Category: Diabetes 101

A small retrospective study recently presented at the annual meeting of the European Society for the Study of Diabetes has demonstrated that elevated accumulation of fat, inflammation, and fibrosis of the liver are associated with a higher risk of cardiovascular disease. The risks are especially high for those who have been diagnosed with diabetes.

“What we are realizing is that [nonalcoholic fatty liver disease] is adding extra cardiovascular risk to people with diabetes, and to those without, on top of that which is already existing,” says Dr. Christopher Byrne, a lead investigator working on the study.

Dr. Byrne, who is a professor of endocrinology and metabolism at the University of Southampton in England, suggested that the findings of the study demonstrate that patients who have documented liver disease may require more aggressive therapies in response to the additional risk they face. Those therapies should target the liver in addition to the heart.

The study was conducted on 112 patients who had been diagnosed with nonalcoholic fatty liver disease, proven by biopsy. The study showed that the participants’ Kleiner scores were highly-correlated with Framingham Risk Score (FRS) as well as QRISK2 — both indicators of cardiovascular risk. The Kleiner score is a histologic measure of non-alcoholic fatty liver disease severity.

“Nonalcoholic fatty liver disease represents a spectrum of fat-mediated liver conditions causing progressive hepatocellular damage,” says Sarah Hudson, a medical student at the University of Southamptom. “There is increasing evidence of an increased cardiovascular risk associated with progression of nonalcoholic fatty liver disease,” continued Hudson. She also noted that the preferred method of determining the severity of non-alcoholic fatty liver disease was through histopathologic tests.

The primary goal of the study was to determine whether Kleiner score is correlated with risk of cardiovascular disease and whether the score was higher in individuals who were already known to have increased cardiovascular risk, especially those who had also been diagnosed with diabetes.

Kleiner scores provide an assessment of a variety of factors, including steatosis, lobular inflammation, fibrosis, and hepatocyte ballooning. As liver disease becomes more severe, Kleiner score increases correspondingly.
The mean age of participants in the study was 48 years; mean Kleiner score among the patients was 5.3, while median FRS and 13 and median QRISK2 score was 8. Mean body mass index (BMI) of the participants was about 34kg/m2.

Not only were Kleiner scores found to be highly-correlated with cardiovascular risk according to both FRS and QRISK2 models, but they were also higher in a group of 32 participants who had been diagnosed with diabetes versus non-diabetic individuals. It was discovered that the increased risk of cardiovascular disease in correlation with non-alcoholic fatty liver disease was independent of hyperglycemia and increased body weight.

“We need more prospective studies to see what markers may be used to help stratify who requires biopsy and how best to manage people who have got NAFLD,” noted the study’s authors.

“Up until now we’ve been very poor in providing cardiovascular risk reduction treatments for patients with NAFLD,” said Dr. Byrne. “But what we don’t know is whether those lifestyle changes are good at decreasing liver inflammation, or decreasing liver fibrosis.”

Dr. Byrne, along with other members of a research team, are now studying the use of highly-purified omega-3 fatty acid ethyl esters in the treatment of fatty liver disease. This form of fish oil has been available in Europe for at least a decade as Omacor and in the United States as since 2004 as Lovaza.

According to a recent study published in the October 1 issue of the “The American Journal of Cardiology,” percutaneous coronary intervention (or PCI) of chronic total occlusions (CTOs) is associated with reduced mortality in people with diabetes and can also reduce the need for coronary artery bypass grafting.

Headed by Bimmer E. Claessen, M.D., with the Cardiovascular Research Foundation of New York City, the study analyzed the long-term clinical outcomes after PCI of CTOs in patients who were known to be either diabetic or non-diabetic. The study used data from 1,742 patients who were classified according to whether they had been diagnosed with diabetes or not (1,347 were non-diabetic and 395 were diabetic). Study participants who underwent PCI of CTOs in the period between 1998 and 2007 were evaluated for five-year clinical outcomes. Patients were stratified according to several factors, including status of diagnosis of diabetes, successful versus failed CTO PCI, and for the use of drug-eluting (DES) versus bare-metal stents (BMS). The study participants received follow-up examinations for an average of three years.

The researchers identified similar procedural success both in patients who had diabetes and those who didn’t. In all, 96.4% of patients with diabetes and 94% of those without the disease received stent implantation after successful CTO PCI. It was also discovered that successful CTO PCI was associated with a significantly reduced long-term mortality risk in patients with diabetes, at 10.4% compared to 13%, as well as a significant reduction in requirements for coronary artery bypass grafting at 2.4% compared to 15.7%. Usage of drug-eluting stents versus bare-metal stents was associated with a decrease in target vessel revascularization in patients both with and without diabetes (17.6% for the former and 26.5% for the latter). Insulin-dependent diabetes was identified in multivariate analysis as a factor that independently predicted mortality in the cohort that had been diagnosed with diabetes.

“Successful CTO PCI in patients with DM was associated with a reduction in mortality and the need for coronary artery bypass grafting,” wrote the authors of the study.

Three of the researchers announced that they had interests associated with the study. Two of the authors associated with the study disclosed that they had financial ties to Cordis Corporation, while one other author disclosed financial ties to Boston Scientific Corporation.

Percutaneous coronary intervention (PCI), more commonly known as angioplasty, is a surgical procedure used to treat narrowed coronary arteries in the heart due to the buildup of cholesterol plaques. It has been shown to improve quality of life and to be more cost-effective than other procedures such as coronary artery bypass grafting in treating patients who have medically refractory myocardial ischemia.

The procedure is sometimes described as “balloon angioplasty” due to the use of an inflated balloon to crush the cholesterol plaque against the arterial walls and break it down. Although balloon inflation within the artery is generally performed in all angioplasties, the procedure typically includes other operatons such as atherectomy, the implantation of stents, and brachytherapy — the use of radiation to inhibit restenosis.

Stents are small mesh tubes that are implanted into the artery to ensure that it stays open. Stenting has been shown to reduce symptoms related to coronary artery disease in addition to reducing cardiac ischemia. Stents can be made of several different kinds of material. Stainless steel is the most commonly used material but it is not always compatible with the human body and steel stents sometimes result in restenosis and thrombosis.

A study recently reported in the journal “Pediatrics” has demonstrated that pregnant women with well-managed diabetes may not be at increased risk of giving birth to preterm infants or infants with very low birth weight.

“With modern management and adequate glycemic control in pregnancies complicated by diabetes mellitus, the risk of respiratory distress syndrome in near-term and term newborns may not be increased beyond that of a nondiabetic control population,” wrote the authors of the study. The investigation was headed by Yoram Bental M.D., with the Department of Neonatology at Laniado Hospital in Israel and the Israel Institute of Technology in Haifa; also affiliated were researchers with the Israel Neonatal Network. “We hypothesized that maternal …DM increases the risk for mortality, respiratory distress syndrome (RDS), and major complications of prematurity,” continued the authors.

The research team used data collected from the Israel National Very Low Birth Weight Infant Database, covering the years 1995 to 2007. Pregnant woman with diabetes were categorized as either pregestational or gestational; the independent effects of diabetes in pregnant women on infant mortality, RDS, and other complications related to premature birth were analyzed with multivariable logistic regression. The two groups of mothers — those with pregestational and gestational diabetes — demonstrated similar results so their data was pooled together in further analysis.

Mothers with diabetes were more likely to have received a complete course of prenatal steroids compared to women who had not been diagnosed with diabetes. The infants of diabetic mothers showed slightly higher gestational age and birth weight than those of non-diabetic women, but the two groups also demonstrated a similar distribution of birth weight percentiles and mean birth weight z scores. The group of diabetic mothers had higher Apgar scores, enough to be considered statistically significant.

The two groups of mothers did not have significantly different rates of delivery room mortality, RDS, and other complications associated with premature birth. In fact, the group of non-diabetic mothers had a significantly higher rate of total mortality and bronchopulmonary dysplasia. Among the mothers with diabetes, adjusted odds ratios were not significantly increased for risk of mortality, RDS, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity, or intraventricular hemorrhage.

“With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM,” wrote the study authors.

Limitations in the study’s methodology that could potentially affect results include a lack of prospective recording of the degree of glycemic control or the type of diabetes with which the mothers had been diagnosed.

The study’s authors concluded that diabetes should not be considered as an extra risk factor in the development of RDS in infants. “Whenever financial limitations are important in the strategic planning of delivery room care of premature infants, and in particular if the issue of prophylactic surfactant is to be discussed, we suggest that IDM should not be considered as an extra risk of developing RDS,” wrote the authors. “This suggestion is probably strengthened from the fact that safe therapeutic alternatives to prophylactic surfactant exist, such as early nasal continuous positive airway pressure. However, this speculation has not been proved and may not be valid in cases of poor glycemic control.”

The Israel National Very Low Birth Weight Infant Database receives partial support from the Israel Center for Disease Control and the Ministry of Health.

Previous research has suggested the possibility that having diabetes could increase an individual’s lifetime risk of also developing thyroid cancer. A new report, however, has solidified that claim, demonstrating that the association holds true for retirement-age Americans. The findings were published in the journal “Thyroid.”

The study was conducted by epidemiologists affiliated with the National Cancer Institute (NCI) and the National Institutes of Health (NIH). After analyzing the results of the study, the researchers found that patients age 50 to 71 who had been diagnosed with diabetes showed a one-quarter increase in 10-year risk of developing thyroid cancer.

The study used data from nearly 500,000 men and women who had participated in the NIH-American Association of Retired Persons (AARP) Diet and Health Study. The study was conducted in 1995 and 1996.

At the beginning of the study, the researchers collected information about the health of the participants through the use of questionnaires. Questions were related to pancreatic health, body mass index (BMI), the presence of diabetes, and other health factors.

Ten years later, the researchers conducted follow-up examinations on many of the participants. The study used data collected from the follow-up tests.

Researchers found that almost one in 10 volunteers had been diagnosed with diabetes at the time of the initial questionnaire. Upon follow-up examination, those who had diabetes at baseline were noted to develop thyroid cancer at a greater average frequency than those who had not been diagnosed with diabetes.

On average, those who had been diagnosed with diabetes were 25% more likely than non-diabetics to be diagnosed with thyroid cancer. The women in the study showed a particularly high risk of developing cancer.

Diabetic men experienced a 4% increase in their chances of developing thyroid cancer, but diabetic women saw their chances of developing thyroid cancer increase much more dramatically, by 46%.

The results are very similar to findings that were published a decade ago in the journal “Clinical Diabetes.” In an issue of the journal from 2000, endocrinologist Patricia Wu with the University of California in San Diego estimated that 6.6% of the population of the United States has some form of thyroid disease. Diabetics are more likely to experience thyroid problems; about 10.8 percent suffer with thyroid conditions, according to Dr. Wu.

The mechanisms underlying the relationship between diabetes and thyroid cancer are unclear. However, some scientists believe that the diseases are related in that they are both disorders of the endocrine system. Additionally, Thyroid Today notes that both diabetes and thyroid conditions are typically linked to increased body mass, age-related risk, and autoimmune problems.

Scientists have been somewhat baffled in recent years by thyroid cancer, specifically the rate at which is occurs. A paper published in the journal “Cancer” states that thyroid carcinomas are more common than doctors once thought. The National Cancer Institute (NCI) estimates that 11 out of every 100,000 Americans are diagnosed with thyroid cancer each year. However, the report in “Cancer” states that the figure was significantly lower until recently.

From 1988 to 1998, thyroid carcinoma diagnoses rose by an average of 3.5% every year. From 1998 to 2005, that number rose by 6.7% every year. The researchers commented that the reason behind the increase in cancer diagnoses needed to be explored.

“Reasons for this increase, including environmental, dietary and genetic causes, need to be explored. To our knowledge, there is no new evidence to suggest that the exposure of human beings to radiation, a well known environmental risk factor, has increased over time to account for the observed increase in thyroid cancer,” said the researchers.

Patients who have been diagnosed with Type 2 diabetes can demonstrate elevated levels of glucose and glycated hemoglobin (HbA1c) even 10 years before their actual diagnosis, according to Esther van’t Riet, Ph.D., with the Department of Epidemiology and Biostatistics at VU University Medical Center in Amsterdam. Dr. van’t Riet presented the information at a poster session at the 47th annual meeting of the European Association for the Study of Diabetes (EASD). According to Dr. van’t Riet, individuals demonstrate moderate increases and then rapid increases in the few years prior to the diagnosis of diabetes, with increases in Hba1c often preceding elevated glucose.

Dr. van’t Riet and her research team used data from the Hoorn Study, a cohort of 565 Dutch participants, aged 50 to 75 at baseline in 1989 and with follow-ups in 1996 and 2000. None of the 565 participants had been diagnosed with diabetes at the beginning of the study.

At follow-up meetings, incident diabetes was diagnosed with the World Health Organization and American Diabetes Association’s 2011 criteria for the disease: fasting blood glucose levels of 7.0 mmol/L (126.1 mg/dL) or greater, or post-load glucose levels of 11.1 mmol/L (200mg/dL) or higher; and/or HbA1c levels of 6.5% or higher. Participants were categorized according to the status of their development of diabetes at baseline and follow-up.

At the 1996 follow-up, 99 of the study participants had developed incident diabetes; by 2000, an additional 48 had developed the disease. At the 2000 follow-up, 418 participants had still not developed diabetes. According to van’t Riet, the development of diabetes was preceded by elevated glucose and HbA1c levels in the years leading up to the diagnosis. “Those who developed diabetes already had elevated levels of glucose and A1c in 1989. So up to 10 years before diagnosis, we already see an elevation of all 3 glycemic measures,” she said. The third measure that the study analyzed was post-load glucose levels, which were obtained two hours into an oral glucose tolerance test.

“When we look at changes in time, we first compared those who never developed diabetes with those who had insulin diabetes in 1996. We see that all 3 glycemic measures show a steep increase from 1989 to 1996. After the diagnosis in 1996, they stabilize,” said Dr. van’t Riet.

The researchers also compared study participants who didn’t develop diabetes throughout the course of the investigation with those who had developed the disease in 2000. Those who developed diabetes saw increases in fasting glucose and post-load glucose between 1989 and 1996 that was “almost comparable for those who developed diabetes and those who never developed diabetes.” However, by 1996, those levels increased in the group that developed diabetes: “A steep increase is observed, which was not seen in those who never developed diabetes,” said dr. van’t Riet.

Unlike blood glucose levels, HbA1c levels did increase between 1989 and 1996 for those who later developed diabetes. “This might indicate that A1c increases earlier than glucose,” said Dr. van’t Riet.

The researchers performed further analysis on study participants with incident diabetes in 2000 who had increased HbA1c levels but lower glucose, and on those who had high glucose and normal HbA1c due to changes in the diagnostic criteria for diabetes.

“In those with diabetes based on high glucose, A1c levels tend to increase also. But in those with diabetes based on high A1c, glucose levels tend to stabilize in the follow-up period…. It might indicate that there are different developmental patterns according to the type of criteria you use,” continued van’t Riet.

Doctors have long extolled the health values of getting eight hours of sleep every night. Add another benefit to the list: new research shows that getting eight and a half hours of sleep every night could reduce the risk of developing Type 2 diabetes in teenagers who are obese. The findings were published in the journal “Diabetes Care.”

The study was conducted on 62 teenagers. The results demonstrated that insulin and blood sugar levels stayed at optimum levels for those who got between seven and a half and eight and a half hours of sleep at night. Getting more or less sleep increased the chance of elevated blood glucose levels; getting less than seven and a half hours of sleep resulted in lowered insulin levels.

According to the research team, which is affiliated with Children’s Hospital of Philadelphia, the results of the study demonstrate that healthy sleeping patterns could be beneficial in warding off diabetes in the participants of the study, who were all obese. The study was headed by Dr. Dorit Koren, who commented that the results corresponded with previous research showing that sleep-deprived adults were at a higher risk of developing Type 2 diabetes.

The study was conducted over a period of one and a half days. The teenagers’ blood sugar levels were monitored throughout the investigation, while their sleeping patterns were tracked and analyzed by the research team.

“Our study found to keep glucose levels stable, the optimal amount of sleep for teenagers is 7.5 to 8.5 hours per night,” said Dr. Koren.

The research team plans to conduct additional research, this time in the teenagers’ own homes rather than in a laboratory, to back up the results of the study.

“In the meantime, our study reinforces the idea that getting adequate sleep in adolescence may help protect against type 2 diabetes,” says Dr. Koren.

Research has shown that teenagers are not getting enough sleep. Another study previously conducted in 2007 showed that one in three British teenagers is getting just four to seven hours of sleep every night.

Another study conducted at the University of Buffalo and headed by Lisa Rafalson found that participants who were sleep-deprived were 4.5 times more likely to develop impaired fasting glucose, a condition that is considered a precedent to Type 2 diabetes. The study analyzed data from 1,455 volunteers over a period of six years; it measured how long the participants slept on average on weeknights. Participants who got less than six hours a night were four times more likely to develop impaired fasting glucose than participants who regularly got six to eight hours of sleep a night. The study’s findings were presented at the 49th annual Conference on Cardiovascular Disease Epidemiology of the American Heart Association in Palm Harbor, Florida.

“Our findings will hopefully spur additional research into this very complex area of sleep and illness,” said Rafalson. “While previous studies have suggested that there may be many genes that each have a very small effect on the risk of diabetes, there is no known genetic predisposition to sleep disturbances that could explain our study’s results, especially in this limited sample size. It is more likely that pathways involving hormones and the nervous system are involved in the association.”

It is speculated by some researchers that a lack of deep sleep is the source of the increased risk of diabetes: a shortage of slow-wave, or deep sleep, impairs the body’s ability to regulate blood glucose levels and increases risk of Type 2 diabetes.

A longitudinal study conducted in Japan has shown that risk of dementia increases when glucose levels swing out of control, especially directly after meals. The study was conducted by Yutaka Kiyohara, M.D., Ph.D., and colleagues at the Kyushu University in Fukuoka, Japan. The results were reported in the September 20 issue of the journal “Neurology.”

Individuals who had been diagnosed with diabetes were 74% more likely to develop some form of dementia over 15 years of follow-up. The study also adjusted for confounding factors. The study followed 1,017 community-dwelling older adults who did not have dementia at the beginning of the study. The participants had an oral glucose test at age 60 or older; the researchers followed them for 15 years to determine if they developed one of the various forms of dementia.

Patients with diabetes were also 2.05 times more likely to develop Alzheimer’s than individuals with normal glucose tolerance levels, after adjustment for confounding factors. As such, diabetes was specifically associated with a higher risk of developing Alzheimer’s disease later in life.

According to Richard Bergenstal, M.D., with the International Diabetes Center at Park Nicollet in Minneapolis, MN, the study’s results were also interesting in that they displayed a strong risk prediction of Alzheimer’s associated with post-load glucose levels during the oral glucose tolerance test.

Patients who displayed higher blood glucose levels two hours after a meal were shown to be at a higher risk of developing dementia, including Alzheimer’s.

Study participants who showed a post-meal blood glucose measurement of 7.8 to 11.0 mmol/L had a 50% greater chance of developing all-cause dementia. Those with a post-meal blood glucose measurement greater than 11.0mmol/L had 2.47-fold increase in risk of all-cause dementia and a 3.42-fold increase in risk of Alzheimer’s.

According to Kiyohara’s research group, the findings demonstrated that “that postprandial glucose regulation is critical to prevent future dementia.” Individuals with diabetes need to manage their post-meal blood glucose levels carefully since they are at a greater risk of developing dementia later in life. “Our findings emphasize the need to consider diabetes as a potential risk factor for all-cause dementia, Alzheimer’s disease, and probably vascular dementia,” added Kiyohara’s group.

Bergenstal, a previous president of the American Diabetes Association, warned that it’s as yet unclear whether improved control of post-meal insulin levels could lower the risk of dementia for patients who already have diabetes. We need to understand it a lot better before we build this into our clinical practice,” said Bergenstal. “We don’t know yet from these studies how to intervene.”

Among the participants of the study, those who displayed diabetes through an oral glucose tolerance test were 2.07 times more likely to develop vascular dementia compared to those with normal glucose tolerance. The numbers were adjusted for age and sex.

The significantly higher risk of vascular dementia in diabetes patients may be a result of the low number of cases of that type of dementia, or because diabetes is associated with hypertension and other cardiovascular complications that are linked to vascular dementia.

Hyperglycemia may have also had an effect on the development of dementia by way of atherosclerosis, oxidative stress, the accumulation of advanced protein glycation, and changes in insulin metabolism that yield altered amyloid metabolism.

Diabetes and prediabetes accounted for 14.6% of all-cause dementia, 20.1% of Alzheimer’s disease, and 17% of vascular dementia risk. The research team noted that further studies were required before the results could be generalized to other ethnic populations.

Cellnovo, a company working towards the development of new insulin delivery technologies, recently received CE Mark approval for its mobile diabetes management system, the first of its kind that the world has seen. The approval is an important milestone for Cellnovo in offering new, flexible technologies that aid diabetics in managing their disease.

“This is Cellnovo’s first step in a journey to bring this mobile diabetes management system to the world,” said William McKeon, Chief Executive Officer at Cellnovo.

The management system, also called Cellnovo, utilized mobile, wireless technology to aid diabetics in the management of their disease. The system is composed of an insulin patch pump, a touch-screen handset equipped with a blood glucose monitor, and an extendable applications set.

“Cellnovo has created the first insulin pump that brings innovation and combines form with function, essential qualities in a device that patients have to interact with 24/7,” said Dr. Pratik Choudhary, a Clinical Lecturer in Diabetes at King’s College London.

The patch pump developed by Cellnovo is the smallest and most precise one yet. The touch screen interface that the system uses will also be familiar and easy to navigate for anyone who has used a handheld mobile device such as an iPhone.

“Cellnovo has combined advanced mobile and medical technology which may create a paradigm shift in diabetes care,” according to Irl B. Hirsch, Professor of Medicine at the University of Washington in Seattle. “For the multitude of patients who could benefit from pump therapy, Cellnovo could be a game-changer.”

Perhaps the most innovative feature of Cellnovo’s diabetes management system is its ability to receive and transmit data wirelessly and in real-time to a portal that both patients and physicians have access to. The automated transmission of blood glucose data simplifies the process of keeping track of such information for patients, removing the need for diabetics to keep track of every measurement. It also ensures that the data is collected quickly, accurately, and consistently, allowing constant and efficient monitoring of the disease by health care professionals. This new capability could redefine the models that physicians use to treat diabetics, according to Dr. Mark Evans, a lecturer and Honorary Consultant with the Institute of Metabolic Science at the University of Cambridge.

“The ability to see real-time data of patients who may be hundreds of miles away provides the opportunity to redefine our care model,” said Dr. Evans.

Dr. David Kerr, a Consultant Physician and Diabetologist at Bournemouth Diabetes and Endocrine Centre, was also optimistic about the role that Cellnovo could play in revolutionizing diabetes care. “Cellnovo has the potential to break new ground in bringing the first mobile diabetes management system to market. It is clear that new technologies for diabetes care, such as Cellnovo’s mobile health solution, are going to forever change the way we practice medicine and more effectively manage diabetes long into the future.”

Cellnovo previously announced that it would be partnering with LifeScan, a Johnson & Johnson company based in California, to utilize LifeScan’s blood glucose monitoring technology with the Cellnovo mobile management system.

“We wanted superb blood glucose monitoring technology inside our mobile handset and LifeScan is a market leader,” said William McKeon, Chief Executive Officer of Cellnovo. “Through our partnership with LifeScan, our combined technologies will advance care through connectivity.”

Cellnovo is a mobile health technology company based in the U.K. Cellnovo’s goal is to utilize mobile technology to allow diabetics greater freedom and simplifying the process of insulin administration and glucose monitoring.

A recent study of 3,400 Chinese adults, age 40 and over, has found that exposure to bisphenol A is not associated with an increased risk of developing diabetes. Bisphenol A is a chemical used in plastics that has been surrounded by controversy since some claimed it was responsible for health problems. The findings were published in the journal “Annals of Internal Medicine.”

The results of the study found that there was no correlation between levels of bisphenol A (better known as BPA) in the urine of study participants and their chances of having diabetes.

The 25% of the study participants with the highest urinary levels of BPA were found to have a higher risk of diabetes than those with a lower concentration of the chemical. However, the researchers did not find a “dose-response” relationship between BPA and diabetes — meaning that they did not discover any evidence that risk of developing diabetes increased as urinary BPA levels increased. The researchers said that, ultimately, they are unable to conclude whether there was a connection between BPA and diabetes.

Despite the research team’s findings, many are not convinced that they have put the issue to rest. Researchers outside the team have questioned the conclusions that they reached.

BPA is an endocrine disruptor: a chemical that can have a negative impact on normal hormonal activity in the human body. It’s also hard to get away from — it has been used for decades in the manufacture of hard plastics and linings for metal food and drink containers. Previous research has suggested that the large majority of Americans — about 95 percent — have some level of BPA in their blood.

Studies conducted recently on animals have suggested that BPA could contribute to certain types of cancer and heart disease and that it could affect neural development in children. Since the controversy around the chemical arose, the major manufacturers of bottles and cups for infants have stopped using it in the manufacture of those products.

Still, the effect of BPA on humans is unknown and remains controversial. In two large studies, elevated levels of BPA were found to be linked to increased risk of heart disease, while a study conducted in 2008 showed that individuals with higher BPA concentrations were at a higher risk of developing diabetes. Despite the associations, however, a causal relationship between the chemical and those conditions has not been proven — only a correlation.

The study analyzed data from 3,423 men and women; 32% of the participants had Type 2 diabetes. The participants were divided into four groups according to the levels of BPA in their urine. The group with the highest percentage of BPA was 37% more likely to have diabetes than the group with the lowest levels of BPA. However, the group with the second-highest concentrations of BPA showed no increased risk of diabetes while the next lowest group did show an increased risk.

Dr. Guang Ning with Shangai Jiao-Tong University School of Medicine, head of the study, stated that there was no “clear, monotonic relationship” between the presence of BPA and an increased risk of diabetes. “The evidence was not sufficient enough to declare an association,” said Ning.

However, an editorial published along with the study stated that the approach the researchers took was “idiosyncratic” because it all but dismissed the group with the highest levels of BPA and the highest risk of diabetes.

“It would be great to see the data released to the wider scientific community,” said Tamara Galloway, professor at the University of Exeter in the United Kingdom and an editorial writer for the study.

A study conducted on elderly (over 65) patients who had been diagnosed with Type 2 diabetes found that they were not as aware of their own hypoglycemic conditions as were middle-aged (age 39-64) patients.

The objective of the study was to determine the subjective responses of elderly patients to hypoglycemic episodes. Such patients are at a higher risk for severe episodes, but their subjective evaluations of their own blood glucose levels had not been previously evaluated. According to the researchers, hypoglycemia is the limiting factor in the management of diabetes, and there is increasing evidence that hypgoglycemic episodes are an important factor in the management of Type 2 diabetes.

The study examined 13 older (over age 65) patients and 13 middle-aged (age 39-64) patients who had been previously diagnosed with Type 2 diabetes. None of the patients demonstrated any symptoms of neuropathy, heart disease, a history of stroke, or overt nephropathy, and none of the patients had experienced a serious hypoglycemic episode that required the help of another person within the last year before the study took place.

Patients were administered insulin and dextrose intravenously, with the controls for the administration located outside the room so the patients would be not be able to tell that they were receiving the substances. The patients were required to fill out a semi-quantitative symptom questionnaire, rating the severity of eleven symptoms of hypoglycemia including dizziness, tingling, blurred vision, difficulty to concentrate, faintness, anxiety, palpitation, hunger, sweating, irritability, and tremor. Once they were finished answering the questionnaire, the patients were asked to estimate their current blood sugar levels.

Researchers had also measured the patients’ reaction times using a standard vigilance task, requiring them to identify changes in frequency of a sound by pressing a button as quickly as possible.

Upon analyzing the results of the study, researchers found that baseline blood glucose levels did not differ between the older and middle-aged group reached a hypoglycemic plateau faster than the older group did. Baseline concentrations of insulin were also similar between the two groups. The results did show that the older patients failed to perceive neuroglycopenic and autonomic hypoglycemic symptoms that the younger patients identified. The researchers stated that the differences in subjective evaluations of hypoglycemic symptoms were not caused by alterations in neuroendocrine counterregulation since the hormonal responses were similar across both age groups.

The authors believed that more studies would be necessary to identify the reason behind the differences, stating that “The mechanisms underlying the severe impairment of hypoglycemia awareness in our older patients cannot be derived from our data.” However, they speculated that the brains of older patients showed a diminished capacity for perceiving its own cognitive and physiological alterations due to hypoglycemia. They suggested that the results had important implications for Type 2 diabetics and that elderly diabetics may be more at risk for severe hypoglycemic episodes since they are less aware of their own hypoglycemic states.

The study was authored by Jan P. Breber, M.D., with the Department of Internal Medicine I at the University of Luebeck in Germany; Kamila Jauch-Chara, M.D., with the Department of Psychiatry and Psychotherapy at the University of Luebeck; Manfred Hallschmid, Ph.D., with the Department of Neuroendocrinology at the University of Luebeck. Corresponding author was Bernd Schultes, M.D., with the Interdisciplinary Obesity Center at Kantonsspital St. Gallen in Switzerland.