Study: Most humans vulnerable to type 2 diabetes
Insulin has met an “evolutionary cul-de-sac, limiting its ability to adapt to obesity and thereby rendering most people vulnerable to Type 2 diabetes".
Henriette Lamprecht – About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries like Namibia. According to the World Health Orginasation 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.
A recent and groundbreaking study has now suggested most humans are vulnerable to type 2 diabetes. The study by scientists from Indiana University School of Medicine, the University of Michigan and Case Western Reserve University have found insulin has met an “evolutionary cul-de-sac, limiting its ability to adapt to obesity and thereby rendering most people vulnerable to Type 2 diabetes”.
The study determined that the sequence of insulin has become entrenched at the edge of impaired production, an intrinsic vulnerability unmasked by rare mutations in the insulin gene causing diabetes in childhood.
Insulin is produced by a series of highly specific processes that occur in specialized cells, called beta cells. A key step is the folding of a biosynthetic precursor, called proinsulin, to achieve the hormone's functional three-dimensional structure. Past studies from this and other groups have suggested that impaired biosynthesis could be the result of diverse mutations that hinder the foldability of proinsulin.
The study sought to determine if the evolution of insulin in vertebrates—including humans—has encountered a roadblock. Has a complex series of steps imposed constraints that have frozen the sequence of insulin at a precipice of non-foldability? And if so, has this left humankind vulnerable to Type 2 diabetes as a pandemic disease of civilization?
According to the study published in the Proceedings of the National Academy of Sciences, the answers are yes and yes.
In another study at Lund University in Sweden and published in ScienceDaily, researchers have now identified biomarkers that can show in advance how the patient will respond to metformin treatment via a simple blood test. Metformin is the first-line drug that can lower blood sugar levels in type 2 diabetes patients. One third of patients do not respond to metformin treatment and 5 per cent experience serious side effects, which is the reason many choose to stop medicating, the study states.
According to international guidelines, when diet and exercise are not enough to regulate blood sugar, metformin is the first drug introduced to treat type 2 diabetes. If it does not have the intended effect in the form of lowered blood sugar levels, or if the patient experiences serious side effects, patients then go on to try other drugs.
Says researcher Charlotte Ling, “If it takes a long time for the patient to receive the correct treatment, there is a risk of complications due to the elevated blood sugar levels.”
Approximately 30 per cent of all patients with type 2 diabetes do not respond to metformin and should be given another drug right from the start. For this reason, it is important to be able to identify these patients upon diagnosis,"she emphasized.
One third of patients experience side effects usually in the form of gastrointestinal difficulties such as nausea, stomach pain and diarrhea. Five per cent stop taking the medicine due to severe side effects.
The study is the first pharmacoepigenetic study in diabetes, i.e. that researchers have studied how epigenetic factors, such as DNA methylation can be used as biomarkers to predict the effect of a drug.
A new study led by a cardiologist from Brigham and Women's Hospital has assessed the cardiovascular and renal outcomes for ertugliflozin, an SGLT2 inhibitor prescribed for patients with type 2 diabetes to help them control blood sugar levels. The Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial (VERTIS CV) found that the drug had a safety profile similar to that of other SGLT2 inhibitors and did not increase risk of major adverse events compared to the placebo. The results did not show a statistically significant benefit, but, taken together with other recent studies of SGLT2 inhibitors, the study results add to a growing body of evidence that supports guidelines for using this class of drugs to help prevent adverse cardiovascular outcomes.
Type 2 diabetes can lead to heart failure hospitalization and renal disease progression, with adult type 2 diabetic patients and their clinicians often navigating cardiovascular and renal concerns while working to control blood sugar levels. Recent studies of other SGLT2 inhibitors have found that they may provide a benefit to both renal and cardiovascular health.
A Swansea University academic has now helped draw up a landmark agreement amongst international experts, setting out the world's first standard guidance on how people with diabetes can use modern glucose monitoring devices to help them exercise safely.
The guidance will be a crucial resource for healthcare professionals around the world, so they can help people with type 1 diabetes.
The guidance, approved by an array of diabetes experts and organisations, was drawn up by a team including Dr Richard Bracken of the School of Sports and Exercise Sciences, College of Engineering and the Diabetes Research group, located in the Medical School at Swansea University.
Physical exercise is an important part of managing type 1 diabetes for people of all age groups. However, the blood sugar response can be difficult to predict, with exercise sometimes increasing the risk of falling blood sugar levels -- known as hypoglycaemia -- or other times causing blood sugar to rise. Levels of glucose therefore have to be closely monitored.
Fear of having a "hypo," which can lead to dizziness, disorientation, anxiety and many other symptoms, is one of the main barriers stopping people with diabetes from incorporating exercise into daily life.
Fortunately, modern real-time glucose monitoring systems are now available for people to manage their glucose levels during exercise. The problem, however, is that these can be complex, and the information can be difficult for patients and health professionals to interpret.
The new guidance looks at the evidence from glucose monitoring technology and uses it as the basis for clear guidance for exercise in adults, children and adolescents with type 1 diabetes.
The guidance covers areas like carbohydrate consumption and safe glucose thresholds. The idea is that it should serve as an initial guidance tool, which can then be tailored for the individual patient in consultation with health professionals.
Sources: diabetesnews; ScienceDaily; WHO
A recent and groundbreaking study has now suggested most humans are vulnerable to type 2 diabetes. The study by scientists from Indiana University School of Medicine, the University of Michigan and Case Western Reserve University have found insulin has met an “evolutionary cul-de-sac, limiting its ability to adapt to obesity and thereby rendering most people vulnerable to Type 2 diabetes”.
The study determined that the sequence of insulin has become entrenched at the edge of impaired production, an intrinsic vulnerability unmasked by rare mutations in the insulin gene causing diabetes in childhood.
Insulin is produced by a series of highly specific processes that occur in specialized cells, called beta cells. A key step is the folding of a biosynthetic precursor, called proinsulin, to achieve the hormone's functional three-dimensional structure. Past studies from this and other groups have suggested that impaired biosynthesis could be the result of diverse mutations that hinder the foldability of proinsulin.
The study sought to determine if the evolution of insulin in vertebrates—including humans—has encountered a roadblock. Has a complex series of steps imposed constraints that have frozen the sequence of insulin at a precipice of non-foldability? And if so, has this left humankind vulnerable to Type 2 diabetes as a pandemic disease of civilization?
According to the study published in the Proceedings of the National Academy of Sciences, the answers are yes and yes.
In another study at Lund University in Sweden and published in ScienceDaily, researchers have now identified biomarkers that can show in advance how the patient will respond to metformin treatment via a simple blood test. Metformin is the first-line drug that can lower blood sugar levels in type 2 diabetes patients. One third of patients do not respond to metformin treatment and 5 per cent experience serious side effects, which is the reason many choose to stop medicating, the study states.
According to international guidelines, when diet and exercise are not enough to regulate blood sugar, metformin is the first drug introduced to treat type 2 diabetes. If it does not have the intended effect in the form of lowered blood sugar levels, or if the patient experiences serious side effects, patients then go on to try other drugs.
Says researcher Charlotte Ling, “If it takes a long time for the patient to receive the correct treatment, there is a risk of complications due to the elevated blood sugar levels.”
Approximately 30 per cent of all patients with type 2 diabetes do not respond to metformin and should be given another drug right from the start. For this reason, it is important to be able to identify these patients upon diagnosis,"she emphasized.
One third of patients experience side effects usually in the form of gastrointestinal difficulties such as nausea, stomach pain and diarrhea. Five per cent stop taking the medicine due to severe side effects.
The study is the first pharmacoepigenetic study in diabetes, i.e. that researchers have studied how epigenetic factors, such as DNA methylation can be used as biomarkers to predict the effect of a drug.
A new study led by a cardiologist from Brigham and Women's Hospital has assessed the cardiovascular and renal outcomes for ertugliflozin, an SGLT2 inhibitor prescribed for patients with type 2 diabetes to help them control blood sugar levels. The Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial (VERTIS CV) found that the drug had a safety profile similar to that of other SGLT2 inhibitors and did not increase risk of major adverse events compared to the placebo. The results did not show a statistically significant benefit, but, taken together with other recent studies of SGLT2 inhibitors, the study results add to a growing body of evidence that supports guidelines for using this class of drugs to help prevent adverse cardiovascular outcomes.
Type 2 diabetes can lead to heart failure hospitalization and renal disease progression, with adult type 2 diabetic patients and their clinicians often navigating cardiovascular and renal concerns while working to control blood sugar levels. Recent studies of other SGLT2 inhibitors have found that they may provide a benefit to both renal and cardiovascular health.
A Swansea University academic has now helped draw up a landmark agreement amongst international experts, setting out the world's first standard guidance on how people with diabetes can use modern glucose monitoring devices to help them exercise safely.
The guidance will be a crucial resource for healthcare professionals around the world, so they can help people with type 1 diabetes.
The guidance, approved by an array of diabetes experts and organisations, was drawn up by a team including Dr Richard Bracken of the School of Sports and Exercise Sciences, College of Engineering and the Diabetes Research group, located in the Medical School at Swansea University.
Physical exercise is an important part of managing type 1 diabetes for people of all age groups. However, the blood sugar response can be difficult to predict, with exercise sometimes increasing the risk of falling blood sugar levels -- known as hypoglycaemia -- or other times causing blood sugar to rise. Levels of glucose therefore have to be closely monitored.
Fear of having a "hypo," which can lead to dizziness, disorientation, anxiety and many other symptoms, is one of the main barriers stopping people with diabetes from incorporating exercise into daily life.
Fortunately, modern real-time glucose monitoring systems are now available for people to manage their glucose levels during exercise. The problem, however, is that these can be complex, and the information can be difficult for patients and health professionals to interpret.
The new guidance looks at the evidence from glucose monitoring technology and uses it as the basis for clear guidance for exercise in adults, children and adolescents with type 1 diabetes.
The guidance covers areas like carbohydrate consumption and safe glucose thresholds. The idea is that it should serve as an initial guidance tool, which can then be tailored for the individual patient in consultation with health professionals.
Sources: diabetesnews; ScienceDaily; WHO
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