and especially uric acid kidney stones.

A new study suggests that doctors may be able to help diagnose diabetes and related warning signs through the use of a “muffin test.” The test would be a type of oral glucose tolerance test designed to identify diabetes and impaired glucose tolerance by analyzing the body’s ability to utilize glucose properly.

Oral glucose tolerance tests commonly require an individual to fast for one night and drink a high-sugar beverage the following day. Doctors monitor the individual’s physiological responses to the high dose of sugar, especially how long blood glucose levels remain elevated.

The study suggested that muffins might be a better food for conducting oral glucose tolerance tests—the test would be more tolerable for patients and it might even give doctors a more accurate idea of the individual’s response to food intake.

According to Dr. Michael Traub with Albert Einstein College of Medicine in New York, current glucose tolerance tests are unpleasant, especially for women. Dr. Traub, who worked on the study, suggested that consuming a muffin would be more pleasant than the glucose solution for most people, noting that many people feel ill following the test.

Dr. Traub commented that a muffin test might also provide more accurate results since it more closely matches what people actually eat.

According to the findings of the study, doctors were able to use muffins in oral glucose tolerance tests to predict impaired glucose tolerance; muffins were also cheaper than standard glucose drinks. Another researcher who did not take part in the study, however, noted that muffin tests may not be as effective as the study indicated and that it may not make the tests more convenient after all.

According to Dr. William Herman, director at the Michigan Diabetes Research and Training Center in Ann Arbor, results from muffin tests may be difficult to measure because no two muffins are exactly the same in nutritional content, especially in different areas of the world. A glucose drink, on the other hand, contains an exact amount of sugar and allows for more accurate measurements.

“Getting a standardized muffin across the United States and across the world I think would be challenging,” said Dr. Herman. Glucose drinks are “probably more convenient. Glucose solutions have a longer shelf-life. We know exactly what’s in them,” he continued.

The muffin study was conducted on 73 middle-aged women in their 40s and 50s. The women fasted for a night and were given muffins from a local bakery the next day. The researchers measured blood glucose levels two hours after the muffins were given. Another 12 women were given standard oral glucose tolerance tests with glucose drinks.

Eight of the group of 72 women demonstrated impaired glucose tolerance. The researchers reported that a standard glucose drink test would have missed more than half the cases of impaired glucose tolerance. The glucose drink test identified one woman as having impaired glucose tolerance; the muffin test identified another individual who the glucose drink test had missed.

A muffin is much cheaper than a glucose beverage test, according to Dr. Traub, at one dollar versus five dollars. None of the women appeared to have stomach problems from the muffins either, unlike the glucose drinks.

Answering Dr. Herman’s criticisms, Dr. Traub’s team commented that even though muffins might vary from area to area, the test should still provide consistent results. Still, they noted that additional research would be required to determine that the test is reliable.

Two former graduate students at MIT’s George R. Harrison Spectroscopy Laboratory have developed new spectrograph technology that could allow diabetics to monitor their blood glucose levels without pricking their fingers to draw blood for testing. Kong and Barman significantly reduced the size of the spectrograph, allowing the technology to be used in much more convenient spaces.

The spectrograph equipment would have previously required too much space to be practical for every day use. Kong and Barman reduced the size of a significant component of the spectrograph and brought the prototype equipment down to about the size of a shopping cart. Tests can be conducted quickly, taking only about a minute.

The Raman spectrograph developed by Kong and Barman tests blood glucose levels by aiming a low-powered laser through the thin area of skin between the thumb and forefinger of the patient being tested. The test has previously been conducted with the use of a compound parabolic concentrator (CPC). The test requires a high degree of collimation, however, which necessitated the use of a very large CPC.

Kong and Barman reduced the size of the equipment by using a smaller mirror—a compound hyperbolic concentrator (CHC)—which focuses the light into a narrow beam through the use of a lens.

“The new design is from five to 20 times smaller than if we used a CPC to achieve the same performance,” said Kong.

Ramachandra Dasari, associate director at the MIT lab, stated that the new smaller Raman spectrographs could have uses beyond simply testing blood glucose levels. They could also identify diseases through the presence of other chemical markers in the bloodstream and to study biopsies to determine if they contain cancerous cells.

“Our next step is to miniaturize this and make it portable,” stated Dasari. The team expects that a portable prototype of the spectrograph equipment will be built within the next couple of years.

The use of spectroscopy technology to diagnose diseases was first envisioned by Michael Feld, a professor of physics at MIT and former director of the Spectroscopy Laboratory. The Raman spectroscopy technique studies the frequency of vibrations that hold molecules together to identify chemical compounds that indicate certain diseases or conditions. The technology has been in development for about 15 years and may someday remove the need to prick fingers to obtain samples for blood glucose testing.

Kong and Barman have worked together in the past: they previously developed a new calibration method for the Raman spectrograph called Dynamic Concentration Correction, which corrects the inaccurate results that can occur in a blood glucose test due to the presence of glucose in the interstitial fluid, or the fluid that surrounds skin cells. The project had been facing difficulties because the spectrograph technology only seemed to penetrate about a half a millimeter under the skin, meaning that the glucose content of the interstitial fluid instead of the blood was being measured. Kong and Barman tested the technology in 10 volunteers, using the newly-calibrated Raman spectrograph to significantly improve the accuracy of blood sugar readings by an average of 15 percent and up to 30 percent in some of the participants.

Regular blood glucose testing is an unavoidable part of life for most diabetics. Elevated blood sugar levels over long periods of time can damage organs and cause other complications while low blood sugar levels can cause fatigue and fainting.