Obesity involves changes in the function of brain regions that regulate body fatness and blood glucose, particularly a region called the hypothalamus. My colleagues and I previously showed that obesity is associated with inflammation and injury of the hypothalamus in rodent models, and we also presented preliminary evidence that the same might be true in humans. In our latest paper, we confirm this association, and show that hypothalamic injury is also associated with a marker of insulin resistance, independently of BMI.
Introduction
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Showing posts with label diabetes. Show all posts
Showing posts with label diabetes. Show all posts
Thursday, 10 December 2015
Thursday, 4 June 2015
Insulin Resistance Predicts a Variety of Age-related Diseases
In the last post, I reviewed a study by Gerald Reaven's group showing that insulin resistance strongly predicts the risk of cardiovascular disease over a 5-year period. In 2001, Reaven's group published an even more striking follow-up result from the same cohort (1). This study shows that not only does insulin resistance predict cardiovascular disease risk, it also predicts a variety of age-related diseases, including hypertension, coronary heart disease, stroke, cancer, type 2 diabetes, and even overall mortality risk.
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Tuesday, 16 December 2014
Is Meat Unhealthy? Part V
In this post, I'll examine the possible relationship between meat intake and type 2 diabetes. Type 2 diabetes is the most common form of diabetes, and it is strongly linked to lifestyle factors.
Non-industrial cultures
Non-industrial cultures have an extremely low prevalence of diabetes, whether they are near-vegan or near-carnivorous. This is supported by blood glucose measurements in a variety of cultures, from the sweet potato farmers of the New Guinea highlands to the arctic Inuit hunters. Here is what Otto Schaefer, director of the Northern Medical Research Unit at Charles Camsell hospital in Edmonton, Canada, had to say about the Inuit in the excellent book Western Diseases (Trowell and Burkitt, 1981):
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Non-industrial cultures
Non-industrial cultures have an extremely low prevalence of diabetes, whether they are near-vegan or near-carnivorous. This is supported by blood glucose measurements in a variety of cultures, from the sweet potato farmers of the New Guinea highlands to the arctic Inuit hunters. Here is what Otto Schaefer, director of the Northern Medical Research Unit at Charles Camsell hospital in Edmonton, Canada, had to say about the Inuit in the excellent book Western Diseases (Trowell and Burkitt, 1981):
Read more »
Tuesday, 14 October 2014
Obesity → Diabetes
A new study adds to the evidence that the prevalence of type 2 diabetes is rapidly increasing in the US, and our national weight problem is largely to blame.
The Centers for Disease Control (CDC) currently estimates that a jaw-dropping 33 percent of US men, and 39 percent of US women, will develop diabetes at some point in their lives (1). Roughly one out of three people in this country will develop diabetes, and those who don't manage it effectively will suffer debilitating health consequences. Has the risk of developing diabetes always been so high, and if not, why is it increasing?
In the same issue of the Annals of Internal Medicine as the low-carb vs. low-fat study, appears another study that aims to partially address this question (2).
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The Centers for Disease Control (CDC) currently estimates that a jaw-dropping 33 percent of US men, and 39 percent of US women, will develop diabetes at some point in their lives (1). Roughly one out of three people in this country will develop diabetes, and those who don't manage it effectively will suffer debilitating health consequences. Has the risk of developing diabetes always been so high, and if not, why is it increasing?
In the same issue of the Annals of Internal Medicine as the low-carb vs. low-fat study, appears another study that aims to partially address this question (2).
Read more »
Friday, 26 September 2014
Help Advance Diabetes Research
A University of Virginia researcher named Hannah Menefee contacted me recently to ask for our help. She and her colleagues are conducting a study on how people with type 2 diabetes use Facebook to manage their health, and how that technology can be leveraged to support effective health communication.
If you have type 2 diabetes, and you'd like to participate in the study, please join their Diabetes Management Study Facebook group. There, you'll receive more information about the study, you'll receive a short survey, and you may be invited into one of the study phases.
If you have type 2 diabetes, and you'd like to participate in the study, please join their Diabetes Management Study Facebook group. There, you'll receive more information about the study, you'll receive a short survey, and you may be invited into one of the study phases.
Wednesday, 11 June 2014
Insulin for Persons Already on Metformin: A Population Health Perspective
As most population health providers know, diabetes guidelines tend to focus on shorter-term or "intermediate" outcomes, such as average blood sugar levels or A1c levels. That's because these short-term measures are surrogates for "long term" outcomes, such as blindness and kidney disease.
Two inconvenient facts have complicated the focus on intermediate outcomes:
1) Once a threshold has been achieved, lower short-term blood glucose control doesn't necessarily lead to better long term outcomes;
2) The side effects of drugs - that otherwise work quite well at achieving short-term blood glucose control - may outweigh any long-term advantages.
And now a just-published research study from JAMA raises the possibility that insulin has additional long-term side-effects.
According to diabetes mellitus treatment guidelines from organizations like the American Diabetes Association, the first medication option for Type 2 diabetes should be metformin. If that doesn't work, the ADA suggests that there are several options for a second drug, including one of several sulfonylureas (glyburide, glipizide or glimepiride) or insulin.
Sulfonylureas are pills, but have a reputation for not leading to the same level of diabetes control as insulin. Unfortunately, while it's a more potent means of blood glucose control, insulin has to be injected.
Further details on the methodology are below.* Basically, Veterans Affairs electronic records were "mined" to find thousands of persons with diabetes who were using metformin and then had to start either insulin or a sulfonylurea. Propensity scoring was then used to create two otherwise similar cohorts of patients and neutralize the impact of the diabetes control and disease burden.
2436 patients on metformin and insulin were compared to 12,180 patients on metformin and a sulfonylurea.
After a median of 50 months of observation, the risk of a heart atttack, stroke or death from all causes was 43 per 1000 person-years in the insulin group vs. 33 in the sulfonylurea group. That difference was statistically significant. When deaths alone were examined, there was likewise an increased number in the insulin group (34 per 1000 person years) vs. the sulfonylurea group (23 per 100 person years).
The Population Health Blog's take:
This study raises the possibility that, among persons with diabetes on metformin, insulin is associated with an increased absolute risk of about 1 per 100 person years (10 per thousand person years, or one person out of a hundred persons followed for one year) of heart attack, stroke or death vs. the sulfonylurea pill. Yikes.
Before we ban insulin in this population, however, the PHB is reminded that this was an observational study. As an accompanying editorial points out, propensity scoring is not perfect and other unmeasured and confounding factors in the population could be biasing the results. Short of a randomized clinical trial, there are other databases that could be mined the same way. That includes those of the population health vendors, who also have a stake in risk stratification and long-term follow-up.
In the course of coaching persons with diabetes on metformin who are considering insulin, the additional risk of heart attack, stroke or death should be raised. While the study above isn't perfect, the possibility is something that health care consumers need to weigh.
++++++++++++++++++++++
*Methodology:
Veterans 18 years and older who.....
1) were followed for at least two years with provider visits every 6 months,
2) who had been placed on metformin and regularly used it between 2001 and 2008,
3) had one year of records prior to the first prescription for metformin and
4) were not on dialysis or in hospice
Once a vet filled a prescription for either insulin (long acting, premixed or short/long acting) or a sulfonylurea (glyburide, glipizide or glimepiride) and continued it for 6 months, their records became eligible for the study. Patient records were excluded if there was no follow-up for six months, if the meformin was stopped for 3 months or a third diabetic drug was prescribed.
52% (approximately 92,000) of the 178,000 vets on metformin did not use another medicine. Most were men (95%) and white (70%). 2948 were started on insulin and 39,990 started a sulfonylurea. The persons placed on insulin had, on average, worse diabetes control (A1c 8.5% vs. 7.5%) and a higher disease burden.
Two inconvenient facts have complicated the focus on intermediate outcomes:
1) Once a threshold has been achieved, lower short-term blood glucose control doesn't necessarily lead to better long term outcomes;
2) The side effects of drugs - that otherwise work quite well at achieving short-term blood glucose control - may outweigh any long-term advantages.
And now a just-published research study from JAMA raises the possibility that insulin has additional long-term side-effects.
According to diabetes mellitus treatment guidelines from organizations like the American Diabetes Association, the first medication option for Type 2 diabetes should be metformin. If that doesn't work, the ADA suggests that there are several options for a second drug, including one of several sulfonylureas (glyburide, glipizide or glimepiride) or insulin.
Sulfonylureas are pills, but have a reputation for not leading to the same level of diabetes control as insulin. Unfortunately, while it's a more potent means of blood glucose control, insulin has to be injected.
Further details on the methodology are below.* Basically, Veterans Affairs electronic records were "mined" to find thousands of persons with diabetes who were using metformin and then had to start either insulin or a sulfonylurea. Propensity scoring was then used to create two otherwise similar cohorts of patients and neutralize the impact of the diabetes control and disease burden.
2436 patients on metformin and insulin were compared to 12,180 patients on metformin and a sulfonylurea.
After a median of 50 months of observation, the risk of a heart atttack, stroke or death from all causes was 43 per 1000 person-years in the insulin group vs. 33 in the sulfonylurea group. That difference was statistically significant. When deaths alone were examined, there was likewise an increased number in the insulin group (34 per 1000 person years) vs. the sulfonylurea group (23 per 100 person years).
The Population Health Blog's take:
This study raises the possibility that, among persons with diabetes on metformin, insulin is associated with an increased absolute risk of about 1 per 100 person years (10 per thousand person years, or one person out of a hundred persons followed for one year) of heart attack, stroke or death vs. the sulfonylurea pill. Yikes.
Before we ban insulin in this population, however, the PHB is reminded that this was an observational study. As an accompanying editorial points out, propensity scoring is not perfect and other unmeasured and confounding factors in the population could be biasing the results. Short of a randomized clinical trial, there are other databases that could be mined the same way. That includes those of the population health vendors, who also have a stake in risk stratification and long-term follow-up.
In the course of coaching persons with diabetes on metformin who are considering insulin, the additional risk of heart attack, stroke or death should be raised. While the study above isn't perfect, the possibility is something that health care consumers need to weigh.
++++++++++++++++++++++
*Methodology:
Veterans 18 years and older who.....
1) were followed for at least two years with provider visits every 6 months,
2) who had been placed on metformin and regularly used it between 2001 and 2008,
3) had one year of records prior to the first prescription for metformin and
4) were not on dialysis or in hospice
Once a vet filled a prescription for either insulin (long acting, premixed or short/long acting) or a sulfonylurea (glyburide, glipizide or glimepiride) and continued it for 6 months, their records became eligible for the study. Patient records were excluded if there was no follow-up for six months, if the meformin was stopped for 3 months or a third diabetic drug was prescribed.
52% (approximately 92,000) of the 178,000 vets on metformin did not use another medicine. Most were men (95%) and white (70%). 2948 were started on insulin and 39,990 started a sulfonylurea. The persons placed on insulin had, on average, worse diabetes control (A1c 8.5% vs. 7.5%) and a higher disease burden.
Tuesday, 10 December 2013
Does "Metabolically Healthy Obesity" Exist?
Obesity is strongly associated with metabolic alterations and negative health outcomes including diabetes, cardiovascular disease, and some types of cancer (1, 2, 3, 4). Excess body fat is one of the primary causes of preventable health problems and mortality in the United States and many other affluent nations, ranking in importance with cigarette smoking and physical inactivity. Obesity is thought to contribute to disease via the metabolic disturbances it causes, including excess glucose and lipids in the circulation, dysregulated hormone activity including insulin and leptin, and inflammatory effects. This immediately raises two questions:
Does metabolically healthy obesity exist?
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- Does metabolically healthy obesity exist?
- If so, are metabolically healthy obese people at an elevated risk of disease and death?
Does metabolically healthy obesity exist?
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Sunday, 24 March 2013
Neuronal Control of Appetite, Metabolism and Weight
Last week, I attended a Keystone conference, "Neuronal Control of Appetite, Metabolism and Weight", in Banff. Keystone conferences are small, focused meetings that tend to attract high quality science. This particular conference centered around my own professional research interests, and it was incredibly informative. This post is a summary of some of the most salient points.
Rapid Pace of Scientific Progress
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Rapid Pace of Scientific Progress
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