Patients also showed improvements in the functioning of the insulin-producing cells that are attacked and destroyed in patients with type 1 diabetes.

Four of the 23 patients who took part in the study remained insulin free for at least three years and one patient went without insulin injections for more than four years.

The patients were the first to receive the novel stem cell transplant therapy to treat their type 1 diabetes.

After receiving transplants of their own blood stem cells, about half of the patients in the study became insulin free for an average of two and a half years.

But the treatment, which included the use of highly toxic immune-system suppressing drugs, was not without troubling side effects.

Two patients developed pneumonia while hospitalized for immunosuppression therapy, and nine developed low sperm counts as a result of exposure to one toxic drug. The latest results from the study appear in the April 15 issue of the Journal of the American Medical Association.

Diabetes specialist David M. Nathan, MD, who was not involved with the study, tells WebMD that the stem cell treatment is promising, but he adds that the side effects remain troubling.

“This is a pretty bold intervention that can involve serious complications,” he says. “The hope is that this will lead to more benign treatments that can keep people off insulin.”
Stem Cells for Diabetes

All the patients included in the stem cell study had been diagnosed with type 1 diabetes within six weeks of treatment, and all were producing some insulin on their own, although this production was greatly diminished.

Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the insulin-producing cells within the pancreas.

The goal of the treatment was to kill the immune cells that were killing the insulin-producing cells and replace them with immature cells not programmed to disrupt insulin production.

The treatment, called autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT), involved several steps.

Soon after diagnosis, the patients were given drugs to stimulate production of blood stem cells. The blood stem cells were then removed from the body and frozen.

Patients were hospitalized and given the toxic drugs that killed their circulating immune cells, and then the harvested blood stem cells were put back into the patient.

The first patient to receive the treatment did not improve, probably because he had too few functioning insulin-producing cells left.

But 20 of the next 22 patients treated with the experimental therapy were able to do without insulin injections or greatly reduce their insulin use for a few months to several years.

Patients who remained insulin-independent showed significant improvement in their ability to produce insulin two years after treatment, compared to pre-treatment production levels.

The ability to show direct improvement in insulin-producing cell function is important because critics have questioned whether the treatment really works.

Soon after being diagnosed with type 1 diabetes, many patients enter what is known as a “honeymoon” period, thought to result from improved diet and lifestyle.

It has been suggested that the early improvements seen in the patients who got the stem cell treatment was because of this lifestyle-related remission and not the treatment.

“This treatment actually stopped the autoimmune process and the remaining [insulin-producing] cells that were not destroyed worked well enough to keep many of these patients off insulin,” Nathan says.

Stem Cells Promising for Type 1 Diabetes

Treating Alzheimer’s with the hormone insulin, or with drugs to boost its effect, may help patients, they claim.

The journal Proceedings of the National Academy of Sciences reports insulin could protect against damage to brain cells key to memory.

UK experts said the find could be the basis of new drug treatments.

The relationship between insulin and brain disease has been under scrutiny since doctors found evidence that the hormone was active there.

The latest study, joint research between Northwestern University in the US and the University of Rio de Janeiro in Brazil, looked at the effects of insulin on proteins called ADDLs, which build up in the brains of Alzheimer’s patients and cause damage.

They took neurons – brain cells – from the hippocampus, a part of the brain with a pivotal role in memory formation.

These were treated with insulin and a drug called rosiglitazone, given to type II diabetics to increase the effect of the hormone on cells.

After this, the cells were far less susceptible to damage when exposed to ADDLs, suggesting that insulin was capable of blocking their effects.

Treatment hope

Professor William Klein, from Northwestern, said that drugs to boost the brain’s sensitivity to insulin could provide “new avenues” for treating Alzheimer’s disease.

“Sensitivity to insulin can decline with aging, which presents a novel risk factor for Alzheimer’s disease – our results demonstrate that bolstering insulin signalling can protect neurons from harm.”

His colleague, Professor Sergio Ferreira, from Rio de Janeiro, said: “Recognising that Alzheimer’s disease is a type of brain diabetes points the way to novel discoveries that may finally result in disease-modifying treatments for this devastating disease.”

A spokesman for the Alzheimer’s Research Trust said that the study shed light on how insulin interacted with toxic proteins linked to the disease.

“People with diabetes are at higher risk of developing Alzheimer’s. It is well known that insulin affects how the brain works, and this research adds more evidence to the possibility that Alzheimer’s could be a type of brain diabetes.

“The most exciting implications are that some diabetes drugs have the potential to be developed as Alzheimer’s treatments.”

BBC NEWS | Health | Alzheimer’s ‘is brain diabetes

Although diabetics are advised to limit dietary protein to delay the progression of kidney disease, recent observations suggest that the benefit to the kidneys may have to do with “the protein source rather than quantity,” the investigators note in the American Journal of Kidney Diseases.

Despite research linking fish to improved outcomes in diabetics, they add, epidemiological evidence of this benefit is scarce.

Dr. Amanda I. Adler, at the Medical Research Council Epidemiology Unit in Cambridge, and fellow researchers therefore conducted a population-based cross-sectional analysis of 22,000 subjects.

Among the 517 subjects with diabetes, the prevalence of albumin (protein) in the urine (macroalbuminuria), an indication of kidney disease, was 8.3 percent.

According to food questionnaire responses, 18 percent of diabetics who ate fish less than once a week had macroalbuminuria, versus 4 percent of those who included fish in their diet more than twice a week.

After adjusting the data for clinical, social, demographic, lifestyle, and dietary factors, regular fish consumption remained a significant predictor of freedom from macroalbuminuria among diabetics.

Adler’s group suggests that “the unique nutrient composition of fish” may prevent kidney damage by enhancing blood sugar control or improving lipid profiles.

They suggest that these findings set the stage for nutritional intervention trials to determine the optimal types of fish, modes of preparation, and dietary frequency to best protect the kidneys of patients with diabetes.

Reuters

Publishing in the October issue of the Journal of General Internal Medicine, researchers from the University of Washington tracked 10,704 Medicare beneficiaries (average age of 75.6 years) who had diabetes and were enrolled in a disease management program in Florida. The participants’ depression status was assessed by physician diagnosis, patient reports of antidepressant use, and answers to a brief screening test.

The researchers followed the participants for two years and recorded any deaths and causes of death that took place during that time.

The participants who had both diabetes and depression had an approximately 36 percent to 38 percent increased risk of dying from any cause. A total of 12.1 percent of these participants died during the study, compared with 10.4 percent of the participants without depression.

Participants who were treated with antidepressant medications in the year prior to the study had a 24 percent increased risk of death, compared to the participants who were not depressed. The study’s authors suspect that the participants treated with antidepressants may have had more severe depression than other mildly depressed participants.

There was no difference in the incidence of cardiovascular or cerebrovascular events between the participants who took antidepressants and those who were not depressed.

“Rates of mortality from vascular disease may be decreasing in recent years among patients with diabetes due to more aggressive treatment of high blood pressure, cholesterol, and glucose levels, as well as widespread use of preventative medications such as aspirin and beta blockers,” the researchers surmised.

The study’s authors said there were several reasons why depression was associated with increased risk of death among the participants in their study.

First, depression has been associated with poor self-care and increased risk of poor health habits such as smoking and overeating. And, depression has been linked with nervous system disorders, endocrine system disorders, and inflammatory markers.

The authors noted that their study has certain limitations. The participants were selected from only one area of the United States, and the follow-up period was relatively short. And the study did not collect information on education, income, weight, smoking habits, physical activity, or compliance in taking medications.

Older Diabetics With Depression Face Higher Death Rate on Yahoo! Health

Chamomile is a mild tea with a fruit flavor many have likened to the scent and taste of apples. Ironically, the word chamomile is derived from the Greek word chamaimēlon, meaning “ground apple” or “earth apple” and is made by drying flowers of the plant Matricaria chamomilla L. and steeping them in water for a few minutes, providing the drinker with a multitude of antioxidants. Chamomile could be called the physician of teas with a variety of uses such as calming stress, soothing anxiety and nervous disorders, inducing sleep at night, relieving stomach cramps, inflammation, skin irritations and gout, while boosting the immune system.  A new study followed chamomile’s progress in lowering certain conditions caused by diabetes.

Researchers from Japan and the United Kingdom reported their findings from giving chamomile extracts to diabetic rats once a day for three weeks. Published in the September 10, 2008 issue of the Journal of Agricultural and Food Chemistry the study tracked the blood glucose levels in the rats compared to other diabetic rats that were fed a normal diet and not the chamomile extract. The University of Toyama in Japan and the United Kingdom’s Institute of Grassland and Environmental Research compared the findings between the two groups of rodents after 21 days. The rats who had received the extract showed a large decrease in their blood glucose levels. Scientists also noticed that the chamomile also triggered a response in two enzymes that can play a role in the decline of the body’s functions due to diabetes. The enzymes, which control nerve damage, cataracts, retinal damage to the eyes, and kidney damage were blocked in the rats induced with chamomile, leading the authors to conclude, “These results clearly suggested that daily consumption of chamomile tea with meals could contribute to the prevention of the progress of hyperglycemia and diabetic complications.”

The findings also might be a first step to scientists developing a drug with chamomile to prevent the common type II diabetes occuring in adults, but that news will have to wait.

Still, these results are preliminary and the transition from rats to adults hasn’t been made yet. The charity Diabetes UK’s Dr. Victoria King recommends more research of chamomile’s effects before perscribing daily cups of it with meals reinforcing good health such as, “Eating a healthy balanced diet, taking regular physical activity and adhering to any prescribed medicines remain key ways to effectively control blood glucose levels, blood pressure and blood fats. Good diabetes management will help reduce the risk of serious complications such as heart disease, stroke and blindness.”

Even if drinking a cup of tea with meals to lower your chances of progressing diabetes further becomes a recommendation sometime in the near future, neither scientists nor doctors will be advising only a “miracle cup of tea” as an alternative to eating healthy, keeping a regular workout routine or continuing with any prescribed medications. In the meantime, however, it’s not a bad idea to keep your body and mind in smooth working condition by steeping a bag or two, soothing your nerves, settling your stomach, and sinking into the couch for a calm night in.

Natural Health – Chamomile May Help to Relieve Diabetes Woes | Health News

The drug, liraglutide, is a laboratory-made version of glucagon-like peptide-1 (GLP-1), a hormone produced by the body. Several members of the GLP-1 family are in clinical trials, and one already has been approved by the U.S. Food and Drug Administration.

In a phase 3 trial, usually the last kind done before marketing approval is sought, liraglutide had greater benefits against type 2 diabetes, the kind that generally develops in the adult years, than a now-standard medication, glimepiride, said a report in the Sept. 25 online issue of The Lancet.

Results of this trial and others have been given to the FDA, which will review them and decide whether to approve the drug for use in the United States, said trial leader Dr. Alan Garber, a professor of medicine, biochemistry and cell and molecular biology at Baylor College of Medicine, in Houston.

“It should be out sometime in the first half of next year,” Garber said.

Like the other GLP-1 versions, liraglutide has all the advantages of the natural molecule, with longer-lasting activity, said Dr. Sten Madsbad, a professor of endocrinology at the University of Copenhagen in Denmark.

“First it stimulates insulin production,” Madsbad said. “Then it also promotes glucagon release from the pancreas. It also changes appetite, and therefore you eat less.”
Advertisement

Glucagon is a hormone that helps manage blood levels of sugar. The trial was sponsored by the pharmaceutical company Novo Nordisk, which already has one GLP-1 diabetes medication on the U.S. market. That drug, exenatide (Byetta), was approved by the FDA in 2005. It is taken by injection twice a day, while liraglutide requires only one daily injection.

Exenatide is actually the form of GLP-1 found in the saliva of the gila monster, explained Dr. John Buse, vice president for medicine and science at the American Diabetes Association and a professor of medicine at the University of North Carolina.

One shadow is a possible risk of pancreatitis, a condition which was reported in two people in the liraglutide trial and whose symptoms include nausea, vomiting and belly pain.

New diabetes drug doing well in phase 3 drug trial | News-Leader.com | Springfield News-Leader

But it’s not clear that this tighter glycemic control translates into fewer complications and a lower mortality rate among people suffering from type 2 diabetes, researchers add.

And two types of premixed insulin — premixed human insulin and premixed insulin analogues (genetically engineered human insulin) — appeared to produce the same benefit.

Various premixed products are already on the market, but the results described in a study in the Sept. 16 issue of Annals of Internal Medicine may help better determine which product benefits which patient.

More than a quarter of patients with type 2 diabetes use insulin alone (16 percent) or insulin combined with an oral medication (12 percent) to help them control their blood-glucose levels.

And as the number of people overall who have type 2 diabetes continues to increase, information on the effectiveness and safety of premixed insulin is even more imperative.

Premixed insulin includes both long- and short-acting insulin together in one preparation. These products are intended to give patients more flexibility as to when they eat.

“This is supposed to treat the post-meal sugar and also the blood sugars for eight to 12 hours after injection,” explained Dr. Spyros Mezitis, an endocrinologist with Lenox Hill Hospital and assistant professor of medicine at New York Presbyterian Hospital/Cornell Medical Center in New York City. “It has more flexibility.”

One injection of long-acting insulin would cover 24 hours, with four short-acting injections given in-between to cover meals.

With premixed, however, patients typically only need two injections: one before breakfast and one before dinner. The first injection covers breakfast and peaks at lunch but disappears by dinner time, at which time a second injection will take care of things until the next morning, explained study lead author Dr. Rehan Qayyum, assistant professor of medicine at Johns Hopkins School of Medicine in Baltimore.

This study was commissioned by the U.S. Agency for Healthcare Research and Quality.

After analyzing findings from 45 previous studies, the authors concluded that premixed insulin analogues and premixed human insulin provided similar blood-sugar control.

The analogues seemed to be more effective in lowering post-meal glucose levels, they said.

The premixed analogues also appeared to be more effective than long-acting insulin analogues and pills in decreasing hemoglobin A1c (a measure of blood-sugar control over time) and post-meal glucose levels.

On the other hand, premixed analogues appeared less effective than long-acting insulin, but better than oral pills, in decreasing fasting glucose levels.

“In terms of clinical practice, what it basically is saying is that if you want to replace premixed human insulin with premixed insulin analog, both seem to work pretty much the same,” said Qayyum.

However, there will be individual patients who react differently to different formulations and may do better with long-acting insulin, for instance, he added.

Also, for individuals taking oral medications whose blood sugar is not well controlled, “premixed analogue is one option that can be looked at instead of titrating up or manipulating these oral diabetic agents,” Qayyum said.

And, Qayyum emphasized, there is almost no data on how these benefits affect clinical outcomes, meaning the various, severe complications of diabetes such as death, blindness and kidney failure. Longer follow-up studies are needed to answer those questions, he said.

Premixed Insulin May Offer Better Blood Sugar Control – Yahoo! News

But a new study introduces a curious wrinkle in the evidence. Led by Dr. Guilherme Campos, director of the Bariatric Surgery Program at the University of California, San Francisco, the study found that gastric-bypass patients with diabetes did not lose as much weight as other patients after the surgery. Of the 310 patients in the study, 92% of those without diabetes were able to lose more than 40% of their excess weight – statistically, that’s considered a successful procedure – while only 79% of diabetes patients were able to drop that much weight after one year. In both cases, doctors used the same surgical technique, which involves permanently sectioning off a small pouch from the stomach and connecting it directly to the intestines, which forces patients to eat less and allows food to bypass the rest of the stomach and the upper part of the intestines.

So why the difference in weight loss between the two groups? Campos notes that although the procedure is the same from patient to patient, doctors currently do not use a standard size when creating the new stomach sac. Instead, surgeons use anatomical landmarks unique to each patient to determine the size of his or her new, smaller stomach. But because the stomach lining remains elastic and flexible, sometimes the small stapled-off pouches simply balloon back to a larger size, which explains why 5% to 15% of people who get gastric bypass surgery often experience little or no weight loss.

The other reason for the weight-loss disparity, Campos says, may have something to do with the medications that diabetes patients take to control blood sugar. “One of the known factors for why diabetics have trouble controlling their weight is the types of medications they take,” says Campos. “Diabetes is a consequence of being overweight, but [another complication] is having to take medications that add to weight gain. It’s a double-edged sword, and a vicious cycle.” The solution, he points out, may be to rely on newer anti-diabetes drugs, such as the DPP-IV inhibitors (like Januvia, the first to receive FDA approval), that can help patients keep their blood sugar and weight under control. “We can have even better results in controlling diabetes after gastric bypass surgery if we change the way we manage diabetes until these patients can get off their drugs,” he says.
(See photos of what makes you eat more food here.)

But despite the fact that diabetes patients lost less weight after surgery than patients without the disease, 90% of the former group still saw their blood-sugar levels fall after the procedure. That meant they could also cut back significantly on the amount of medication they needed. According to Dr. Osama Hamdy, director of the Obesity Clinical Program at Joslin Diabetes Center, the chances may be even better for those patients who address their diabetes early on. “If you have had diabetes for a long time, your response to surgery may not be as good as that of people who have had diabetes for a short period of time,” he says. “People who have had a longer duration of diabetes may reduce their medication, but they may never be able to stop them completely.”

Campos’ study did not stratify the diabetes patients in his study by how long they had been living with their disease. But researchers think the benefits of gastric bypass may indeed be greatest in those obese patients who are recently diagnosed with diabetes, since their bodies are more likely to revert back to normal sugar metabolism after surgery. That’s because much of the post-bypass weight loss is spurred by a shift in the hormonal feedback loop that controls hunger and satiety. Production of certain weight-related hormones, such as ghrelin, or the hunger hormone, are directly reduced by the patient’s physically smaller stomach (ghrelin is produced by glands in the stomach), leading to a reduction in food intake. Meanwhile, the smaller stomach more readily triggers hormones that signal satiety to the brain, sending the message that the body has taken in its fill of calories. But the longer this system has been overwhelmed with too much sugar and too many calories as occurs in diabetes, experts suspect, the more difficult it is to normalize the body’s metabolic thresholds and molecular messages.

“I believe that the benefits of gastric bypass surgery outweigh any risk that a patient will have,” says Hamdy. “If you look at the mortality in relation to obesity itself, especially if it occurs with diabetics, that is much, much higher than the risk of mortality from the surgery.”

What Campos’ study shows, however, is that patients should have realistic expectations of what the surgery can do for them: People without diabetes have the best chance of losing weight and reaping the heart and metabolic benefits of being slimmer; among diabetes patients, those undergoing surgery early on in their disease might fare better than those who wait longer. Both Campos and Hamdy remind patients that surgery is never the final answer – weight-loss maintenance continues long after you’re discharged from the hospital, and can only be done the old-fashioned way, with a healthy diet and exercise plan. Surgery, after all, can only get you so far.

Gastric Bypass Surgery Less Helpful for Diabetics – Yahoo! News

The drug, liraglutide, is a laboratory-made version of glucagon-like peptide-1 (GLP-1), a hormone produced by the body. Several members of the GLP-1 family are in clinical trials, and one already has been approved by the U.S. Food and Drug Administration.

In a phase 3 trial, usually the last kind done before marketing approval is sought, liraglutide had greater benefits against type 2 diabetes, the kind that generally develops in the adult years, than a now-standard medication, glimepiride, said a report in the Sept. 25 online issue of The Lancet.

Results of this trial and others have been given to the FDA, which will review them and decide whether to approve the drug for use in the United States, said trial leader Dr. Alan Garber, a professor of medicine, biochemistry and cell and molecular biology at Baylor College of Medicine, in Houston.

“It should be out sometime in the first half of next year,” Garber said.

Like the other GLP-1 versions, liraglutide has all the advantages of the natural molecule, with longer-lasting activity, said Dr. Sten Madsbad, a professor of endocrinology at the University of Copenhagen in Denmark, who wrote an accompanying editorial.

“First it stimulates insulin production,” Madsbad said. “Then it also promotes glucagon release from the pancreas. It also changes appetite, and therefore you eat less.”

Glucagon is a hormone that helps manages blood levels of sugar.

The trial was sponsored by the pharmaceutical company Novo Nordisk, which hopes to market the drug. If approved, liraglutide would be the second GLP-1 diabetes medicine on the U.S. market. The first is exenatide (Byetta), which was approved by the FDA in 2005. It is marketed by Amylin Pharmaceuticals and Eli Lilly. It is taken by injection twice a day, while liraglutide requires only one daily injection.

Exenatide is actually the form of GLP-1 found in the saliva of the gila monster, explained Dr. John Buse, president for medicine and science at the American Diabetes Association and a professor of medicine at the University of North Carolina. A new formulation of exenatide allowing once-a-week injection has successfully been tested, Buse added.

“There has been a lot of enthusiasm about exenatide based on reports of weight loss,” Buse said.

In a head-to-head test, liraglutide was more effective in controlling diabetes, Garber said. The newly reported study, he said, “shows that in patients already taking doses of existing oral medications, they did better when they switched to liraglutide.”

New Diabetes Drug Works Well in Trial – washingtonpost.com

For months, skeptical traders have expressed concern that the diabetes drug, if approved by the Food and Drug Administration, might end up with an FDA cancer advisory. Fears that the inhaler would never take off were still lurking Tuesday, even though MannKind said that trials of its Technosphere insulin delivery system showed no elevated cancer risk.

Analysts said those concerns helped push the company’s stock down 14% to $2.92 on Tuesday. MannKind shares have fallen 54% since April 1.

MannKind’s founder, Los Angeles billionaire Alfred Mann, remains optimistic. He says independent market surveys suggest that, even with an FDA warning, Technosphere will be a “blockbuster product.” It could pull in more than $1 billion in annual sales, he said in a phone interview.

And a warning label, which would probably blanket the entire class of insulin inhalers, is unlikely, he said. Technosphere should fly through the approval process and be relatively cheap to produce, he said.

“We fill a really poorly met need,” he said. “So we don’t understand the negativity.”

MannKind said Tuesday that results from a year of study suggested that Technosphere was as effective as traditional injection treatments, according to the company. Patients with Type 1 diabetes experienced stable or lower weight and better blood sugar levels between meals, MannKind said.

The company said the drug had no negative effect on lung function, a problem that had loomed over other inhalers.

The data came with news of a collaboration between MannKind and Pfizer Inc. and anticipation of MannKind’s Sept. 23 presentation at the UBS Global Life Sciences Conference.

“These observations confirm the results of earlier studies and build on the important differentiating features of this product, including its positive effects on fasting glucose levels,” Dr. Peter Richardson, the company’s chief scientific officer, said in a statement.

But for all its promises of producing a super drug, MannKind has been battered by bad buzz for much of the year.

Pfizer stopped selling MannKind’s Exubera powder in October after abysmal sales, sparking an exodus from inhaler development by pharmaceutical companies, including Novo Nordisk in January and Eli Lilly & Co. in March.

When Pfizer revealed in April that Exubera may have caused lung cancer in six patients, MannKind’s stock promptly plunged nearly 60%.

MannKind and Pfizer said Tuesday that they hoped to transition some Exubera patients — particularly those with severe fear of needles and negative reactions to insulin injections — to the Technosphere inhalant.

If approved by the FDA, Technosphere “will find itself in the unenviable position of having to entirely rebuild a decimated market in the wake of the notorious failure of Exubera,” Cory Kasimov, an analyst with JP Morgan, said Tuesday in a note to investors.