Diabetes

Posted on Cardiovascular disease, Diabetes

One in three have a dysfunctional metabolism, but intermittent fasting helps!

Panda and Manoogian

Emily Manoogian and Satchin Panda Credit Salk Institute

Approximately one-third of adults in the United States have metabolic syndrome, a group of conditions that greatly increase a person’s risk of heart disease, stroke, and type 2 diabetes. These conditions consist of high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol levels.

In a recent clinical trial, researchers at the Salk Institute and the University of California San Diego School of Medicine discovered that time-restricted eating, also known as intermittent fasting, could provide significant health benefits to adults with metabolic syndrome. Patients who adhered to a consistent eight-to-ten-hour eating window each day for three months experienced improvements in various markers of blood sugar regulation and metabolic function compared to those who received standard treatments.

“Our bodies process sugars and fats very differently depending on the time of day,” says Salk Professor Satchidananda Panda, co-corresponding study author and holder of the Rita and Richard Atkinson Chair. “In time-restricted eating, we are re-engaging the body’s natural wisdom and harnessing its daily rhythms to restore metabolism and improve health.”

“For many patients, metabolic syndrome is the tipping point that leads to serious and chronic diseases such as diabetes and heart disease,” says co-corresponding author Pam Taub, who is a professor of medicine at the UC San Diego School of Medicine and a cardiologist at UC San Diego Health. “There is an urgent need for more effective lifestyle interventions that are accessible, affordable, and sustainable for the average American.”

Western diets high in sugar, salt, and fat, combined with increasingly sedentary lifestyles, are believed to have led to increasing rates of metabolic dysfunction. While the initial recommendation may be to “eat less and move more,” these lifestyle changes are challenging for most people to maintain long-term. Researchers suggest that time-restricted eating provides a more practical approach that is accessible to a wider range of patients, including those already on medication.

“Unlike expensive pharmaceuticals like Ozempic, which require lifetime use, time-restricted eating is a simple lifestyle change that doesn’t cause side effects and can be maintained indefinitely,” says first author Emily Manoogian, a staff scientist in Panda’s lab at Salk. “Patients appreciate that they don’t have to change what they eat, just when they eat.”

The new study customised time-restricted eating protocols to each participant’s eating habits, sleep/wake schedules, and personal commitments. The resulting regimen had them reduce their eating window to a consistent eight to ten hours per day, beginning at least one hour after waking up and ending at least three hours before going to sleep. Manoogian says this personalized approach made the intervention easier for patients to complete, compared to other intermittent fasting studies, which typically assign the same strict time window to all participants.

The TIMET study also accepted participants who were on medication for metabolic syndrome—a group usually excluded from such trials. This makes it the first study to measure the benefits of time-restricted eating in addition to existing standard-of-care pharmacological treatments. 

The study randomly sorted 108 adults with metabolic syndrome into either the time-restricted eating group or the control group. Both groups continued to receive standard-of-care treatments and underwent nutritional counselling on the Mediterranean diet. Participants also logged their meals using the myCircadianClock mobile app, developed at Salk. 

After three months, patients who had completed the time-restricted eating regimen showed improvements in key markers of cardiometabolic health, including blood sugar and cholesterol. They also saw lower levels of haemoglobin A1c, a marker of long-term blood sugar control. This reduction was similar in scale to what is typically achieved through more intensive interventions by the National Diabetes Prevention Program. 

The time-restricted eating group also showed 3-4% greater decreases in body weight, body mass index (BMI), and abdominal trunk fat, which is closely linked to metabolic disease. Importantly, these participants did not experience significant loss of lean muscle mass, which is often a concern with weight loss.

Posted on Diabetes

Widely used test for gestational diabetes misses 70% of cases

When screening pregnant women for gestational diabetes, casual blood glucose testing misses 70% of the cases. This Kobe University study should encourage obstetricians to depend on more reliable tests to help prevent pregnancy complications and the development of type II diabetes in mothers and children.
When screening pregnant women for gestational diabetes, casual blood glucose testing misses 70% of the cases. This study from Kobe University should encourage obstetricians to rely on more reliable tests to help prevent pregnancy complications and the development of type II diabetes in mothers and children.

Gestational diabetes mellitus is a condition in which previously healthy women experience high blood sugar levels during pregnancy. When treated, most women deliver healthy babies. However, if left unmanaged, it can lead to pregnancy complications, larger-than-usual babies, and an increased risk of developing type II diabetes later for both the mother and the child. To address this, the International Association of the Diabetes and Pregnancy Study Groups recommends that all women who have not been previously diagnosed with diabetes undergo an oral glucose tolerance test between weeks 24 and 28 of pregnancy. This multi-step procedure involves fasting for 8-12 hours, taking a baseline blood sample, consuming a standardized glucose solution, and using another blood sample to assess sugar metabolism. However, many health facilities use a simpler “casual” blood glucose test, which is cheaper and quicker. This test involves analyzing blood glucose levels at any time, without considering the woman’s recent food intake. Only if women test positive in the simple screening are they asked to undergo the more rigorous glucose tolerance test.

The obstetrician Tanimura Kenji and his graduate student Tomimoto Masako from Kobe University were worried that the current two-tier approach might be overlooking cases of diabetes during the initial screening. They conducted a study at the perinatal centre of Kobe University Hospital where they combined the casual blood glucose screening with a more sensitive glucose challenge test into a single protocol for all women visiting their centre. They then asked women who tested positive in the glucose challenge test to also take the glucose tolerance test, in order to determine how many positive cases would have been missed if they had relied only on the casual blood glucose screening.

The study, published in the Journal of Diabetes Investigation, found that out of 99 women diagnosed with gestational diabetes mellitus, 71.7% had blood sugar levels in their first blood sample, which would have led to a negative (no diabetes) diagnosis. Tomimoto explained, “Although previous studies have shown that the casual blood glucose test is less sensitive than others, no studies have directly compared the results in the same individuals. Our study confirmed that this screening method, widely used in practice, often fails to detect the condition it is meant to identify.”

Posted on Children's health, Diabetes

New blood test could be an early warning for child diabetes

Antiphospholipid syndrome
Antiphospholipid syndrome

A new type of blood test using lipids could make it easier to identify children at risk of complications around obesity, including type two diabetes, liver and heart disease, say scientists.

A new study from King’s College London, published in Nature Medicine, reveals a new relationship between lipids and diseases impacting metabolism in children. This relationship could serve as an early warning system for conditions like liver disease.

The researchers suggest using machines that test blood plasma in babies already in hospitals to help doctors spot early signs of disease in children quicker and help them access the right treatment.

The findings also contest the common idea that cholesterol is a leading cause of complications related to obesity in children, identifying new lipid molecules that contribute to health risks like blood pressure but are not only correlated with a child’s weight.

Lipids have traditionally been considered fatty acids in the body, either good or bad types of cholesterol or triglycerides, fats found in the bloodstream that is the most common in the human body. Recent studies from the same scientists have suggested that the picture is more complex.

Current evidence, using a technique associated with chemistry called mass spectrometry, estimates the thousands of different lipids present in the body, each with a separate function.

The team took a control sample of 1,300 children with obesity and assessed their blood lipids. Afterwards, 200 of them were put on the HOLBAEK model for a year, a lifestyle intervention popular in Denmark for people with obesity.

Subsequent readings showed that among the intervention group, lipid counts tied to diabetes risk, insulin resistance, and blood pressure decreased despite limited improvements in some children’s BMI.

Dr Cristina Legido-Quigley, a group leader in Systems Medicine at King’s College London, Head of Systems Medicine at the Steno Diabetes Centre Copenhagen (SDCC) and principal author, said: “For decades, scientists have relied on a classification system for lipids that have split them into good and bad cholesterol, but now with a simple blood test we can assess a much broader range of lipid molecules that could serve as vital early warning signs for illness. In the future, this has the potential to be an entirely new way to evaluate someone’s risk of disease, and by studying how to change lipid molecules in the body, we could even prevent metabolic diseases like diabetes altogether.”

Obesity continues to be a risk factor for conditions like fatty liver disease, but the team hope that doctors can use these measurements to treat children when they are at risk and not just a little larger than their peers.

Dr Karolina Sulek, who participated in the study and performed analysis at the SDCC, said: “Early recognition of children at risk for these life-threatening diseases is crucial. The study provides strong evidence of the great need for obesity management and gives parents confidence to intervene more compassionately in their children’s lives, helping them to lose weight.”

Posted on Diabetes, Obesity

Impact of weight loss and blood sugar control in T2 Diabetes

Study finds that type 2 diabetes patients treated with GLP-1RAs who lowered their BMI also reduced their cardiovascular risk
Study finds that patients with type 2 diabetes treated with GLP-1RAs who reduced their BMI also lowered their cardiovascular risk.

A research team from the Cleveland Clinic has recently conducted the first study evaluating the separate real-world effects of weight loss and blood sugar control on clinical outcomes in individuals with type 2 diabetes who are being treated with antidiabetic medications, specifically GLP-1RAs, which includes drugs like Ozempic and Wegovy.

The study discovered that for every 1% decrease in BMI, there was a 4% decrease in cardiovascular risk, irrespective of changes in blood sugar levels. Additionally, effective control of blood sugar, regardless of weight change, was associated with a reduced risk of chronic kidney disease. These findings are significant from a clinical standpoint and underscore the importance of addressing both glycemic control and obesity in individuals with type 2 diabetes.

The retrospective findings, which were published in Diabetes, Obesity, and Metabolism, used de-identified electronic health record-derived data from over 1,300 patients with type 2 diabetes who were evaluated at Cleveland Clinic.