Researchers Look for Explanation Behind High Incidence of Diabetes Among Asian Indians
18 April 2008
The incidence of type 2 diabetes is rising, especially in urbanized parts of the world where sedentary lifestyles and obesity abound. In addition to weight and inactivity, race puts some people at increased risk for developing type 2 diabetes.
The incidence of diabetes is rapidly increasing globally, and Asian Indians have the highest prevalence. An estimated 32 million Asian Indians have been diagnosed with this condition, and some expert expect this number to double over the next 30 years.
In a study published in the March issue of Diabetes, Mayo researchers examined whether Asian Indians have observable differences in the way their cells convert nutrient fuel to available energy and whether these differences may increase the risk for diabetes.
"We know that Asian Indians are highly susceptible to this condition, and they often acquire the disease at an earlier age and at lower body mass index than people of European origin," explains Mayo endocrinologist K. Sreekumaran Nair, M.D., Ph.D., the study's lead researcher. "The question we asked is whether any metabolic differences between Asian Indians and Americans of Northern European origin can explain the higher incidence of diabetes in Indians."
Once known as adult-onset or non-insulin-dependent diabetes, type 2 diabetes is a chronic condition that affects the way the body utilizes sugar (glucose). People with type 2 diabetes don't produce enough insulin -- a hormone that regulates the absorption of sugar into cells -- and their cells resist the effects of insulin (insulin-resistant). While death rates due to heart attack, stroke and even cancer are decreasing, deaths related to diabetes are increasing. Type 2 diabetes is the leading cause of cardiovascular deaths, kidney failure, blindness, sexual dysfunction and many other chronic complications.
Mayo researchers studied 13 diabetic Indians, 13 nondiabetic Indians, and 13 nondiabetic northeast Americans of European descent who were matched for gender, age and body mass to Indian study participants. Study participants were fed the same diet and underwent tests for insulin resistance and muscle biopsy to see whether differences occurred at the cellular level among the different study subject groups.
The study yielded a number of interesting findings. Researchers observed that the Indian subjects, irrespective of their diabetic status, had a greater degree of insulin resistance than the American subjects of Northern European origin, even though the study subjects were not obese, a condition commonly associated with insulin resistance. Earlier research has established that people with insulin resistance typically have poorly functioning muscle mitochondria.
Mitochondria are the part of cells responsible for converting energy from nutrients to ATP (adenosine triphosphate), the chemical form of cellular energy that the body uses for almost all functions.
"Our study showed that the Indian diabetic and nondiabetic subjects with insulin resistance actually had mitochondrial function that was higher than those observed in the Northern European American subjects," says Dr. Nair.
Dr. Nair hypothesizes that key to understanding this difference may lie in an examination of how populations adapt as they become more urbanized. Urban societies typically move away from lifestyles that involve a higher level of physical activity and diets dominated by low-calorie foods.
"The higher capacity to produce ATP that the Indian subjects displayed may have been an adaptive advantage for the generations that preceded them, when energy content of their diet was lower. But today, this trait may be a disadvantage given the higher energy content of their current diets," explains Dr. Nair.
Dr. Nair and his team are hopeful that the information gained from this study will have a substantial impact on understanding the cause of the global epidemic in diabetes.
"Our findings have potential to help determine the energy requirements of different populations and what role this plays in the onset of diabetes" says Dr. Nair.
Wednesday, April 23, 2008
Friday, April 18, 2008
Dbethics can help reduce costs of treating Diabetes
The global diabetes epidemic has devastating human, social and economic effects. The largest costs of diabetes worldwide are its devastating effects on families and national economies.
Impact on families and people with diabetes
Diabetes is expected to cause 3.8 million deaths worldwide in 2007, about 6% of total global mortality, about the same as HIV/AIDS. Using World Health Organization (WHO) figures on years of life lost per person dying of diabetes, this translates into more than 25 million years of life lost each year.
The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23 million years of life are lost to the disability and to reduced quality of life caused by the preventable complications of diabetes.
People living with diabetes and their families feel the impact of diabetes most directly. They feel the often crushing expenses of diabetes treatments as costs are not subsidized, and family income is frequently reduced when diabetes interferes with work.
It is often the case that caring for diabetes steals valuable time from education, paid work and leisure. In many countries, individuals and families fear and experience the disability, reduced quality of life, and the lost years of life that untreated diabetes brings.
*
People with diabetes face the near certainty, in many countries the stark reality, of premature death.
*
Type 1 diabetes is particularly costly in terms of mortality in poor countries, where many children die because access to life-saving insulin is not subsidized by governments (who instead tax it heavily), and is often not available at any price.
*
Studies recently carried out in Zambia, Mali and Mozambique highlight a stark reality: a person requiring insulin for survival in Zambia will live an average of 11 years; a person in Mali can expect to live for 30 months; in Mozambique a person requiring insulin will be dead within 12 months.
*
In the poorest countries, people with diabetes and their families bear almost the entire cost of whatever medical care they can afford.
*
In Latin America, families pay 40-60% of diabetes care costs out of their own pockets.
*
In India, for example, the poorest people with diabetes spend an average of 25% of their income on private care. Most of this money is used to stay alive by avoiding fatally high blood sugar levels.
With many successful story Dbethics has helped to reduce the costs of treating diabetes.
see many real life changing experiences in www.springwell.biz; www.dbethics.com
Impact on families and people with diabetes
Diabetes is expected to cause 3.8 million deaths worldwide in 2007, about 6% of total global mortality, about the same as HIV/AIDS. Using World Health Organization (WHO) figures on years of life lost per person dying of diabetes, this translates into more than 25 million years of life lost each year.
The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23 million years of life are lost to the disability and to reduced quality of life caused by the preventable complications of diabetes.
People living with diabetes and their families feel the impact of diabetes most directly. They feel the often crushing expenses of diabetes treatments as costs are not subsidized, and family income is frequently reduced when diabetes interferes with work.
It is often the case that caring for diabetes steals valuable time from education, paid work and leisure. In many countries, individuals and families fear and experience the disability, reduced quality of life, and the lost years of life that untreated diabetes brings.
*
People with diabetes face the near certainty, in many countries the stark reality, of premature death.
*
Type 1 diabetes is particularly costly in terms of mortality in poor countries, where many children die because access to life-saving insulin is not subsidized by governments (who instead tax it heavily), and is often not available at any price.
*
Studies recently carried out in Zambia, Mali and Mozambique highlight a stark reality: a person requiring insulin for survival in Zambia will live an average of 11 years; a person in Mali can expect to live for 30 months; in Mozambique a person requiring insulin will be dead within 12 months.
*
In the poorest countries, people with diabetes and their families bear almost the entire cost of whatever medical care they can afford.
*
In Latin America, families pay 40-60% of diabetes care costs out of their own pockets.
*
In India, for example, the poorest people with diabetes spend an average of 25% of their income on private care. Most of this money is used to stay alive by avoiding fatally high blood sugar levels.
With many successful story Dbethics has helped to reduce the costs of treating diabetes.
see many real life changing experiences in www.springwell.biz; www.dbethics.com
Tuesday, April 15, 2008
Diabetes in Pregnancy can be cured with Dbethics
Diabetes is a disorder of carbohydrate metabolism that requires immediate changes in lifestyle. In its chronic forms, diabetes is associated with long-term vascular complications, including retinopathy, nephropathy, neuropathy and vascular disease. Approximately 650,000 women give birth in England and Wales each year, and 2–5% of pregnancies involve women with diabetes. Approximately 87.5% of pregnancies complicated by diabetes are estimated to be due to gestational diabetes (which may or may not resolve after pregnancy), with 7.5% being due to type 1 diabetes and the remaining 5% being due to type 2 diabetes. The prevalence of type 1 and type 2 diabetes is increasing. In particular, type 2 diabetes is increasing in certain minority ethnic groups (including people of African, black Caribbean, South Asian, Middle Eastern and Chinese family origin).
Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. In addition, diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre-existing diabetes.
This clinical guideline contains recommendations for the management of diabetes and its complications in women who wish to conceive and those who are already pregnant. The guideline builds on existing clinical guidelines for routine care during the antenatal, intrapartum and postnatal periods. It focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies.
Where the evidence supports it, the guideline makes separate recommendations for women with pre-existing diabetes (type 1 diabetes, type 2 diabetes and other forms of diabetes, such as maturity onset diabetes of the young) and gestational diabetes. The term 'women' is used in the guideline to refer to all females of childbearing age, including young women who have not yet transferred from paediatric to adult services.
The guideline will assume that prescribers will use a drug’s summary of product characteristics to inform their decisions for individual women.
Insulin aspart has marketing authorisation specifically for pregnant women. At the time of publication (March 2008), none of the other drugs recommended in the guideline have UK marketing authorisation specifically for pregnant women. Informed consent should be obtained and documented.
Woman- and baby-centred care
This guideline offers best practice advice on the care of women with diabetes who are planning to become pregnant, or who are already pregnant, and their newborn babies.
Treatment and care should take into account women’s needs and preferences. Women with diabetes should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If women do not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines – ‘Reference guide to consent for examination or treatment’ (2001) (available from www.dh.gov.uk). Healthcare professionals should also follow a code of practice accompanying the Mental Capacity Act (summary available from www.publicguardian.gov.uk).
Good communication between healthcare professionals and women is essential. It should be supported by evidence-based written information tailored to the woman's needs. Treatment and care, and the information women are given about it, should be culturally appropriate. It should also be accessible to women with additional needs such as physical, sensory or learning disabilities, and to women who do not speak or read English.
Care of young women in transition between paediatric and adult services should be planned and managed according to the best practice guidance described in ‘Transition: getting it right for young people’ (available from www.dh.gov.uk). Adult and paediatric healthcare teams should work jointly to provide care for young women with diabetes.
Key priorities for implementation
Pre-conception care
• Women with diabetes who are planning to become pregnant should be informed that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. It is important to explain that risks can be reduced but not eliminated.
• The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence for women with diabetes.
• Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before discontinuing contraception.
Antenatal care
• If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy.
• Women with insulin-treated diabetes should be advised of the risks of hypoglycaemia and hypoglycaemia unawareness in pregnancy, particularly in the first trimester.
• During pregnancy, women who are suspected of having diabetic ketoacidosis should be admitted immediately for level 2 critical care , where they can receive both medical and obstetric care.
• Women with diabetes should be offered antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks
More diabetes news in www.dbethics.com
www.springwell.biz
Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. In addition, diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre-existing diabetes.
This clinical guideline contains recommendations for the management of diabetes and its complications in women who wish to conceive and those who are already pregnant. The guideline builds on existing clinical guidelines for routine care during the antenatal, intrapartum and postnatal periods. It focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies.
Where the evidence supports it, the guideline makes separate recommendations for women with pre-existing diabetes (type 1 diabetes, type 2 diabetes and other forms of diabetes, such as maturity onset diabetes of the young) and gestational diabetes. The term 'women' is used in the guideline to refer to all females of childbearing age, including young women who have not yet transferred from paediatric to adult services.
The guideline will assume that prescribers will use a drug’s summary of product characteristics to inform their decisions for individual women.
Insulin aspart has marketing authorisation specifically for pregnant women. At the time of publication (March 2008), none of the other drugs recommended in the guideline have UK marketing authorisation specifically for pregnant women. Informed consent should be obtained and documented.
Woman- and baby-centred care
This guideline offers best practice advice on the care of women with diabetes who are planning to become pregnant, or who are already pregnant, and their newborn babies.
Treatment and care should take into account women’s needs and preferences. Women with diabetes should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If women do not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines – ‘Reference guide to consent for examination or treatment’ (2001) (available from www.dh.gov.uk). Healthcare professionals should also follow a code of practice accompanying the Mental Capacity Act (summary available from www.publicguardian.gov.uk).
Good communication between healthcare professionals and women is essential. It should be supported by evidence-based written information tailored to the woman's needs. Treatment and care, and the information women are given about it, should be culturally appropriate. It should also be accessible to women with additional needs such as physical, sensory or learning disabilities, and to women who do not speak or read English.
Care of young women in transition between paediatric and adult services should be planned and managed according to the best practice guidance described in ‘Transition: getting it right for young people’ (available from www.dh.gov.uk). Adult and paediatric healthcare teams should work jointly to provide care for young women with diabetes.
Key priorities for implementation
Pre-conception care
• Women with diabetes who are planning to become pregnant should be informed that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. It is important to explain that risks can be reduced but not eliminated.
• The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence for women with diabetes.
• Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before discontinuing contraception.
Antenatal care
• If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy.
• Women with insulin-treated diabetes should be advised of the risks of hypoglycaemia and hypoglycaemia unawareness in pregnancy, particularly in the first trimester.
• During pregnancy, women who are suspected of having diabetic ketoacidosis should be admitted immediately for level 2 critical care , where they can receive both medical and obstetric care.
• Women with diabetes should be offered antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks
More diabetes news in www.dbethics.com
www.springwell.biz
Roy Partridge a Champion Sailor who travelled the world
Roy, a type one diabetic since the age of 14, decided to make a Mirror dinghy from kit form.
Having built the boat, he then had to learn to sail it as he had no previous experience of sailing.
On one of his first outings he managed to snag the main sail sheet and capsized the boat.
He persevered with the sailing, built many more boats, learnt how to fine tune the sails and rigging, and years later became Area, National, European and World Champion.
He was invited by the Mirror Class Associations from around the world to share his sailing knowledge, which he did with enthusiasm and pleasure. He went to such places as Barbados, Canada and South Africa.
He wrote a book called Sailing the Mirror which was considered the “class bible” for many years and is still selling today around the world.
*His diabetic routine was an injection of long-acting Actrapid and short-acting soluble insulin a.m. He was meticulous with his diet.
In the boat he would take Mars Bars in case his blood sugar should drop too low.
He never managed to eat them because he was too involved in the racing. He did have Dextro tablets that he would eat even when they were wet and soggy. He always ate a large sandwich before going out on the water.
Menna, his wife would often be seen at the waters edge with food for Roy when the boats came in after a race.
Among his joint achievements was 59 years of marriage. We know, but for the love care and devotion that our mother gave him, he would not have lived as long as he did. He died aged 82.
Zena Healy (nee Partridge)
Diabetes.uk
More testimonies in www.springwell.biz
www.dbethics.com
Having built the boat, he then had to learn to sail it as he had no previous experience of sailing.
On one of his first outings he managed to snag the main sail sheet and capsized the boat.
He persevered with the sailing, built many more boats, learnt how to fine tune the sails and rigging, and years later became Area, National, European and World Champion.
He was invited by the Mirror Class Associations from around the world to share his sailing knowledge, which he did with enthusiasm and pleasure. He went to such places as Barbados, Canada and South Africa.
He wrote a book called Sailing the Mirror which was considered the “class bible” for many years and is still selling today around the world.
*His diabetic routine was an injection of long-acting Actrapid and short-acting soluble insulin a.m. He was meticulous with his diet.
In the boat he would take Mars Bars in case his blood sugar should drop too low.
He never managed to eat them because he was too involved in the racing. He did have Dextro tablets that he would eat even when they were wet and soggy. He always ate a large sandwich before going out on the water.
Menna, his wife would often be seen at the waters edge with food for Roy when the boats came in after a race.
Among his joint achievements was 59 years of marriage. We know, but for the love care and devotion that our mother gave him, he would not have lived as long as he did. He died aged 82.
Zena Healy (nee Partridge)
Diabetes.uk
More testimonies in www.springwell.biz
www.dbethics.com
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