View in browser
Issue 8 Alzheimer’s Insights by Curation Health 14 May 2015
The increase in strokes amongst younger people hit the headlines this week; we analyse the data and learn how diabetic retinopathy might put you at a higher risk and what’s to be done about this. The relative value of weight loss, exercise and reducing calorie intake to prevent type 2 diabetes have been clarified – all three together is best. Reassurance over the safety of gliptins is welcomed and, finally, we look at whether “smart plates” are really such a smart concept…
Most read stories this week
Ideal setting for diabetes screening may be dental office
Montreal Institute and AstraZeneca Work on Heart and Diabetes Genetic Screens
Diabetes drug may curb heart attack risk in HIV patients
Cognitive Behavior Therapy for Diabetes
Why Diabetes Drug Prices Are Soaring
Stroke rates rises along with waistlines
Since 2000 there has been an increase of 46% in hospital admissions for stroke among men aged between 40 and 54 in England, according to an analysis by the Stroke Association. Their press release was picked up by many UK newspapers, including this piece in The Daily Mail. For women the increase in admissions was 30%. In people of working age (20-64), strokes had risen by a quarter.

In a stroke (cerebrovascular accident) a part of the brain is deprived of its oxygen supply, usually caused by a clot within the artery supplying it (thromboembolic stroke) and victims are offered a “clot busting” treatment to disperse it and allow the blood to flow again. A rarer cause of stroke is when an artery ruptures (haemorrhagic stroke). Any clot busting treatment is best given as soon as the stroke is recognised, which is why suspected stroke victims are urgently assessed in hospitals. This may account for some of the increase in hospital admissions but the major culprits for the actual increase in the number of strokes are the rising levels of obesity and sedentary lifestyles.

The known risk factors for stroke include diabetes, an irregular pulse (atrial fibrillation), high blood pressure (hypertension), smoking, high cholesterol (dyslipidaemia), poor diet, obesity and sedentary lifestyle. Many of these risk factors are amenable to lifestyle changes, but some may also require medications. In people with type 2 diabetes, it is especially important to address all these risk factors in order to reduce the chances of a stroke, heart attack and the other complications of diabetes.

This advice is not changed by some recent widely reported research, which generated headlines such as “Could being FAT help diabetics live longer?” The study, published in the Annals of Internal Medicine, followed over 10,000 English older adults with type 2 diabetes for 10 years and found that overweight people (but not obese people) had a 13% reduced risk of death compared with people with type 2 diabetes who had a normal Body Mass Index (BMI).

Taken at face value, these results may tempt people with type 2 diabetes to remain overweight or obese, however, this excellent analysis of the study published on the NHS choices website shows this is definitely not the case! Weight loss remains a vital lifestyle change to make in type 2 diabetes.

Diabetes Research
Diabetic retinopathy reflects presence of atherosclerosis
The eyes may be the window to the soul but they may also be a window to the heart and the arteries, according to a study in Cardiovascular Diabetology. It has shown that those who have diabetic retinopathy as a result of their type 2 diabetes are more likely to suffer severe atherosclerosis (“furring of the arteries”) in their carotid arteries than those with type 2 diabetes but no retinopathy.

The severity of atherosclerosis was measured by the presence and number of plaques in the carotid artery. These plaques represent the build-up of fatty substances and cholesterol deposits on the inner lining of the carotid artery. If these get too extensive then the flow of blood to the brain is reduced and the blood itself becomes more likely to clot, increasing the risk of strokes. The plaques themselves may come away from the wall, float along and then end up blocking smaller arteries in the brain. Those with diabetic retinopathy were found to be around twice as likely to have two or more plaques as those without diabetic retinopathy.

The authors suggest that an ultrasound examination of the carotid arteries should be considered in patients with diabetic retinopathy in order to determine their individual risk of having a stroke and other cardiovascular complications. This risk level can then indicate the degree of lifestyle changes and medical interventions needed to help prevent complications.

Diabetes Complications
Exercise, diet and weight loss all vital in reducing type 2 diabetes risk
A study from Saint Louis University, published in Diabetes Care, has clarified the individual benefits of the trinity of lifestyle interventions recommend to reduce the risk of developing type 2 diabetes. People at risk of type 2 diabetes are encouraged to do three things: exercise, restrict their calorie intake and lose weight.

The problem is that many people are happy to do one or two of these, but perhaps not all three. They assume that the benefit of doing the one is equivalent to the benefit of doing the other and there is no additional benefit in doing them all. This research, however, shows that each lifestyle intervention offers separate and cumulative benefits, so those at risk of type 2 diabetes should strive to do all three.

Researchers measured how effectively the body was able to use insulin in sedentary, overweight, middle-aged men and women. These people were then encouraged to lose weight through exercise, calorie restriction, or a combination of both.

They found that either exercise alone, or calorie restriction alone, had beneficial effects on insulin sensitivity, but combining the two had twice the benefit. What was unexpected was that the benefit of calorie restriction was not mainly due to the actual weight loss it caused: calorie restriction is of benefit, even if no weight loss was achieved. This is analogous to the benefit of exercise in those at risk of type 2 diabetes - even if exercise does not lead to actual weight loss, its value has already been well established.

What this research tells us is that it is not adequate to have a healthy weight but then just eat unhealthily, or restrict calorie intake and then not exercise. Exercising, restricting calories and losing weight are the triad of lifestyle measures that, when all done together, will have most benefit in those at risk of type 2 diabetes.

Diabetes Lifestyle
Reassurance over effects of sitagliptin on the heart
The fears that all the members of a class of type 2 diabetes drugs called DPP-4 inhibitor (gliptins) may cause increased death rates from heart problems have just been allayed in the US. These concerns were previously reported in Diabetes INSIGHTS , issue 4 but now more data has become available.

In the US, previous studies had prompted changes to the labelling of some the other drugs in the gliptins group to highlight the risk of heart problems, but sitagliptin (Januvia) will probably not require one. The new study, TECOS which will be reported at the American Diabetes Association Scientific Sessions in Boston this June, showed taking sitagliptin had no adverse effect on the rates of myocardial infarction, nonfatal stroke, unstable angina requiring hospitalisation, or cardiovascular-related death.

This is good news because it suggests that the gliptins do not all have the same potential adverse effects on the heart. Furthermore, since sitagliptin accounts for around three quarters of the gliptins that are used globally, any problems with it could impact a large number of people with type 2 diabetes. Sitagliptin is also used in a drug called Janumet, where it combined with metformin.

Gliptins are of benefit in type 2 diabetes because they increase levels of incretins - hormones that act to lower glucose production in the liver and also increase the production of insulin. The current National Institute of Clinical Excellence (NICE) guidelines on the use of sitagliptin can be found here.

Diabetes Treatment
From smartphones to “SmartPlates”
Wouldn’t it be lovely to be able to waft your smartphone in the general direction of the plate of food in front of you and get an instant readout of how much carbohydrates, protein and fat is in your meal? Well, we are getting closer to this dream courtesy of SmartPlate, which just launched a Kickstarter campaign to raise $100,000 to bring the plate to market in 2016.

The SmartPlate is a fancy piece of flatware that uses built-in cameras and sensors to recognise, weigh and log everything placed on it. It transmits this data to an app that then calculates the nutritional breakdown of the meal and keeps a handy diary of all your food intake. It would be then be only a small programming step to get this app to advise you of the appropriate insulin dose to take, if you so needed. Already, the SmartPlate will send an alert to the app if it thinks you are overdoing the carbohydrates…

The downside is that one SmartPlate will cost around two hundred dollars and it cannot be used in the dishwater or the microwave. This to me is a complete deal breaker: diabetes or no diabetes, I ain’t gonna do no hand washing of my crockery! Also, am I expected to carry around my SmartPlate with me all the time? At home, I have control over what I eat and can thus calculate the nutritional breakdown of it, but it’s when I am dining out that I would need this plate the most…

I think the future for this sort of concept lies in using a smartphone to take a photo of the pie you are about to devour, the picture is sent to some fancy software in the cloud to be analysed and it then sends you back the full low-down on it. Or maybe this is just pie in the sky thinking…

Diabetes Technology
You are not alone… famous people with type 2 diabetes
James Bond star Roger Moore was shaken and stirred when he was diagnosed with type 2 diabetes. Read his story as told to the Irish Mirror .
And Finally… Are you aspiring to take aspirin?
The joy of CurationHealth feeds is that they take you to websites for newspapers in places you would otherwise never visit. I came across this Annual Checklist For Managing Diabetes on The Craig Daily Press from Colorado, USA. One thing that caught my attention was recommendation seven which states to “take a daily baby aspirin” to reduce the risk of a first stroke and/or first heart attack (so-called “primary prevention”).

This seemed very clear cut advice and it got me wondering what the official UK position on low dose aspirin use in type 2 diabetes is. I found the short answer from the National Institute of Clinical Excellence (NICE) here and it was that “an antiplatelet drug (usually aspirin 75 mg daily) is indicated for people with controlled blood pressure who are 50 years of age or over, or younger people who are at high risk of cardiovascular disease”.

So, not quite the blanket recommendation suggested in the US article, but still a good reminder for us all to consider if we should be taking aspirin. Finally, just to muddy the waters, the European Society of Cardiology and the European Association for the Study of Diabetes do NOT recommend primary prevention with aspirin in patients with diabetes at all…

This just highlights the problems of different countries/authorities having different guidelines for managing diabetes; this is why for consistency in this newsletter I usually refer back to the NICE guidelines.
More Diabetes Feeds on CurationHealth
Diabetes Complications
Diabetes Lifestyle
Diabetes Technology
Diabetes Research
Diabetes Treatment
CurationHealth is a health communications company and not a healthcare company. The information it relays from online and offline publications is provided as is without either endorsement or warranties as to the accuracy or fitness for any specific purpose and should under no circumstances be read as medical or scientific advice, neither as in any sense a prescription or a substitute for the professional advice of a doctor or otherwise trained specialist in matters of health and wellbeing. While information relayed from third parties is conveyed in good faith, no warranties are offered as to the accuracy of information supplied in this way, nor indeed from such agents or follow-on links quoted by third parties from other sources.
Tweets of the week twitter logo
Dr Shibley (@dr_shibley)
On pre diabetes opening up new markets "Pre-diabetes label ‘unhelpful and unnecessary’"… @DocMartin68
Ash Paul (@pash22)
@Cleverestcookie @parthaskar @RslewisSally @portsmouthCCG @nhsconfed @NHSEngland National Diabetic Audit results are very disappointing IMO
Paul Knoepfler (@pknoepfler)
Statin dilemma: heart & maybe prostate cancer benefits, but big bump in Diabetes risk
Shawn Watson (@Shawn_G_Watson)
* Iron deficiency may lead to false diagnosis of diabetes | @bioDiabetes…
Mike Bryan (@functionalfood)
Fish Oil Can Reverse Diabetes Nerve Damage: Study #fishoil
Follow Diabetes Insights
About Diabetes Insights
Diabetes Insights is an online newsletter created for people who live with the challenge of diabetes. The present focus is mainly on Type 2 diabetes. Based upon intelligent search algorithms that scour the Internet for the most read, relevant and useful stories from around the world, it is curated and published each Thursday by a team of health and publishing experts.
Fintan Coyle  
Fintan Coyle Senior Curator
A retired General Practitioner, Fintan has been a writer, columnist and medical editor for both consumer titles and medical journals. His strong personal interest in diabetes began when he developed late onset type 1 diabetes in his thirties. He is committed to highlighting the important issues for you, applying his medical knowledge to breaking stories alongside his real-life insights into what it’s like to live with diabetes.
Explain This!
When was diabetes first classified into type 1 and type 2?
Click here to find out
Powered by Curation© Corporation
25 Copthall Avenue | London | EC2R 7BP | United Kingdom
Curation Corporation Limited is registered in England no.07864348
Curation Corporation Limited is an Appointed Representative of Makor Securities LLP who are authorised and regulated by the Financial Conduct Authority.