Diabetes Archive

The condition increases type 2 diabetes risk.

People with psoriasis suffer from chronic patches of irritated, flaky skin. A new study finds that psoriasis may also put people at risk for another chronic disease: type 2 diabetes. A recent study in Archives of Dermatology found a strong correlation between the two. "Both diseases are driven by inflammation," says Dr. Jeffrey Sobell, a dermatologist at Harvard-affiliated New England Baptist Hospital who's considered an international authority on psoriasis. "The same cells that trigger the inflammation of psoriasis are also associated with insulin resistance and type 2 diabetes."

But psoriasis isn't just linked to diabetes. Because it's a systemwide inflammatory disease, Dr. Sobell says there's a correlation to other inflammation-sensitive conditions such as arthritis and cardiovascular disease.

A cup of beans or lentils each day, when combined with a low-glycemic diet, may help lower blood sugar levels and coronary artery disease risk in patients with type 2 diabetes. Legumes help dampen blood sugar responses and lower blood pressure.

If you like numbers and statistics, especially those about health, two reports released this week should keep you occupied for days: the massive Global Burden of Disease study was published in The Lancet, and the American Heart Association released its annual “Heart and stroke statistics” report. The Global Burden of Disease project found that average life expectancy continues to rise in most countries. It also found that infection and other communicable causes of disease no longer dominate deaths and disability. Today, so-called non-communicable causes like traffic accidents, violence and war, heart disease, cancer, and other chronic conditions account for two-thirds of world deaths and the majority of years lost to disability and death. According to the American Heart Association’s annual report, the percentage of deaths due to heart attack, stroke, and other cardiovascular diseases has fallen by nearly one-third since 1999, but don’t expect that to continue. Increases in high blood pressure, high cholesterol, diabetes, overweight, and inactivity threaten to reverse these gains.

Q. I've heard bariatric surgery can reduce type 2 diabetes. How about type 1?

A. People who are obese are more likely to develop type 2 diabetes. People who are obese and already have type 2 diabetes find it easier to control their diabetes if they lose weight. The link between obesity and type 2 diabetes is strong, and bariatric surgery can lead to substantial weight loss. So you wouldn't be surprised if the surgery reduced the risk for type 2 diabetes. Nevertheless, in a recent study from Sweden, the magnitude of the benefit was remarkable. The researchers identified over 3,000 obese people without diabetes and followed them for 15 years. The risk of developing type 2 diabetes in those who received bariatric surgery was 83% lower than in those who didn't receive the surgery. There are different types of bariatric surgery, but they are all designed to reduce the absorption of calories in the intestine. That surely accounts for part of the weight loss seen following the surgery. However, we're now learning that the surgery also changes the levels of various hormones that affect appetite and metabolism, and that this also contributes to the weight loss—and possibly the reduced risk of developing type 2 diabetes. Most people with type 1 diabetes, which usually starts in childhood, are not obese. There is little reason to perform bariatric surgery in such patients. However, if a patient with type 1 diabetes is obese, and diet and exercise can't get the weight off, bariatric surgery could make sense. Type 1 diabetes greatly increases the risk of heart disease, and so does obesity. Bariatric surgery might not make type 1 diabetes easier to control, but it could help reduce the risk of heart disease.

A study conducted at Massachusetts General Hospital has confirmed that a vaccine designed to raise levels of tumor necrosis factor (TNF) temporarily restores insulin secretion in people with type 1 diabetes. The human study followed a 2001 mouse study by the same team of researchers, led by Dr. Denise Faustman, director of the immunobiology laboratory at MGH and an associate professor at Harvard Medical School. That study determined that increasing production of TNF, an immune system modulator, enabled insulin-producing pancreatic islet cells to regenerate.

Because high doses of TNF are toxic, the researchers substituted the bacillus Calmette-Guerin (BCG) vaccine, which elevates TNF levels safely. In type 1 diabetes, the body attacks its own insulin-producing cells and destroys them. By raising levels of TNF, the BCG vaccine kills the destructive autoimmune cells, leaving the islet cells to grow and flourish.

Q. I am 58 years old and in pretty good health, but at 120 milligrams per deciliter (mg/dL), my blood glucose test was a little high on my last routine physical. My physician told me not to worry about it, but I am wondering if I should get screened for diabetes with some other test.

A. Your concern that your glucose level may be evidence that you have diabetes or are headed in that direction is legitimate. Type 2 diabetes is very common in people of your age and older, and it tends to be preceded by a long period of "prediabetes," in which glucose levels are mildly elevated. Research has shown that the risk of progression to diabetes can be prevented through lifestyle modifications, which would likely reduce your risk of complications of diabetes, including cardiovascular disease.

Bariatric surgery may significantly reduce a person's odds of developing type 2 diabetes. This stomach procedure that restricts food intake may reduce the long-term incidence of type 2 diabetes in obese individuals.

Many medical studies confirm what we know or suspect. Every once in a while, though, one surprises us, turning “conventional wisdom” on its head. That just happened with the sudden shutdown of a long-running diabetes trial called Look AHEAD (Action for Health in Diabetes). Begun in 2001 and scheduled to last another two years, Look AHEAD was designed to see if an intensive diet and weight loss program could reduce the number of heart attacks, strokes, and other cardiovascular problems in people with type 2 diabetes. An early peek at the data showed that the program had little apparent effect, and the investigators concluded it would be futile to continue. This does not mean that we should ignore diet and exercise in treating of type 2 diabetes. Instead, the details of the study results, which haven’t yet been published, are likely to reveal other explanations.

As part of its 200th anniversary celebration, today’s New England Journal of Medicine carries an article called “The Past 200 Years in Diabetes.” It describes some of the advances made in understanding and treating this disease, like the discovery of insulin and the development of personal blood-sugar monitors. But it doesn’t tell much about how living with diabetes has changed. Just 50 years ago, checking blood sugar and administering insulin were big ordeals, and people with diabetes weren’t expected to live more than a few years after their diagnoses. today, it’s a cinch to check blood sugar with a quick finger prick, and pen-like devices almost painlessly deliver insulin, and people with diabetes who take care of themselves have almost normal life expectancies. Advances in protecting and treating the heart, eyes, kidneys, and limbs have helped reduce complications from diabetes.

Q. I am 72 years old, and have had diabetes and high blood pressure for about 15 years. I thought these problems were pretty well controlled, but I recently learned that my kidney function is declining. My creatinine level is now 2.2 milligrams per deciliter (mg/dL). How serious is this?

A. Kidney damage is one of the most common and serious consequences of both diabetes and hypertension. Ask your doctor what your glomerular filtration rate (GFR) is. This test measures how much blood your kidneys filter every minute. If your GFR is 60 or higher, your kidney function is still normal; a lower GFR level means your kidney function bears close watching.