Diabetes Cure

The first definitive, large-scale clinical trial to investigate if a vitamin D supplement helps prevent or delay type 2 diabetes in adults who have prediabetes is underway.

The study, funded by the National Institutes of Health, is taking place at about 20 study sites across the United States, involving adults who are at high risk for developing type 2 diabetes.

The multiyear Vitamin D and Type 2 Diabetes (D2d) study will include about 2,500 people. The goal is to learn if vitamin D -- specifically D3 (cholecalciferol) -- will prevent or delay type 2 diabetes in adults aged 30 or older with prediabetes. People with prediabetes have blood glucose levels that are higher than normal but not high enough to be called diabetes.

“This study aims to definitively answer the question: Can vitamin D reduce the risk of developing type 2 diabetes?” said Myrlene Staten, M.D., D2d project officer at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of NIH. “Vitamin D use has risen sharply in the U.S. in the last 15 years, since it has been suggested as a remedy for a variety of conditions, including prevention of type 2 diabetes. But we need rigorous testing to determine if vitamin D will help prevent diabetes. That’s what D2d will do.”

“Past observational studies have suggested that higher levels of vitamin D may be beneficial in preventing type 2 diabetes,” said Anastassios G. Pittas, M.D., the study’s principal investigator at Tufts Medical Center, Boston, “but until this large, randomized and controlled clinical trial is complete, we won’t know if taking vitamin D supplements lowers the risk of diabetes.”

First of its kind

D2d is the first study to directly examine if a daily dose of 4,000 International Units (IUs) of vitamin D -- greater than a typical adult intake of 600-800 IUs a day, but within limits deemed appropriate for clinical research by the Institute of Medicine -- helps keep people with prediabetes from getting type 2 diabetes. Based on observations from earlier studies, researchers speculate that vitamin D could reduce the diabetes risk by 25%. The study will also examine if sex, age or race affect the potential of vitamin D to reduce diabetes risk.

“An estimated 79 million Americans have prediabetes, and nearly 26 million more have diabetes,” said NIDDK Director Griffin P. Rodgers, M.D. “With D2d, we seek evidence for an affordable and accessible way to help prevent or delay type 2 diabetes.”

Researchers are recruiting volunteers to take part in D2d. Half of the participants will receive vitamin D. The other half will receive a placebo -- a pill that has no drug effect. Participants will have check-ups for the study twice a year, and will receive regular health care through their own health care providers.

In the dark

The study will be double-blinded, so neither participants nor the study’s clinical staff will know who is receiving vitamin D and who is receiving placebo. The study will continue until enough people have developed type 2 diabetes to be able to make a scientifically valid comparison between diabetes development in the two groups, likely about four years.

There have been other NIH-funded studies of methods to delay or prevent type 2 diabetes, including the Diabetes Prevention Program, which showed that -- separately -- lifestyle changes to lose a modest amount of weight and the drug metformin are both effective in slowing development of type 2 diabetes in people with prediabetes. However, additional safe and effective preventative strategies are needed to stem the increasing numbers of people developing type 2 diabetes.

Type 2 diabetes, along with heart disease and cancer, seems to be a curse of civilization, increasing rapidly in many industrialized nations, with diagnosed cases increasing by 100 percent or more in 18 states between 1995 and 2010, according to a recent study by the Centers for Disease Control and Prevention (CDC). 

Both types of diabetes have a genetic component. What triggers the development of type 1 is not fully understood while type 2 diabetes is often associated at least partly with obesity and a sedentary lifestyle.

It's type 2 diabetes -- too much glucose in the bloodstream -- that has been increasing at such an alarming rate in recent years, marching along in tandem with the incidence of overweight and obesity and the increasingly sedentary lifestyle found in developed countries.

So, if that's the cause of diabetes, it should be easy to find a cure, right? Unfortunately, no. Someone once compared type 2 diabetes to a car wreck -- once it happens, the resulting injuries can treated but the only complete  cure is to avoid the accident in the first place.

Reducing weight through exercise and a healthy diet can often reduce the severity of type 2 diabetes and even enable some people to return to more normal glucose levels. In more severe cases, it is sometimes possible to nudge type 2 diabetes into remission through weight-loss surgery, a drastic step but one that is sometimes the most effective option for the morbidly obese.

However, it's important to note that a remission is not a cure. If the patient regains the weight, as many do, the diabetes is likely to return.

Potential type 1 cures

Researchers are developing and testing many potential cures for both types of diabetes, including stem cell therapy, which could theoretically be used to build new pancreatic cells that would generate and control insulin for those with type 1 diabetes.

But while stem cells may hold the key to treating many types of illness, there is still no proven method for implanting them in humans, so any cure involving stem cells is far from imminent.

Islet cell transplantation can improve the quality of life for patients with type 1 diabetes, by enabling the pancreas to produce and regulate insulin more effectively but while it may improve quality of life, it is not yet regarded as a cure.

Type 2

But while stem cells and islet cell transplants are seen as potential cures for type 1 diabetes, there is still no cure on the horizon for type 2 diabetes, which is why prevention is so important and why public health officials are so alarmed at the virulent spread of type 2 diabetes.

The Internet is full of ads and bogus news stories about "natural" and "secret" cures for diabetes -- the types of claims we hear about every chronic disease, often using phrases like "the diabetes cure they don't want you to know about."

Such claims can cause consumers to pursue phony treatments that may leave them worse off than when they started -- while also draining their bank accounts.

"I keep receiving bill for a book. I already paid for a book called 30 Day Diabetes Cure with a check that was cashed by Bottom Line Books," said Marjorie of Greenville, N.C., in a recent posting to ConsumerAffairs.

Even cookware manufacturers have been known to claim that using their pots and pans will somehow prevent or cure diabetes. Rena Ware International, Inc., agreed to pay more than $600,000 a few years ago to settle claims by the California attorney general that it "made fraudulent and unethical claims" that its high-priced cookware could cure diseases such as diabetes and heart disease.

A good rule of thumb is to immediately dismiss any claims -- about anything -- that supposedly reveal a "secret" known only to a handful of insiders. While the CIA may still have a few secrets up its sleeve, the truth is that very few things are secret in today's wide-open world of information, misinformation and disinformation.

Rest assured, if anyone develops a cure for diabetes, scientists, public health officials, the government, the press and the health insurance companies that now pay billions to treat diabetes will be quick to publicize it.

"Natural" cures

Consumers should also be cautious of claims made by nutrition supplement peddlers and those who say there are "natural" cures for diabetes and other diseases.

There is a natural prevention for type 2 diabetes -- maintaining a good diet, keeping weight to a healthy level and exercising regularly. While this may not be 100 percent effective, most experts agree it would prevent millions of new cases of type 2 diabetes.

Will adding a few magnesium and chromium supplements to your diet prevent or cure diabetes? Not likely.

While vitamin and mineral supplements may contribute to overall health, it's important to talk with your doctor before taking any supplement. Many can conflict with prescription medications or aggravate existing health conditions.

Misinformation

The Internet has arguably done a few good things for humanity but enabling  the spread of false and misleading health information is not one of them. There are many sources of sound information, including the American Diabetes Association website and sites operated by major medical centers, like the Mayo Clinic and the Johns Hopkins Diabetes Center.

However, it's important to remember that all health information pubished in books, on websites and elsewhere is general in nature. Only your doctor can apply general information to your particular situation.

It's worth noting that taking the steps recommended to prevent or treat diabetes -- a heathy diet, regular exercise, limited or no use of alcohol -- can also contribute to a reduced risk of heart disease, stroke, cancer and many other health problems.

Sitting in a chair reading fraudulent claims on the Internet isn't nearly as good as taking a brisk walk around the neighborhood.

Cases of diabetes and pre-diabetes in the United States have nearly doubled since 1988, with obesity apparently to blame, according to new research from the Johns Hopkins Bloomberg School of Public Health.

The burden of the disease has not hit all groups equally, with alarming increases in diabetes in blacks, Hispanics and the elderly.

According to new research reported in the April 15, 2014 issue of the Annals of Internal Medicine, diabetes increased from 6% to 10% in the past two decades and pre-diabetes also doubled in prevalence over the same period. Depending on the definition used, current estimates of the prevalence of pre-diabetes range from 12% to 30% in the population.

“There is a growing need to recognize this serious issue, especially since most cases of diabetes can be prevented through weight loss and other lifestyle changes,” said lead author, Elizabeth Selvin, PhD, MPH, an Associate Professor at the Johns Hopkins Bloomberg School of Public Health.

More cases being diagnosed

“The implications of the increase in pre-diabetes and diabetes are enormous but the good news is we are doing better with screening and diagnosis,” says Selvin.

While diabetes has increased dramatically in the population, the investigators found that the proportion of undiagnosed cases has decreased. Currently, only 11% of diabetes cases in the U.S. population are undiagnosed, suggesting major improvements in screening and diagnosis of diabetes during the last two decades.

However, major challenges still exist despite improvements in screening and treatment for diabetes. The investigators found a greater prevalence of pre-diabetes and diabetes, particularly undiagnosed diabetes, in ethnic minorities compared with whites. This disparity has increased over the past 20 years.

“The substantially greater prevalence of pre-diabetes and diabetes, and poor rates of glycemic control (even among persons with medication-treated diabetes) in ethnic minority populations is particularly concerning,” Selvin said. “Especially since blacks and Mexican Americans are also at a greater risk for complications of diabetes.”

Total diabetes in blacks was nearly double the prevalence in whites (15% vs. 9%). Mexican Americans also had a greater prevalence of diabetes than whites (12% vs. 9%).

43,000 cases studied

In 2010, approximately 21 million American adults aged 20 or older had confirmed diabetes (either diagnosed or undiagnosed). The investigators analyzed data from more than 43,000 participants collected over two decades in the National Health and Nutrition Examination Surveys (NHANES), hoping to update national trends in pre-diabetes, diabetes and its treatment based on data from the NHANES.

One novel aspect of this study was to “confirm” cases of undiagnosed diabetes in the population. The investigators used a lab test that measures glucose over the past three months to confirm all cases of undiagnosed diabetes in their study to give the most realistic estimate of the burden of the condition in the population.

The study was funded by the National Institutes of Health.

In the last decade there has been an explosion in the number of type 2 diabetes cases, coinciding with a massive rise in obesity.

The disease is a long-term condition caused by too much glucose, a type of sugar, in the blood.

Now, researchers at Newcastle University in the UK say they have found a simple way to reverse it; lose weight.

After a small trial, the scientists have concluded that reducing the amount of fat around the pancreas in type 2 diabetes patients returns organ functions to normal. They say this shows that the excess fat in the diabetic pancreas is specific to type 2 diabetes and important in preventing insulin from being made.

When that excess fat is removed, insulin secretion increases to normal levels. In other words, they were diabetes free.

Previous research

This isn't the first study to suggest weight loss might reverse type 2 diabetes. Last year, researchers at the Cleveland Clinic found that bariatric surgery – reducing the size of the stomach so the patient loses weight – appeared to be effective in reversing diabetes.

Meanwhile, like most chronic diseases, type 2 diabetes is treated with drugs, including the newly approved Jardiance.

Roy Taylor, a professor at Newcastle University, says losing weight simply helps patients with type 2 diabetes drain excess fat out of the pancreas, and that allows function to return to normal.

One gram of pancreas fat

“So if you ask how much weight you need to lose to make your diabetes go away, the answer is one gram. But that gram needs to be fat from the pancreas,” Taylor said. “At present the only way we have to achieve this is by calorie restriction by any means – whether by diet or an operation.”

In the trial, type 2 diabetes patients saw the fat levels in their pancreas decrease by as much as 1.2% over eight weeks. With an average pancreas for a person with Type 2 diabetes having a volume of 50 ml, this is the equivalent of around 0.6 grams of fat.

The patients who had never had diabetes experienced no change in the level of fat in their pancreas. That told the scientists that the increase in fat in the pancreas is specific to people who develop type 2 diabetes.

The fat in the pancreas may, in fact, be a trigger for the disease, and individuals vary in how much fat they can tolerate in the pancreas before type 2 diabetes develops.

What to do

Taylor says the research may transform the thinking about type 2 diabetes and its treatment.

Keep in mind, this is a report of research findings. It should not be used by patients to make unilateral decisions about their care or to start or stop prescribed medications.

If you have concerns about type 2 diabetes treatments, you should discuss them with your doctor, mentioning this study. 

Diabetes is becoming a more common disease in the U.S. but one that remains little understood by those most at risk.

An estimated 26 million U.S. children and adults have either diabetes 1 or 2 and another 79 million have what is known as “prediabetes,” meaning they are at risk of developing type 2 diabetes.

Type 1 diabetes is a condition in which the body does not produce insulin. It usually develops in children or young adults and is nowhere near as common as type 2, comprising only 10% of all U.S. diabetes cases. Type 1 is primarily genetic, meaning it's not related to lifestyle.

Type 2 diabetes usually develops from lifestyle factors, such as poor diet and excessive weight. It's similar to type 1 in that insulin levels are out of control. The result is excessive levels of blood sugar.

Managing type 2 diabetes

Some people may be able to control type 2 diabetes symptoms by losing weight, eating a healthy diet, exercising, and monitoring their blood glucose levels. But it's usually a progressive disease and the patient will probably have to take insulin to treat it.

Because of America's obesity epidemic, type 2 diabetes is growing at an alarming rate. A late 2012 study by the U.S. Centers for Disease Control and Prevention found 18 U.S. states saw diabetes cases increase more than 100% from 1995 to 2010.

The report, appearing in CDC's Morbidity and Mortality Weekly Report, found that states with the largest increases are Oklahoma (226 percent), Kentucky (158 percent), Georgia (145 percent), Alabama (140 percent), and Washington (135 percent).

"Regionally, we saw the largest increase in diagnosed diabetes prevalence in the South, followed by the West, Midwest, and Northeast," said Linda Geiss, a statistician with CDC's Division of Diabetes Translation and lead author of the report. "These data also reinforce findings from previous studies, which indicate that the prevalence of diagnosed diabetes is highest in the southern and Appalachian states."

Extremely serious

Undiagnosed, diabetes is extremely serious. Those with the disease can lose limbs and their eyesight and they can die from its complications.

How do you know if you have it? Being obese or overweight is a major risk factor. Having a lot of visceral fat, also known as central obesity or belly fat, is a risk multiplier, causing the body to release chemicals that can play havoc with the body's cardiovascular and metabolic systems.

The risk also increases as a person ages, though experts aren't sure why.

According to the National Institutes of Health (NIH), symptoms of diabetes include blurry vision, excessive thirst, fatigue, hunger, frequent urination and unexplained weight loss.

Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms.

Symptoms of type 1 diabetes develop over a shorter period of time. People may be very sick by the time they are diagnosed.

Diagnostic tests

A urine test may reveal elevated blood sugar levels but by itself does not diagnose diabetes. Measuring blood sugar levels after fasting is a much more reliable method.

According to NIH, diabetes is diagnosed if the fasting blood glucose level is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

Once diagnosed, a patient will need to measure their blood sugar daily using a glucose meter.

“Many patients will need to test 6-8 times per day, but some will need to test more, depending upon their activity level, how often they eat and what other types of activities their day may include,” said Carol Wysham, MD, section head for the Rockwood Center for Diabetes and Endocrinology. “It is not reasonable or practical to set a specific number for all people with diabetes who are on intensive insulin regimens, as no two people’s lives are the same. Even for the same individual, no two days are exactly alike. A person may need to test six times one day and 10 the next.”

Possible new treatment

While diabetes is normally treated with insulin, University of Michigan (U-M) researchers have found that amlexanox, an off-patent drug currently prescribed for the treatment of asthma and other uses, also reverses obesity, diabetes and fatty liver in mice.

“One of the reasons that diets are so ineffective in producing weight loss for some people is that their bodies adjust to the reduced calories by also reducing their metabolism, so that they are ‘defending’ their body weight,” said researcher Alan Saltiel. “Amlexanox seems to tweak the metabolic response to excessive calorie storage in mice.”

Saltiel is teaming up with clinical-trial specialists at U-M to test whether amlexanox will be useful for treating obesity and diabetes in humans.

There's been a turnaround of sorts in some of the complications suffered by people with diabetes.

According to a study by the Centers for Disease Control and Prevention (CDC), rates of five major diabetes-related complications among U.S. adult diabetics have declined substantially in the last 20 years.

The study, published in the current issue of the New England Journal of Medicine, found that rates of lower-limb amputation, end-stage kidney failure, heart attack, stroke, and deaths due to high blood sugar (hyperglycemia) all declined.

Cardiovascular complications and deaths from high blood sugar decreased by more than 60% each, while the rates of both strokes and lower extremity amputations -- including upper and lower legs, ankles, feet, and toes -- declined by about half. Rates for end stage kidney failure fell by about 30%.

A long way to go

“These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”

Because the number of adults reporting diabetes during this time frame more than tripled -- from 6.5 million to 20.7 million -- these major diabetes complications continue to put a heavy burden on the U.S. health care system.

Nearly 26 million Americans have diabetes and an additional 79 million have prediabetes and are at risk of developing the disease. Diabetes and its complications account for $176 billion in total medical costs each year.

CDC researchers used data from the National Health Interview Survey, National Hospital Discharge Survey, U.S. Renal Data System, and Vital Statistics, to examine trends in the occurrence of diabetes-related complications in the United States between 1990 and 2010.

Although all complications declined, the greatest declines in diabetes-related complications occurred for heart attack and stroke -- particularly among people aged 75 years and older.

The study authors attribute the declines in diabetes-related complications to increased availability of health care services, risk factor control, and increases in awareness of the potential complications of diabetes.

Smartphones may soon be able to add one more entry to their rolodex of skills: the ability to act as a tool to measure blood glucose levels for those suffering from Type 1 diabetes.

After 20 years of research, University of Virginia School of Medicine researchers are in the final testing phases of a system that can automatically measure and monitor blood sugar levels. Early testing produced promising results. Now, researchers say actual patient testing is going well, and the system is circling the landing towards completion.

The app—called “InControl”—can control everything people with diabetes need, eliminating the need for finger pricks and manual insulin injections. This ease of the system could prove to be a game-changer in the lives of 1.25 million people who suffer from the disease.

Effortlessly manages levels

The so-called “artificial pancreas” has been in the works since 2006, says lead researcher Boris Kovatchev, director of the Centre for Diabetes Technology in the US. 

Kovatchev’s own father suffered from diabetes, so he saw firsthand the need for an easier way to live with the disease. “We show that it is not only possible, but it can run on a smartphone,” says Kovatchev.

Every five minutes, the system will report blood glucose level results to the app on a nearby android smartphone. It will analyze the data, and if necessary, adjust insulin levels on a small, wearable insulin pump.

Wirelessly controls pump

The app works by controlling an insulin pump: a device which is already used by approximately 350,000 diabetes sufferers in the US. The pump works by delivering user-adjusted doses of insulin to the bloodstream through a very fine needle; it can be worn discreetly under an article of clothing or hooked to a belt.

The wireless monitor, which talks to the pump, is as tiny as a flash drive and can be worn anywhere on the body. Together, the two devices create a digital treatment ecosystem of sorts that can handle the burden of the disease.

"It runs on a five-minute cycle and takes information from these devices and calculates the next best option for the patient pretty much any point in time,” said Chad Rogers, the CEO of TypeZero Technologies, which has licensed and refined the technology.

Final phases of testing 

The ultimate goal is to make managing Type 1 diabetes automatic and effortless.

“If it is working, you do not know that it is there,” says Francis Doyle III, dean of Harvard’s Paulson School of Engineering and Applied Sciences, who is collaborating with Kovatchev on the system

UVA researchers have brought the system to nine locations across the U.S. and Europe to try it on 240 patients. Researchers hope to have the trials complete and the system perfected in four years.

A study of more than three million American children and adolescents finds a "significant" increase in both type 1 and type 2 diabetes occurred between 2001 and 2009.

Despite widespread concern about a diabetes "epidemic," there has been limited data to support the concern. 

"The increases in prevalence reported herein are important because such youth with diabetes will enter adulthood with several years of disease duration, difficulty in treatment, an increased risk of early complications, and increased frequency of diabetes during reproductive years, which may further increase diabetes in the next generation," the researchers write. "Further studies are required to determine the causes of these increases." 

The study appears in the May 7 issue of JAMA, a theme issue on child health. This issue is being released early to coincide with the Pediatric Academic Societies Annual Meeting.

The analysis included cases of physician-diagnosed type 1 diabetes in youth ages 0 through 19 years and type 2 diabetes in youth 10 through 19 years of age in 2001 and 2009. The study population came from five centers located in California, Colorado, Ohio, South Carolina, and Washington state, as well as data from selected American Indian reservations in Arizona and New Mexico.

In 2001, the prevalence of type 1 diabetes among a population of 3.3 million was 1.48 per 1,000, which increased to 1.93 per 1,000 among 3.4 million youth in 2009, which, after adjustment, indicated an increase of 21 percent over the 8-year period.

The greatest prevalence increase was observed in youth 15 through 19 years of age. Increases were observed in both sexes and in white, black, Hispanic, and Asian Pacific Islander youth.

"Historically, type l diabetes has been considered a disease that affects primarily white youth; however, our findings highlight the increasing burden of type l diabetes experienced by youth of minority racial/ethnic groups as well," the authors write.

Dana Dabelea, M.D., Ph.D., of the Colorado School of Public Health, Aurora, Colo., and Elizabeth J. Mayer-Davis, Ph.D., of the University of North Carolina, Chapel Hill, and colleagues with the SEARCH for Diabetes in Youth Study, conducted the study.

Type 1 diabetes is generally regarded as genetic, but new experiments on mice show that mouse mothers can protect their pups from developing type 1 diabetes by eating a gluten-free diet and reseachers at the University of Copenhagen say the findings may apply to humans.

"Preliminary tests show that a gluten-free diet in humans has a positive effect on children with newly diagnosed type 1 diabetes. We therefore hope that a gluten-free diet during pregnancy and lactation may be enough to protect high-risk children from developing diabetes later in life," said assistant professor Camilla Hartmann Friis Hansen from the Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences.

The findings have recently been published in the journal Diabetes.

Findings from experiments on mice are not necessarily applicable to humans, but the study's co-author, Prof. Axel Kornerup, says that may not be the case with diabetes.

"Early intervention makes a lot of sense because type 1 diabetes develops early in life. We also know from existing experiments that a gluten-free diet has a beneficial effect on type 1 diabetes," he said.

Experiments of this type have been going on since 1999, originally initiated by Prof. Karsten Buschard from the Bartholin Institute at Rigshospitalet in Copenhagen, another co-writer on the study.

"This new study beautifully substantiates our research into a gluten-free diet as an effective weapon against type 1 diabetes," Karsten Buschard explains.

Gluten-free diet affects bacteria

The experiment showed that the diet changed the intestinal bacteria in both the mother and the pups. The intestinal flora plays an important role for the development of the immune system as well as the development of type 1 diabetes, and the study suggests that the protective effect of a gluten-free diet can be ascribed to certain intestinal bacteria.

The advantage of the gluten-free diet is that the only side effect seems to be the inconvenience of having to avoid gluten, although more research is needed to be certain.

"We have not been able to start a large-scale clinical test to either prove or disprove our hypothesis about the gluten-free diet," Buschard said.

With diabetes cases growing rapidly in the last decade, more people are sensitive to possible symptoms.

But if you're approaching 50 it's very easy to confuse real symptoms of diabetes with normal signs of aging. For example, your vision and hearing may be degrading. Cuts and bruises take longer to heal.

It could be a sign of diabetes. Then again, it could just be a sign you're getting older. It's important to be able to tell the difference.

Risk increases with age

As you get older you have an greater risk of developing type 2 diabetes. If you are overweight – even just as little as 10 pounds overweight – your diabetes risk rises.

Genes play a role too, not just in developing diabetes but also high blood pressure, high triglyceride levels and low HDL cholesterol. If you are African American, Latino, American Indian or Asian you also may be at higher risk.

Complicating things further is the fact that type 2 diabetes symptoms tend to be more subtle. Often you have the disease and don't know it. In fact, an estimated 7 million people with the disease are unaware of it.

Type 2 diabetes affects the way your body metabolizes sugar – or glucose -- your body's main source of fuel. A healthy body turns glucose into energy but if you have type 2 diabetes the glucose continues to build, leading to high blood sugar, causing a variety of symptoms.

When to ask a doctor

Here are some signs that you may have diabetes and should consult a doctor:

• Communication problems: you have a hard time understanding people when they talk. Your eyesight seems to be failing, causing you to squint. Hearing loss may just be a matter of age but is twice as common in people with diabetes as in those who don’t have the disease, according to research.
• Feeling tired and grouchy: this could be because you're getting older and having a more difficult time doing the things you once did. But if you have type 2 diabetes your body isn’t effectively converting glucose in your blood to energy. As a result you usually feel exhausted and, when you’re tired, you tend to be irritable.
• Odd symptoms: have you recently developed dry, itchy skin? Or maybe you've noticed darkening and velvety patches of skin around your neck or other parts of the body. Does it take cuts and bruises a long time to heal? Have you felt tingling and numbness in your hands and feet? Many of these symptoms occur because the blood vessels and nerves are damaged by the excessive amounts of glucose.

Gotta go

Other diabetes symptoms include feeling hungry all the time or needing frequent bathroom breaks.

If you have diabetes you have an excess of glucose and your body tries to get rid of the glucose that’s building in your blood by causing you to urinate frequently. When you do you lose a lot of fluid, making you dehydrated and thirsty.

According to the National Institutes of Health (NIH) type 2 diabetes usually occurs slowly over time. In most cases people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.

If you are unsure your symptoms are diabetes or age related, by all means ask your doctor. Fortunately, type 2 diabetes is treatable, often without medication – just lifestyle changes.

A growing number of people in the U.S. have diabetes -- and a lot of them don't know it.

According to a report released by the Centers for Disease Control and Prevention (CDC), more than 29 million people in this country diabetes 3 million more than the CDC estimated in 2010. The scary thing is that 25% of those who have it don't know.

Another 86 million adults in the U.S. -- that's more than one -- have predicates, where their blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes. Without weight loss and moderate physical activity, 15-to-30% of them will develop type 2 diabetes within 5 years.

Alarming development

“These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country,” said Ann Al bright, Ph.D., R.D., director of CDC’s Division of Diabetes Translation. “Diabetes is costly in both human and economic terms. It’s urgent that we take swift action to effectively treat and prevent this serious disease.”

According to the National Diabetes Statistics Report, 2014 (based on health data from 2012):

• 29 million people in the United States (9.3%) have diabetes.
• 1.7 million people aged 20 years or older were newly diagnosed with diabetes in 2012.
• Non-Hispanic black, Hispanic, and American Indian/Alaska Native adults are about twice as likely to have diagnosed diabetes as non-Hispanic white adults.
• 208,000 people younger than 20 years have been diagnosed with diabetes (type 1 or type 2).
• 86 million adults aged 20 years and older have predicates.
• The percentage of U.S. adults with predicates is similar for non-Hispanic whites (35%), non-Hispanic blacks (39%) and Hispanics (38%).

Danger lurks

Diabetes is a serious disease that can be managed through physical activity, diet, and appropriate use of insulin and oral medications to lower blood sugar levels. Another important part of diabetes management is reducing other cardiovascular disease risk factors, such as high blood pressure, high cholesterol and tobacco use.

People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death.

In 2012, diabetes and its related complications accounted for $245 billion in total medical costs and lost work and wages. This figure was $174 billion in 2007.

Statins -- the drugs that lower cholesterol -- have no doubt saved many lives by preventing heart attacks. But they can also have a devastating side effect, raising the risk of diabetes in some users.

Now, Canadian researchers at McMaster University say they have found one of the pathways that link statins to diabetes, a key tool in developing the next generation of statins.

"Statins are among the most prescribed drugs in the world, and have been fantastic at reducing cardiovascular events," said McMasters researcher Jonathan Schertzer. "But the side effects of statins can be far worse than not being able to eat grapefruit. Recently, an increased risk of diabetes has been added to the warning label for statin use. This was perplexing to us because if you are improving your metabolic profile with statins you should actually be decreasing the incidence of diabetes with these drugs, yet, the opposite happened."

Immune response

Schertzer's group investigated further.

"We found that statins activated a very specific immune response, which stopped insulin from doing its job properly. So we connected the dots and found that combining statins with another drug on top of it, Glyburide, suppressed this side effect."

He says the finding has the potential to develop new targets for this immune pathway that do not interfere with the benefits of statins.

Schertzer emphasized that statins are important and widely prescribed drugs and understanding how they promote adverse effects may lead to necessary improvements in this drug class, which has the potential to affect a large segment of the population.

"With the new federal warning label on the risk of diabetes with statin usage, people are heavily debating its pros and cons. We think this is the wrong conversation to have. Statins are a great drug for many people. What we really should be talking about is how to make them better and we are beginning to understand the basic biology of statins so we can do just that."

The research is published in the medical journal Diabetes and was supported by funding from the Canadian Institutes of Health Research and the Canadian Diabetes Association.

Over 29 million people in the U.S. have diabetes, and over eight million who have it are undiagnosed, according to a 2014 statistical analysis. Although the disease affects so many, it has been hard for scientists and researchers to nail down a cure. This is due, in part, to the fact that the disease can take different forms, and there are still some things that researchers do not know about them.

However, a recent study conducted at the University of Pennsylvania has shed some light on type 2 diabetes. Researchers at the Perelman School of Medicine believe that they have finally found the cause of insulin resistance, which is characteristic of this particular type of the disease.

Excess fat

Many people attribute insulin resistance to fluctuating sugar levels in the body, but researchers say that it also has to do with the amount of fat in the body. In particular, too much fat inside of skeletal muscle is one main cause of insulin resistance.

With this in mind, scientists went about trying to find out how excess fat could be removed from skeletal muscle. If this fat could be removed, they reasoned, then it would also be possible to prevent insulin resistance from occurring. But in order to do that, there were some questions that had to be answered first.

“This research sought to answer a few large questions. . . How does fat get into skeletal muscle? And how is the elevation of certain amino acids in people with diabetes related to insulin resistance?” asked Dr. Zoltan Arany, senior author of the study. “We have appreciated for over ten years that diabetes is accompanied by elevations in the blood of branched-chain amino acids, which humans can only obtain in their diet. However, we didn’t understand how this could cause insulin resistance and diabetes. How is elevated blood sugar related to these amino acids?”

New way to treat diabetes

In order to answer these questions, Dr. Arany and his team began examining amino acids and what happened when they broke down. They found that when these compounds broke down, a byproduct called 3-HIB was created. After being secreted by muscle cells, 3-HIB activated certain cells which resulted in more fat being stored in skeletal muscle tissue.

Researchers observed this phenomenon in mice and saw that when it happened it led to insulin resistance. By blocking 3-HIB from synthesizing, researchers were able to keep excess fat from going to the skeletal muscle and insulin resistance was no longer a problem.

Dr. Arany is quick to note that 3-HIB byproducts are also plentiful in humans who have type-2 diabetes, so although there will need to be more research to prove that there is a link, he is confident that one may be discovered in the future.

“The discovery of this novel pathway – the way the body breaks down these amino acids that drives more fat into the muscles – opens new avenues for future research on insulin resistance, and introduces a conceptually entirely new way to target treatment for diabetes,” he said.

The full study has been published in Nature Medicine. 

Oftentimes, scientists and medical experts need to look at the most minute details in order to understand the human body and the diseases that affect it. And since technology in the field is advancing all the time, they are able to do it to a greater degree.

In that vein, new research on how the body produces insulin may allow future therapies to evolve that better treat diabetes. Dr. Markus Grompe, who is best known for his work with stem cells, has found that there are at least four subtypes of insulin-producing beta cells in humans. It is the first study of its kind that has identified multiple types of such cells, and the information could mean a lot.

“Further understanding of cell characteristics could be the key to uncovering new treatment options, as well as the reason why some people are diabetic and others are not,” explained Grompe.

Identifying new cell types

Diabetes currently affects over 29 million people in the U.S. alone, and it occurs when a person’s insulin-producing beta cells are disrupted or cease to function. Without these cells doing their job, a person loses their ability to regulate their blood sugar levels, which can result in extreme fatigue, weight loss, vision ailments, pain in the extremities, and nerve damage, to name a few.

Up until this point, the medical community had thought that only one type of beta cell existed, but Grompe and his colleagues were able to isolate beta cells and classify three additional types.

Additionally, they found that there are hundreds of genes that differently express cell types, which leads to varying production of insulin in the body. The differences between these genes and cells could explain the differences between the types of diabetes and why certain people are susceptible to them.

“Some of the cells are better at releasing insulin than others, whereas others may regenerate quicker. Therefore, it is possible that people with different percentages of the subtypes are more prone to diabetes,” Grompe explains.

The next step for the researchers will be to attempt to understand how different cell subtypes are created so that they can create an approach for medical treatment. The full study has been published in the journal Nature Communications. 

There's a lot of talk about the high cost of health care, but do you know which conditions contribute most to health care spending?

If you said diabetes, you're right -- a new study finds diabetes costs $101 billion annually in diagnosis and treatment and is growing 36 times faster than the cost of heart disease, the leading cause of death and the second most-expensive condition. 

"While it is well known that the US spends more than any other nation on health care, very little is known about what diseases drive that spending." said Dr. Joseph Dieleman, lead author of a paper published in JAMA and Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively."

In fact, the study found that just 20 conditions make up more than half of all spending on health care in the United States.

While diabetes and heart disease primarily affected consumers 65 and over, lower back and neck pain, the third-most-expensive condition, primarily strikes adults of working age.

These three top spending categories, along with hypertension and injuries from falls, comprise 18% of all personal health spending and totaled $437 billion in 2013.

This study distinguishes between spending on public health programs from personal health spending, including both individual out-of-pocket costs and spending by private and government insurance programs. It covers 155 conditions.

$2.4 trillion

In addition to the $2.1 trillion spent on the 155 conditions examined in the study, Dr. Dieleman estimates that approximately $300 billion in costs, such as those of over-the-counter medications and privately funded home health care, remain unaccounted for, indicating total personal health care costs in the US reached $2.4 trillion in 2013.

Other expensive conditions among the top 20 include musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome, and rheumatoid arthritis; well-care associated with dental visits; and pregnancy and postpartum care.

Other key findings include:

• Women ages 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 40% was expended on cardiovascular diseases, Alzheimer's disease, and falls.
• Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a spouse at home to provide care.
• Less than 10% of personal health care spending is on nursing care facilities, and less than 5% of spending is on emergency department care. The conditions leading to the most spending in nursing care facilities are Alzheimer's and stroke, while the condition leading to the most spending in emergency departments is falls.
• Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, totaled an estimated $77.9 billion in 2013, less than 3% of total health spending.

Top 10 diseases

The top 10 most costly health expenses in 2013 were:

1. Diabetes - $101.4 billion

2. Ischemic heart disease - $88.1 billion

3. Low back and neck pain - $87.6 billion

4. Hypertension - $83.9 billion

5. Injuries from falls - $76.3 billion

6. Depressive disorders - $71.1 billion

7. Oral-related problems - $66.4 billion

8. Vision and hearing problems - $59 billion

9. Skin-related problems, such as cellulitis and acne - $55.7 billion

10. Pregnancy and postpartum care - $55.6 billion