Body shape is a clue to your risk of getting type 2 diabetes

People who carry fat around their abdomen run a higher risk of developing type 2 diabetes , experts say.

Their findings come after comparing gene variants in people with abdominal fat with those who carry weight around their hips and thighs.

The team from Massachusetts General Hospital said: “We tested whether abdominal adiposity was associated with diabetes and the answer was a firm yes.”

The study suggests drugs that modify fat distribution could help prevent it, the journal JAMA reported.

Experts from Massachusetts General Hospital (MGH) in the US found that having a genetic predisposition to “abdominal adiposity” – or an apple-shaped body – was associated with a higher risk for type 2 diabetes and coronary heart disease.

Their study, published in the journal JAMA, examined the pattern of gene variants associated to this body shape – in which weight is deposited around the abdomen, rather than in the hips and thighs.

Using data from a previous study that identified 48 gene variants associated with waist-to-hip ratio adjusted for body mass index – an established measure for abdominal adiposity – they developed a genetic risk score.

The experts then used this risk score against six previous genome studies and to individual data from the UK Biobank – assessing data on more than 400,000 people.

They found that having a genetic predisposition to abdominal adiposity is linked to significant increases in the incidence of type 2 diabetes and coronary heart disease, along with increases in blood lipids, blood glucose and systolic blood pressure.

Senior report author Sekar Kathiresan, associate professor of medicine at Harvard Medical School and director of the MGH Centre for Genomic Medicine, said: “People vary in their distribution of body fat – some put fat in their belly, which we call abdominal adiposity, and some in their hips and thighs.

“Abdominal adiposity has been correlated with cardiometabolic disease, but whether it actually has a role in causing those conditions was unknown.

“We tested whether genetic predisposition to abdominal adiposity was associated with the risk for type 2 diabetes and coronary heart disease and found that the answer was a firm ‘yes’.”


Mulberry leaf extract could reduce the risk of type 2 diabetes

Consuming refined carbohydrates is linked to a heightened risk of developing type 2 diabetes, not to mention heart disease. But what if a supplement could decrease the breakdown of carbohydrates into simple sugars? That might reduce a person’s risk of developing type 2 diabetes. Our latest study, published in PLOS ONE, shows that an extract made from mulberry leaves might do just that.

Previous research shows that herbal medicines could be effective in regulating blood glucose levels. Indeed, the history of the commonly used diabetic drug metformin can be traced back to the use of a herbal medicine, Galega officinalis (goat’s rue or French lilac) in medieval Europe. G. officinalis was found to be rich in guanidine, a substance with blood glucose-lowering activity that formed the chemical basis of metformin (biguanide). This insulin sensitising drug was introduced in 1957

Mulberry leaves have been used in traditional Chinese medicine for several millennia and its use was first recorded in around 500AD. In the Grand Materia Medica, it states that “if the juice (of the herb) is decocted and used as a tea substitute it can stop wasting and thirsting disorder”. Wasting (weight loss) and excessive thirst along with increased urination and tiredness are symptoms associated with diabetes. We aimed to investigate the effects of mulberry extract on blood glucose and insulin responses in healthy volunteers with a randomised, double-blind, placebo-controlled clinical trial – the gold standard for a clinical trial.
Promising results

We took blood samples from 37 healthy volunteers after they had consumed a carbohydrate rich drink (containing maltodextrin, a dietary starch with a high glycaemic index that is commonly added to many foods and beverages). Each participant took either a placebo or one of three doses of the extract along with the drink on four separate days. We measured each person’s glucose and insulin levels over the following two hours.

Our analysis showed that the standard strength mulberry extract (250mg) reduced the total glucose and insulin rises by 22% and 24% respectively compared to a placebo. These results were both statistically significant (unlikely to be due to chance) and clinically significant, and thus could have meaningful health benefits. The extract effectively reduced the total amount of sugar being absorbed into the bloodstream by over 20%.

The extract didn’t cause any side effects in the volunteers, such as nausea and flatulence – side effects which are common with many diabetic medications. An active component in the extract, 1-deoxynojirimycin (DNJ), blocks the breakdown of carbohydrates into simple sugars, preventing the absorption of sugar, lowering blood-glucose rises. Although mulberry leaves can be used to make tea, the particular extract we used had undergone strict quality control processes in order to guarantee consistency of its DNJ content.

In order to draw definitive conclusions about the long-term health benefits of mulberry leaf extract, longer, more pragmatic trials reflecting real-life dietary habits are needed to show if this herbal supplement could prevent the development of type 2 diabetes. The initial results are certainly promising.


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72% of Youth With Type 2 Diabetes Have Complications

Diabetes-related complications occur substantially among 14- to 25-year-old patients with type 1 or type 2 diabetes, but especially in those with type 2 diabetes, according to a new study published in the February 28 issue of the Journal of the American Medical Association.

Dana Dabelea, MD, of Colorado School of Public Health, Denver, and colleagues analyzed data from a nationally representative registry of young patients who had had diabetes for a mean of 7.9 years.

Their logistic regression model estimated that, at age 21, one in three patients with type 1 diabetes and almost three in four patients with type 2 diabetes had at least one of the following complications or comorbidities: diabetic kidney disease, retinopathy, peripheral neuropathy, arterial stiffness, or hypertension.

“Providers…might not expect to see [diabetes] complications at such a young age and after such a short duration,” Dr Dabelea told Medscape Medical News.

The findings suggest that “once [young patients] have diabetes, monitoring their glucose control and other risk factors (lipids, obesity, blood pressure) is going to be crucial to prevent the development of these complications or to slow their progression,” she stressed.

Clinicians should follow the American Diabetes Association (ADA) guidelines for monitoring HbA1c, lipids, microalbuminuria, and blood pressure in young patients with diabetes, as well as the recommendations for eye examinations, foot examinations, and other care.

Based on the HbA1c measures, treatment may have to be modified for optimal glucose control. And a small number of patients may require lipid lowering or antihypertensive therapies at a young age.

Nephropathy, Neuropathy, Retinopathy in Type 1 vs Type 2 Diabetes

The prevalence of type 2 diabetes among children and adolescents has been increasing in most populations since the 1990s, and the prevalence of type 1 diabetes has also been increasing for a long time in the United States and, in fact, worldwide, Dr Dabelea and colleagues observe.

But it has not been clear if diabetes complications (retinopathy, neuropathy, and nephropathy) and comorbidities (hypertension and arterial stiffness) differ in adolescents and young adults with type 2 diabetes vs type 1 diabetes.

To investigate this, the researchers examined data from the SEARCH for Diabetes in Youth registry at five sites in the United States from patients who had been diagnosed with type 1 or type 2 diabetes when they were 10 to 20 years old and who later had diabetes complications and comorbidities measured in a single visit from 2011 to 2015.

They identified 1746 patients with type 1 diabetes and 272 patients with type 2 diabetes.

On average, the patients with type 1 diabetes had been diagnosed when they were 10 years old, and they were 18 years old at the follow-up visit; the patients with type 2 diabetes had been diagnosed when they were 14 years old and were 22 years old at the follow-up visit.

Most patients with type 1 diabetes were white (76%), followed by Hispanic (12%), black (8%), other (4%), or Indian (<1%), and most were normal weight (59%) or overweight (27%). Most (41%) came from families in the highest annual household income category (>$75,000 per annum).

In contrast, most patients with type 2 diabetes were black (43%), followed by white (26%), Hispanic (21%), Indian (7%), or other (3%), and most were obese (72%) or overweight (18%). Most (41%) came from families in the lowest annual household income category (<$25,000).

Monitoring to Spot or Slow Microvascular Complications

At the follow-up visit, the teenagers and young adults with type 2 diabetes had greater odds of having diabetic kidney disease, retinopathy, and peripheral neuropathy than those with type 1 diabetes, after adjustment for changes in glycemic control, central obesity (waist-to-height ratio), and arterial blood pressure over time.

Patients with type 2 diabetes were also more likely to have hypertension and arterial stiffness than patients with type 1 diabetes. However, after adjustment for central obesity, patients with type 2 diabetes no longer had increased odds of these outcomes.

Odds of Complications/Comorbidities With Type 2 Diabetes vs Type 1 Diabetes

Complication Type 2 diabetes, % Type 1 diabetes, % HR (95% CI)* P
Diabetic kidney disease 19.9 5.8 2.58 (1.39–4.81) 0.003
Retinopathy 9.1 5.6 2.24 (1.11–4.50) 0.02
Peripheral neuropathy 17.7 8.5 2.52 (1.43–4.43) 0.001
Arterial stiffness 47.4 11.6 1.07 (0.63–1.84) 0.80
Hypertension 21.6 10.1 0.85 (0.50–1.45) 0.55
*Model adjusted for age, sex, diabetes duration, clinical site, race/ethnicity, and changes in glucose control, central obesity, and blood pressure over time

“We were surprised” at the high rate of complications in these young patients, Dr Dabelea said, “because one would think that with the current better treatments that are available — especially more advanced insulin regimens and pumps and glucose monitoring — we may not have seen so many complications.

“We do have better treatments, but on the other hand, we have a changing population” with more patients with type 2 diabetes, “which is a totally different disease and strongly associated with obesity,” she explained.

“These kids come from disadvantaged families, [often with a single parent], mostly from [racial] minorities, and some don’t have a diabetes provider.”

The findings overall “support early monitoring for development of complications” among all young patients, with both types of diabetes, she and her colleagues conclude.


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Irregular sleeping habits could increase risk of obesity and type 2 diabetes

Irregular sleeping habits could increase the risk of obesity and type 2 diabetes among those who are genetically overweight, according to new findings.

The University of Glasgow study looked at how different sleep patterns can affect people and their health.

They found that people with high genetic risk for obesity who slept for too short or too long a time, napped during the day, and worked shifts appeared to have a fairly substantial adverse influence on body weight.

In what the researchers say is the first study of its kind, the effects of these abnormal sleeping habits were observed alongside genetics of participants.

People who are genetically prone to weight gain were shown to be roughly 4kg heavier if they slept for more than nine hours, while those who got less than seven hours of shut eye were 2kg heavier.

Lead author Dr Jason Gill, from the Institute of Cardiovascular and Medical Sciences, explained that while the outcome was the same regardless of diet, health or socio-demographics, no link was found among those with a lower genetic risk of obesity.

“The influence of adverse sleep characteristics on bodyweight is much smaller in those with low genetic obesity risk – these people appear to be able to ‘get away’ with poorer sleep habits to some extent,” he said.

Co-author Dr Carlos Celis, who is a research associate of the Institute of Cardiovascular and Medical Sciences, added: “It appears that people with high genetic risk for obesity need to take more care about lifestyle factors to maintain a healthy body weight.

“Our data suggest that sleep is another factor which needs to be considered, alongside diet and physical activity.”


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Too little gluten in our diet may increase the risk of type 2 diabetes

ople with celiac disease or who are gluten intolerant may benefit from a low-gluten diet. A considerable number of people who do not have these diseases still adopt a gluten-free diet in the hope that it benefits their health. New research, however, suggests that a low-gluten diet may even have some adverse health effects, by raising the risk of diabetes.
[assorted laves of bread]

Gluten is a protein mainly found in wheat, barley, and rye, as well as baked goods and other foods that contain these cereals. People with celiac disease – an autoimmune disorder affecting at least 3 million people in the United States – avoid gluten because their immune system responds to it by attacking the small intestine.

However, more and more people are adopting a gluten-free diet, despite its health benefits being unclear.

In fact, some nutritionists advise against avoiding gluten. Instead, they recommend a well-balanced diet that includes fruit and vegetables, as well as whole-grain wheat and other foods containing gluten.