
	Posted on Thu, Aug. 10, 2006

	Fat babies added to epidemic The number of obese infants has increased by 73.5 percent over 22 years, a study says. Chicago Tribune CHICAGO \| - Add babies to the growing ranks of overweight Americans. In a new study, Harvard Medical School researchers document a 73.5 percent increase in fat babies over a 22-year period — a trend they warn has worrisome implications for the nation’s obesity epidemic. Some factors are at play. More babies are large for their gestational age at birth than a quarter-century ago because more moms are entering pregnancy overweight and developing gestational diabetes. And more babies are gaining weight rapidly in their first few months. The numbers suggest that “our obesity prevention efforts need to start at the earliest stages of human development,” said Matthew Gillman, senior author and associate professor of ambulatory care and prevention at Harvard. That doesn’t mean that parents should be putting babies with telltale rolls of fat on diets, doctors advised. But it does imply that they should talk about nutritional concerns with their pediatricians. The study tracked extremely chubby infants less than 6 months old. Their weight, adjusted for height, placed them at or above the 95th percentile on growth charts, the cutoff point for being considered overweight. By 2001, these babies accounted for 5.9 percent of infants, up from 3.4 percent in 1980, according to Gillman’s report, published in Obesity, a medical journal.

Diabetes complications falling
Study signals improved care
By Alicia Chang
Associated Press

Sunday, June 12, 2005 - Far fewer Americans with diabetes are ending up in emergency rooms or developing kidney failure a sign that diabetes care has improved dramatically over the last decade, the government reported Saturday.

The federal Centers for Disease Control and Prevention said the rate of people with diabetes who need hospitalization or develop kidney failure has dropped about a third since the mid- 1990s.

However, a separate study raises concern that doctors may be missing opportunities to diagnose and treat kids with Type 1 diabetes, who need insulin to survive. Many children were misclassified as Type 2, the diabetes linked to obesity, possibly because their weight problems are throwing doctors off track.

Both studies were presented at an American Diabetes Association meeting in San Diego Saturday.

From 1994 to 2002, the rate of diabetes-related hospitalizations fell from 55 to 36 per 1,000 diabetics. Similarly, the rate of diabetes patients with kidney failure dropped from 327 to 229 per 100,000 population between 1996 and 2002.

Researchers used two sources of information. The kidney failure rates came from a national database of people who had dialysis or transplants in the last decade. The hospitalization rates were based on figures from big hospitals across the country.

"We are at last improving the quality of life for diabetics,' said Alan Cherrington, president of the diabetes association and professor at Vanderbilt University Medical Center, who had no role in the study.

The number of people with both types of diabetes has tripled over the past two decades to an estimated 18 million Americans, but more than 90 percent have Type 2. It is the sixth leading cause of death, and complications can include heart, kidney and nerve disease, eye damage and limb amputation.

Doctors have urged people with diabetes to control their blood sugar and blood pressure to avoid or delay kidney failure, which often requires a transplant or dialysis, in which a machine cleans the blood of wastes normally filtered by the kidneys.

"We've been working really hard to make diabetes a more common household word and to educate people with diabetes to reduce their risk factors,' said Nilka Rios Burrows, an epidemiologist at the CDC's diabetes division.

About 130,000 diabetics underwent dialysis or kidney transplant in 2000. The new research suggests that many more have avoided those drastic measures by controlling their blood sugar.

In another study presented at the meeting, researchers found that one out of three children diagnosed with Type 2 diabetes were found to be Type 1 after they were given a more sensitive test that is not commonly used in doctors' offices.

Diabetes treatment differs depending on the type. Type 1 patients cannot make insulin and need to get this hormone, which regulates blood sugar levels, through shots or a pump. Those with the more common Type 2, linked to obesity, often can't effectively use the insulin their bodies make. They are advised to lose weight, eat a healthy diet and exercise, and sometimes drugs are prescribed.

Researchers led by Dr. Diana Petitti of Kaiser Permanente of Southern California, a large health insurer, looked at medical records of 2,868 children and adolescents diagnosed with Type 1 or Type 2 diabetes by their health care providers in 2001-2002.

The patients went to one of six participating U.S. medical centers to be given a highly sensitive biochemical test. Researchers compared the results and found that 31 percent of children who had been diagnosed with Type 2 actually were Type 1, according to the test.

Specialists say the finding raises questions about whether young diabetics are getting proper treatment and whether this test should be more available to doctors.

Childhood obesity has become more prevalent in the United States, raising the risk of diabetes and many other diseases. An estimated 210,000 young people have diabetes.

"What we're finding is that diabetes is much more complicated than we thought,' Petitti said.

The study was funded by the CDC and the National Institutes of Health.

Posted on Tue, Mar. 22, 2005

Waist size seen as diabetes indicator
Body mass index not as definitive, study suggests

BALTIMORE — A man's waist size seems to be a stronger indicator of diabetes risk than the body mass index (BMI), new research suggests.

Johns Hopkins scientists reviewed data from 27,270 men tracked over 13 years and put them into five groups according to their waist size. Of them, 884 had diabetes.

Compared with those in the group with the smallest waists, 29 to 34 inches, men with larger waist sizes were at least twice as likely to have diabetes. Those with the largest waist size — 40 inches and above — were up to 12 times more likely to have type 2 diabetes, the kind associated with obesity.

When the men were divided into groups based on their BMI — a formula based on weight and height — the level of risk wasn't as pronounced.

The study's lead author, Youfa Wang, an assistant professor with the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, said waist size could indicate a strong risk for diabetes whether or not a man's BMI indicates he's overweight.

Alan Cherrington, president of the American Diabetes Association, said the study backed earlier research that found waistline fat “is worse for you than other kinds of fat.”

Researchers think fat cells in that area may affect the liver differently or there are signaling molecules in that type of fat cell that may affect diabetes, said Cherrington, also the chairman of the department of molecular physiology and biophysics at Vanderbilt University.

The findings are in the March issue of the American Journal of Clinical Nutrition.

— The Associated Press

Posted on Tue, Oct. 14, 2003

The growing problem of diabetes
By KAREN UHLENHUTH
The Kansas City Star

The "good life" is turning us into a nation of diabetics.

Too much food and too much convenience are making us overweight and out of shape, and, according to a study released last week by the Journal of the American Medical Association, one in three Americans now being born can count on developing diabetes -- perhaps even fairly soon, given current trends in children and adolescents.

It's estimated that between 8 percent and 45 percent of diabetes cases now being diagnosed occur among children. The rate varies with race.

Diabetes spells years of disability followed by premature death. The Centers for Disease Control and Prevention, which conducted the recently published study, calculates that, on average, a woman who's diagnosed with diabetes before the age of 40 can count on 14.3 fewer years of life and 18.6 years of impairment.

It's estimated that diabetes now costs the United States $132 billion annually in medical bills and lost productivity.

How does diabetes develop? And what does it mean for those living with it? Below is an introduction to the condition that is becoming ever more a part of the American health landscape.

TYPES OF DIABETES

• Type 1 diabetes, once known as juvenile-onset diabetes, is an autoimmune condition in which the pancreas does not produce any insulin.

The body needs insulin to use glucose in the cells and to keep the blood sugar within normal levels. After you eat, your blood sugar naturally rises. A healthy pancreas releases insulin into the bloodstream. The insulin then tells cells throughout the body to take up glucose, a simple form of sugar, removing it from the blood. The glucose then is either burned as fuel or converted to fat. This keeps the blood sugar within a healthy range. Type 1 diabetes accounts for only about 5 percent to 10 percent of diabetes cases.

• Type 2 diabetes, which accounts for the other 90 percent to 95 percent of diabetes, is the form of the disease that has been dramatically increasing.

Generally the body loses its responsiveness to insulin. In reaction to that, the pancreas often produces ever more insulin in an effort to prompt the cells to take more sugar from the blood. If the condition continues long enough, it can cause the pancreas to wear out, making insulin injections necessary.

• Insulin resistance, also known as pre-diabetes, is characterized by a decreased responsiveness to the signals of the insulin molecules and, sometimes, by an elevated blood-sugar level. If not addressed, it often leads to Type 2 diabetes.

• Gestational diabetes is a usually temporary condition that affects some pregnant women. Although it usually resolves after giving birth, about half of women with the pregnant condition develop Type 2 diabetes later.

RISK FACTORS FOR TYPE 2 DIABETES

Diabetes is thought to develop when an inherited vulnerability collides with certain aspects of a lifestyle.

Factors that increase your odds of developing diabetes include:

• Excess weight, meaning a body mass index more than 30 or a waist circumference greater than 40 inches in men or 34 inches in women.

• Engaging in little or no exercise.

• Having a parent or sibling with the disease.

• Being of African-American, Hispanic, Asian-American, Pacific Islander or Native American heritage.

• Excessive levels of stress hormones such as adrenaline, which can hike blood sugar and thereby figure into the development of Type 2 diabetes. Excessive stress can result from, for example, surgery, infection, vehicle accidents.

EARLY SIGNS

As diabetes in effect starves the body's cells of the glucose they need to function, a variety of symptoms begin to manifest themselves. They include:

• Fatigue or even, in extreme cases, fainting or coma.

• Frequent and intense hunger and thirst.

• Excessive urination.

• Effortless weight loss.

• Blurred vision.

• Slow-healing sores and persistent infections.

BLOOD-SUGAR LEVELS

A diagnosis of diabetes is based on two abnormal measurements of blood sugar, or glucose. Tests can be taken on an empty or full stomach, although the definition of a normal reading varies considerably.

• Seventy to 110 milligrams of glucose per deciliter is considered normal in someone who has not eaten for eight or more hours. After a meal, the blood sugar should rise no higher than 140. Blood sugar generally peaks within two hours of eating and then declines.

• One hundred eleven to 125 milligrams per deciliter after an eight-hour fast is considered pre-diabetic.

• One hundred twenty-six or more milligrams per deciliter after an eight-hour fast is considered diabetic.

LONG-TERM DAMAGE

Diabetes wrecks havoc on systems throughout the body. It interferes with circulation in several ways. The excess sugar makes the blood thicker, like maple syrup, meaning it doesn't move well through arteries and veins. The blood has particular trouble moving through the tiny capillaries that feed many of the body's organs and tissues. The result: Starvation and asphyxiation of cells all over the body. Then they die.

It's thought that excess blood sugar coats the red blood cells, making them stiffer. That in turn causes them to damage the blood vessel walls as they bump along through those little tubes. The sharp-sided glucose molecules themselves also scratch the vessel walls. That, in turn, makes the blood vessels more susceptible to accumulating fatty deposits, which block blood flow. Narrowed arteries are a prime factor leading to heart attacks.

Diabetes also interferes with the nerve system. Again, the excess sugar is thought to coat the outside of the nerve cells, or neurons. It acts as insulation and interferes with the transmission of messages from one neuron to the next. Impaired circulation and nerve function cause most of the damage of diabetes.

The fallout includes:

• Higher incidence of heart attack and stroke. About 85 percent of diabetics die of heart attack or stroke. Pre-diabetes has been shown to increase by 50 percent the incidence of heart attack and stroke. That continues as diabetes develops. James Casey, chief of pediatric endocrinology at the University of Kansas Hospital, said he has seen people in their 20s and 30s suffering heart attacks and strokes caused by Type 2 diabetes.

• Nerve damage, also known as neuropathy. This can develop almost anywhere in the body but occurs most frequently in the feet and hands. It's characterized by tingling or numbness. The lack of feeling can result in damage that, unnoticed and untreated, can fester and ultimately require amputation. About 50 percent of diabetics have some nerve damage, although not all are aware of it. Diabetes is the leading non-traumatic cause of amputations.

• Kidney failure. Of the 16 million Americans with diabetes, about 100,000 suffer kidney failure. That means they need dialysis or a transplanted organ. Diabetes is the No. 1 cause of kidney failure.

• Blindness. Small hemorrhages on the retina, which can eventually lead to blindness, afflict 50 percent of people who've had diabetes for seven years and 90 percent of people who've been diabetic for 15 years.

THE TREATMENT

Weight loss, exercise, diet modification

• Obesity is a major factor in the diabetes epidemic, and weight loss has proven effective at postponing or controlling diabetes. Studies have found that among people with pre-diabetes, a regimen of 150 minutes weekly of exercise such as brisk walking and a weight loss of 5 percent to 7 percent cut their odds of developing Type 2 diabetes by 58 percent. The results were more impressive than those achieved by a diabetes drug.

• Medication. While injected insulin has a long history as a treatment for both types of diabetes, a number of other pharmaceutical treatments have come along recently that address the Type 2 variant. There are now five classes of drugs that use different mechanisms to counter diabetes. One pushes the pancreas to produce more insulin, another increases the body's sensitivity to insulin, another cuts the liver's production of glucose, another reduces sugars produced after eating, and another slows the colon's absorption of carbohydrates.

PREVENTION

• Maintain a healthy weight.

• Exercise regularly. Physical activity maintains the body's sensitivity to insulin.

DON'T BELIEVE IT...

If you've heard that eating candy or drinking soda will cause you to get diabetes, don't believe it. Simple sugars found in the sweets we eat lack nutrients and are heavy on the calories, but, provided you maintain a healthy weight, eating them does not contribute to the development of diabetes.

RESOURCES

• American Diabetes Association, (800) 342-2383, www.diabetes.org.

• National Diabetes Information Clearinghouse, (800) 860-8747, or (301) 654-3327, www.diabetes.niddk.nih.gov.

• Centers for Disease Control and Prevention, (877) 232-3422, www.cdc.gov/diabetes.

Thursday, August 08, 2002

JDRF Washington Report, Vol. 5, No. 19

SENATE APPROPRIATIONS SUBCOMMITTEE ON DEFENSE INCLUDES $3 MILLION FOR DIABETES RESEARCH IN FISCAL YEAR 2003 DEPARTMENT OF DEFENSE APPROPRIATIONS ACT

We are pleased to report that the Senate Appropriations Subcommittee on
Defense recently approved its it Fiscal Year 2003 Department of Defense bill
and included $3 million for the Technologies for Metabolic Monitoring (TMM)
Initiative. This is the level of funding JDRF is seeking for the project in
the coming year. As we reported to you earlier, the House of
Representatives included $2.5 million for this project, and we will be
working with our supporters in both the House and Senate to preserve the $3
million included in the Senate bill during Conference on the measure.

This initiative could benefit both the military and individuals with
juvenile diabetes. The goal of the program is to develop a means to
understand, predict, and closely monitor metabolic products, with an
emphasis on the monitoring of blood glucose levels. Technologies that would
allow individuals with juvenile diabetes to monitor their blood sugar levels
accurately, constantly, and non-invasively could ultimately improve the
control of fluctuations in their blood glucose levels and potentially reduce
the severity of debilitating complications.

Please join us in thanking Senator Daniel Inouye (D-HI), Chairman of the
Defense Appropriations Subcommittee; Senator Ted Stevens (R-AK), Ranking Member of the Appropriations Committee and Defense Subcommittee; Senator Susan Collins (R-ME); and Senator Mark Dayton (D-MN) for their leadership in securing funding for this program. Thank you letters should be sent to the following addresses and faxed to their offices as well:

Senator Daniel Inouye Senator Ted Stevens
U.S. Senate U.S. Senate
Washington, D.C. 20510 Washington, D.C. 20510
(202)224-6747 (fax) (202)224-2354 (fax)

Senator Susan Collins Senator Mark Dayton
U.S. Senate U.S. Senate
Washington, D.C. 20510 Washington, D.C. 20510
(202)224-2693 (fax) (202)228-2186 (fax)

SENATE APPROPRIATIONS COMMITTEE COMPLETES THE FIVE YEAR EFFORT TO DOUBLE THE BUDGET OF THE NATIONAL INSTITUTES OF HEALTH

The Senate Appropriations Committee recently approved its Fiscal Year 2003
Labor, Health and Human Services and Education Appropriations bill, which
includes funding for the National Institutes of Health (NIH). The bill
provides a $3.7 billion increase for the NIH, which completes the five-year
effort to double the NIH budget. The NIDDK received an increase of 11.7%
over last year's level, for a total of $1.64 billion. In the Report
accompanying the bill, JDRF worked with many Members of Congress to include language encouraging a number of the NIH Institutes to continue and expand upon their juvenile diabetes research efforts.

The House is expected to consider its Labor, Health and Human Services and
Education bill in September when Congress returns from its August recess.
We will continue to keep you updated as this bill moves through the
legislative process.

Volume 346:1829-1830		June 6, 2002		Number 23

Diabetes Prevention

To the Editor: In the study by the Diabetes Prevention ProgramResearch Group (Feb. 7 issue),¹ the protocol did not includea washout period after metformin therapy. Such an approach couldhave been used to determine whether the subjects' plasma glucoseconcentrations were maintained within the nondiabetic rangein the absence of treatment, as recommended by the 1997 criteriaof the American Diabetes Association.² Such a finding wouldbe necessary in order to conclude that metformin prevents type2 diabetes.

Yousef Y. Bo-abbas, M.D.
Amiri Hospital
Rumaithya 25559, Kuwait
yboabbas@hotmail.com

References

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403. [Abstract/Full Text]
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183-1197. [ISI][Medline]

To the Editor: The findings of the Diabetes Prevention ProgramResearch Group are important with respect to the effect of lifestylechanges on the development of type 2 diabetes mellitus. However,the role of metformin in preventing type 2 diabetes mellituswill remain ambiguous unless the side effects of metformin canbe dissociated from its capacity to reduce insulin resistance.

In a previous study, Carlsen et al.¹ found that metformin inducedsubstantial weight loss in patients with a body-mass index (theweight in kilograms divided by the square of the height in meters)of more than 27, but they did not dissociate the observed decreasein insulin resistance from the secondary weight loss mediatedby metformin. Since the current study also involved obese patientsand demonstrated substantial weight loss in patients takingmetformin, I believe the authors should have evaluated the effectof weight reduction secondary to metformin as a possible confounderin the drug's capacity to reduce insulin resistance and thusprevent the onset of type 2 diabetes mellitus.

Valerie Julie Brousseau, B.Sc.H.
McGill Medical School
Montreal, QC H3G 1Y6, Canada
vajulie@sympatico.ca

References

Carlsen SM, Grill V, Folling I. Evidence for dissociation of insulin- and weight-reducing effects of metformin in non-diabetic male patients with coronary heart disease. Diabetes Res Clin Pract 1998;39:47-54. [ISI][Medline]

To the Editor: There is one puzzling aspect of the article bythe Diabetes Prevention Program Research Group on reductionin the incidence of type 2 diabetes with lifestyle intervention.The goals for intensive lifestyle intervention included "physicalactivity of moderate intensity, such as brisk walking, for atleast 150 minutes per week." Brisk walking at about 20 minutesper mile results in an energy expenditure of 3.5 to 4.0 metabolicequivalents (MET) per hour. Two and a half hours of walkingat that intensity would therefore result in the expenditureof about 10 MET-hours per week. At base line, the level of leisurephysical activity of the study cohort ranged from 15.5 to 17.0MET-hours per week. If brisk walking were the activity, it wouldmean that, on average, at base line, the participants were walkingbriskly for 240 minutes per week, exceeding the goal by a substantialamount. Assuming that my calculations are correct, is it possible,because the Modifiable Activity Questionnaire was used, thatbase-line physical activity included some occupational and homeactivities as well as leisure activities?

Donald B. Louria, M.D.
New Jersey Medical School
Newark, NJ 07107-3000
louriado@umdnj.edu

To the Editor: The results of the Diabetes Prevention ProgramStudy raise a number of relevant public health questions. Howmany people in the United States might be eligible for interventionsfor primary prevention? It has been suggested that at least10 million people could potentially benefit from interventionslike those used in the program.¹ Should adults with impairedfasting glucose but not impaired glucose tolerance be targeted?Can children and adolescents, among whom the burden of type2 diabetes appears to be increasing,² benefit? How will we identifypersons who are eligible? Will we use clinical measures, suchas the body-mass index, or will blood screening be necessary?

How can the results of the Diabetes Prevention Program be translatedinto actual practice? For example, to be consistent with theintervention strategies used in the program, and given a minimumof 10 million eligible persons, thousands of case managers willbe needed. Is it feasible to implement such a widespread program?Moreover, where will we get the resources for primary preventionof type 2 diabetes, when there are not enough resources to provideadequate secondary and tertiary care for people who alreadyhave diabetes?

Stephanie M. Benjamin, Ph.D.
Rodolfo Valdez, Ph.D.
Frank Vinicor, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30341
rvaldez@cdc.gov

References

Diet and exercise dramatically delay type 2 diabetes: diabetes medication metformin also effective. Press release of the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., August 8, 2001.
Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 2000;136:664-672. [ISI][Medline]

The authors reply:

To the Editor: At the present time, we can address some, butnot all, of the questions that have been raised about the DiabetesPrevention Program. Dr. Bo-abbas asks whether plasma glucosein the metformin-treated participants would remain at nondiabeticlevels after the treatment was discontinued - that is,during a washout period. The fasting plasma glucose level andglucose tolerance were periodically evaluated throughout thestudy and caused only a brief interruption of the interventions.Specifically, medications were withheld on the morning of thefasting glucose or oral glucose-tolerance test, so that themost recent dose had been administered approximately 12 hoursbefore testing. Similarly, volunteers were advised not to exerciseon the morning of the testing. Nevertheless, we have performeda drug-washout study among participants who did not have diabetesat the end of the study, and the results will be reported separately.

Ms. Brousseau points out that metformin's preventive effectcould be mediated by both weight loss and a reduction in insulinresistance. We are conducting further data analyses to determinethe extent to which weight loss accounts for the observed actionof metformin and the extent to which metformin affects insulinresistance, as estimated on the basis of plasma insulin andglucose levels.

Dr. Louria asks whether the estimate of physical activity atbase line was limited to leisure activity. The data on physicalactivity reported include all leisure activities, includingwalking, but not occupational activities. As shown in Figure1 of the article, participants in the lifestyle-interventiongroup increased their physical activity beyond their base-linelevels, primarily through walking.

Benjamin et al. ask about implementing the findings. Whetherthese interventions should be applied to persons who do notmeet the eligibility criteria for the Diabetes Prevention Program,such as younger persons or those with impaired fasting glucoselevels but not those with impaired glucose tolerance, cannotbe determined on the basis of our study. The lifestyle recommendations,however, can be made to the general public and need not be restrictedto those who are at high risk for diabetes. Although there arecertainly many other methods of identifying persons at highrisk for type 2 diabetes, they cannot be evaluated within theDiabetes Prevention Program, which, as a clinical trial, hada specific set of eligibility criteria.

William C. Knowler, M.D., Dr.Ph.
George Washington University
Rockville, MD 20852
knowler@nih.gov
for the Diabetes Prevention Program Research Group

Fat babies added to epidemic

The number of obese infants has increased by 73.5 percent over 22 years, a study says. Chicago Tribune

Waist size seen as diabetes indicator Body mass index not as definitive, study suggests

The growing problem of diabetes By KAREN UHLENHUTH The Kansas City Star

Thursday, August 08, 2002

The number of obese infants has increased by 73.5 percent over 22 years, a study says.
Chicago Tribune

Waist size seen as diabetes indicator
Body mass index not as definitive, study suggests

The growing problem of diabetes
By KAREN UHLENHUTH
The Kansas City Star