Researchers in The Netherlands found that healthy people who had just one night of short sleep can show signs of insulin resistance, a condition that often precedes Type 2 diabetes.

You can a read paper on the study, led by Dr Esther Donga of Leiden University Medical Center, which is about to be published in the May print issue of The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism, JCEM, in an early online April issue of the journal.

Donga told the press that over the last ten years the average night’s sleep in western societies has shortened, coinciding with a rise in cases of insulin resistance and type 2 diabetes. These findings suggest this may be more than a coincidence, and that:

“… a short night of sleep has more profound effects on metabolic regulation than previously appreciated,” said Donga.

Other studies have already shown that several nights of shorter sleep can lead to impaired glucose tolerance, but this is the first to show insulin sensitivity can change after only one night of partial sleep.

For their study, Donga and colleagues recruited 9 healthy participants, and measured their insulin sensitivy following one night of about 8 hours of normal sleep and again following one night of only 4 hours of partial sleep.

They measured the participants’ insulin sensitivity using the “hyperinsulinemic euglycemic clamp method” which infuses glucose and insulin into the bloodstream via catheters and allows you to work out how much glucose is necessary to compensate for an increased insulin level without causing hypoglycemia.

Donga said their results suggest that day to day insulin sensitivity is not fixed in healthy people, but depends on how much sleep they have had the previous night.

“In fact it is tempting to speculate that the negative effects of multiple nights of shortened sleep on glucose tolerance can be reproduced, at least in part, by just one sleepless night,” she added.

Prompted by their findings the researchers suggested further investigations should be done to find out whether improving sleep duration could help stabilize glucose levels in patients with diabetes.

“A Single Night of Partial Sleep Deprivation Induces Insulin Resistance in Multiple Metabolic Pathways in Healthy Subjects.”

Diabetics, under the gun to better manage their disease by controlling their food intake and weight, may find themselves in the sticky wicket of needing treatment that makes them hungry, researchers said.

Attempts to maintain healthy blood sugar levels and prevent weight gain may suggest an eating disorder when the disease and its treatment are to blame, said Dr. Deborah Young-Hyman, pediatric psychologist at the Medical College of Georgia’s Georgia Prevention Institute.

“You can’t use the same criteria to diagnose eating disorders that you use in non-diabetic populations because what we actually prescribe as part of diabetes treatment is part of disordered eating behavior. Food preoccupation is one example,” she said.

Preoccupation with food, in fact, is required for optimal disease management. Questions like “What are you putting in your mouth? Did you know that was going to raise your blood sugar?” are a part of life, Dr. Young-Hyman said. Young women, and increasingly young men, also are not immune from societal pressures to be thin, she noted.

Side-by-side comparisons of young people with and without diabetes are needed to answer fundamentals such as the incidence of eating disorders among diabetics, who is at risk and whether treatment can be modified to reduce the risk, researchers report in a review article in the March issue of Diabetes Care.

Answers could include better methods of insulin delivery and new therapies that address hunger-related hormones, which also become dysregulated in type 1 diabetes.

Dr. Young-Hyman and her colleagues extensively reviewed related literature enabling them to connect the dots between the disordered eating behavior reported by some diabetics with the dysregulation of hunger-related hormones and/or inadequate management of insulin therapy.

In type 1 diabetes, the immune system attacks the insulin producing cells of the pancreas complicating food metabolism. The treatment – insulin by injection or pump – spurs hunger. If the insulin dose isn’t exactly calibrated with food intake, blood sugar levels rise and require more insulin which could drop the blood sugar levels and increase hunger even more.

The cycle of inexact insulin dosing can cause weight gain which increases insulin requirements and resistance.

And there’s another factor at work: the insulin producing-cells attacked by the disease also make amylin which works with other appetite regulating hormones such as leptin to regulate the sensation of fullness. The resulting difficulty of diabetics to determine whether they are full has been documented in anorexia.

Interestingly, most type 1 diabetics lose a lot of weight before diagnosis because they excrete rather than metabolize calories. For a period of months, they may be able to eat large amounts of food and not gain weight. When they start taking insulin to “control” their disease, they can gain a lot of weight quickly. “It’s not hard to see how the treatment of the disease can lead to disordered eating behavior to control weight gain,” Dr. Young-Hyman said.

As a psychologist, Dr. Young-Hyman has treated many type 1 diabetics diagnosed with an eating disorder. In fact, one patient she describes as accomplished, funny and discouraged by her inability to control how much she ate and her subsequent weight gain, helped inspire Dr. Young-Hyman to learn more about eating disorders in patients with diabetes.

The conundrum expressed by this patient can lead, particularly for young women, to unhealthy behavior such as skipping or reducing insulin doses or binging-purging in an effort to avoid weight gain. The behaviors create immediate risks such as hypoglycemia or extreme high blood sugar levels, and are associated with long-term complications of diabetes such as eye, nerve and heart damage.

Controversy persists about whether type 1 patients have increased rates of diagnosable eating disorders or disordered eating behavior; incidence projections range from as low as 3.8 percent to up to 40 percent in young females when skipping or reducing an insulin dose is considered.

“We need to document that these patients are experiencing dysregulation in satiety and that it’s not only connected with factors one usually associates with disordered eating behaviors such as societal pressure, anxiety and depression,” Dr. Young-Hyman said. “It’s also associated with having diabetes.”

A new study claims that having sugary drinks every day could put people at a greater risk of developing Type 2 diabetes and heart disease.

American researchers found that the excessive consumption of sugary drinks, which can contain up to 200 calories each, contributed to 130,000 cases of Type 2 diabetes and 14,000 cases of heart disease between 1990 and 2000 in the USA.

The researchers also concluded that sugary drinks are fuelling the obesity epidemic. The findings of the research were presented at the American Heart Association Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Increased risk

“This study adds to the wealth of research around the health risks associated with long-term consumption of high calorie, high sugar drinks,” said Florence Brown, Care Advisor at Diabetes UK. “These drinks can lead to easy weight gain which can increase the risk of developing Type 2 diabetes, a serious life-long condition that can lead to complications such as blindness, heart disease and amputation.

“Sugary drinks should be avoided wherever possible and cutting them out is an easy, instant way to improve your health. As well as cutting out sugary drinks, you can reduce your risk of developing Type 2 diabetes by combining regular physical activity with a healthy balanced diet rich in fruit and vegetables and low in fat, sugar and salt.”

Over 60 per cent of Canadians are classified as overweight or obese. This epidemic is a concern for experts around the world. One of the major problems is high levels of lipids in the blood, which can lead to cardiovascular disease, fatty liver disease and Type 2 diabetes. But a University of Alberta researcher has taken a major step in protecting people against these diseases.

Richard Lehner and his research group found that decreasing the activity of an enzyme called triacylglycerol hydrolase, or TGH, in an animal model results in lowering the amount of fat in the blood and improves glucose metabolism. It also appears to keep fat from being deposited into organs that aren’t meant to store fat, like the liver.

A lack of TGH also showed to protect the beta cells in the pancreas that produce insulin and this can potentially protect from the development of diabetes in obese patients.

The benefits don’t end there. Animal models that lack the enzyme also showed to burn more fat and were more physically active compared to those who had the enzyme.

This discovery shows that TGH could eventually be used as a target for pharmaceuticals to combat metabolic complications associated with obesity.

A daily dose of vitamin D may just be what Chicagoans need to get through the long winter, according to researchers at Loyola University Chicago Marcella Niehoff School of Nursing (MNSON). This nutrient lifts mood during cold weather months when days are short and more time is spent indoors.

“Vitamin D deficiency continues to be a problem despite the nutrient’s widely reported health benefits,” said Sue Penckofer, PhD, RN, professor, MNSON. “Chicago winters compound this issue when more people spend time away from sunlight, which is a natural source of vitamin D.”

Diet alone may not be sufficient to manage vitamin D levels. A combination of adequate dietary intake of vitamin D, exposure to sunlight, and treatment with vitamin D2 or D3 supplements can decrease the risk of certain health concerns. The preferred range in the body is 30 – 60 ng/mL of 25(OH) vitamin D.

Loyola faculty members plan to take vitamin D research a step further by evaluating whether weekly vitamin D supplements improve blood sugar control and mood in women with diabetes. Depression is associated with increased insulin resistance, so people with diabetes have a greater risk for the disease than those without depression. Women also tend to have greater rates of depression and poorer blood sugar control than men with diabetes.

“There is evidence to suggest that vitamin D supplementation may decrease insulin resistance,” said Dr. Penckofer. “If we can stabilize insulin levels, we may be able to simply and cost effectively improve blood sugar control and reduce symptoms of depression for these women.”

Loyola is currently enrolling women in this clinical trial. In order to enter the study, they must be 18 to 70 years of age, have stable type 2 diabetes, signs of depression and no other major medical illness. Eighty women with type 2 diabetes and signs of depression will be given a weekly dose of vitamin D (50,000 IU) for a period of six months. Study participants will be evaluated at three points during this time.

“Vitamin D has widespread benefits for our health and certain chronic diseases in particular,” Dr. Penckofer said. “Our research may shed greater light on the role this nutrient plays in managing two conditions that impact millions of Americans. If proven to be successful, vitamin D may an important addition to care for diabetes and depression.”

A study in the March 1 issue of the journal SLEEP shows that African-American and Hispanic young adults with short or long sleep durations had greater increases in belly fat over a five-year period compared with those who reported sleeping six to seven hours a night.

Results show that in participants younger than 40 years of age, both short and long sleep durations were associated with significant increases in body mass index (BMI), as well as in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) fat accumulation. Compared with people who reported a nightly sleep duration of six to seven hours, those with a self-reported sleep duration of five hours or less per night had an average BMI increase over a five-year period that was 1.8 kg/m2 higher, and greater accumulations of SAT (42 cm2) and VAT (13 cm2); and those who reported sleeping eight hours or more had a BMI increase that was 0.8 kg/m2 higher, as well as greater accumulations of SAT (20cm2) and VAT (6 cm2). No significant relationship existed between sleep duration and abdominal fat change in participants older than 40 years of age.

Lead author Kristen G. Hairston, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine in Winston-Salem, N.C., said that obtaining a sufficient amount of sleep is important for people of all races and ethnicities. However, ethnic minorities disproportionately report extremes in sleep duration, putting them at risk for negative metabolic outcomes such as obesity and type 2 diabetes.

“Appropriate amounts of sleep are important for maintenance of healthy weight,” said Hairston. “In a group of African-American and Hispanic participants, those who slept less than this had greater increases in belly fat over a five-year period.”

Information was obtained from 1,107 people in the IRAS Family Study, an extension of the Insulin Resistance Atherosclerosis Study (IRAS). Data were collected from 332 African-Americans and 775 Hispanics with a mean age of 41.7 years at baseline and an age range from 18 to 81 years. Sixty-two percent of participants were female. Mean sleep duration at baseline was 6.7 hours in response to the question, “On average, about how many hours of sleep do you get a night?” Seventeen percent of the sample reported sleeping five hours or less per night, 55 percent slept six to seven hours per night and 28 percent averaged eight or more hours of sleep per night.

Abdominal computed tomography (CT) scans and BMI were obtained at a five-year interval. Dietary intake was assessed using a short, retrospective, one-year, semi-quantitative food-frequency interview. An estimate of usual frequency of participation in vigorous activities also was obtained. Generalized estimating equations using linear regression models assessed the association between sleep duration and five-year fat accumulation with adjustment for age, race, gender, study site, baseline fat measure, physical activity, total calorie intake, smoking status and education.

In those younger than 40 years old, a short sleep duration of five hours or less was most frequently reported by Hispanic men (30 percent), and a long sleep duration of eight or more hours was most frequently reported by Hispanic women (53 percent). Participants reporting five hours of sleep or less consumed more total calories (2,224 kcal) than those reporting six to seven hours (1,920 kcal) or eight or more hours (2,199 kcal).

The authors proposed that short sleep may impact fat accumulation by promoting increased caloric intake via increased hunger, or by reducing energy expenditure via altered thermoregulation and increased fatigue. Both increased caloric intake and decreased vigorous activity were observed in the short sleep group.

The authors also suggested that it is just as important for doctors to encourage patients to get adequate sleep as it is for them to promote a healthy diet and physical activity. This is particularly relevant when young adults make transitions involving college, marriage and childbearing, because these life stages often are associated with sleep deprivation.

New research has identified four aspects of immune system disturbance which lead to the development of coeliac disease. Nearly 40 different inherited risk factors which predispose to the disease have now been identified. These latest findings could speed the way towards improved diagnostics and treatments for the autoimmune complaint that affects 1 in 100 of the population, and lead to insights into related conditions such as type 1 diabetes.

David van Heel, Professor of Gastrointestinal Genetics at Barts and The London School of Medicine and Dentistry has led an international team of researchers towards the discovery. Results of their research, funded by the Wellcome Trust, and supported by the patient charity Coeliac UK, are published online in Nature Genetics on 28 Feb 2010.

Professor van Heel, commenting on the latest findings said: “We can now shed light on some of the precise immune disturbances leading to coeliac disease. These include how T cells in the body react to toxic wheat proteins, how the thymus gland eliminates these T cells during infancy, and the body’s response to viral infections. We now understand that many of these genetic risk factors work by altering the amounts of these immune system genes that cells make. The data also suggests that coeliac disease is made up of hundreds of genetic risk factors, we can have a good guess at nearly half of the genetic risk at present.”

The study also shows that there is substantial evidence to indicate a shared risk between the gene associated with coeliac disease and many other common chronic immune mediated diseases. Previously Professor van Heel had identified an overlap between coeliac disease and type 1 diabetes risk regions, as well as coeliac disease and rheumatoid arthritis.

Coeliac disease is common in the West, affecting around one per cent of the population. It is an auto-immune disease triggered by an intolerance to gluten (a protein found in foods containing wheat, barley and rye) that prevents normal absorption of nutrients. If undetected it can lead to severe health problems including anaemia, poor bone health, fatigue and weight loss.

A study in the March 1 issue of the journal Sleep shows that frequent napping is associated with an elevated prevalence of type 2 diabetes and impaired fasting glucose in an older Chinese population.

Results show that the prevalence of type 2 diabetes was 36 percent higher (adjusted odds ratio = 1.36) in participants who reported napping four to six times a week and 28 percent higher (OR = 1.28) in those who napped daily. Similar associations were found between napping and impaired fasting glucose. The observed associations were unaltered in statistical analyses that removed participants with potential ill health and daytime sleepiness, suggesting it is less likely that diabetes leads to daytime sleepiness and raising the possibility that napping may increase the risk of diabetes.

According to the authors, napping in China is a social norm, which is practiced by all ages primarily as a habit started in childhood. In Western countries, napping is less common and is often unplanned and prompted by sleepiness likely caused by aging, deteriorating health status or nighttime complaints.
Lead author Neil Thomas, PhD, reader in epidemiology at the University of Birmingham, U.K., said that additional research is needed to determine if napping itself plays a causative role in the development of type 2 diabetes, or if other factors are involved.

“In many non-Mediterranean, Western countries a large proportion of those that nap are generally older or have other conditions that cause tiredness and create an urge to nap,” said Thomas. “The napping can therefore be a marker of disease.”

This cross-sectional study analyzed baseline data from the Guangzhou Biobank Cohort Study, a collaboration between the Guangzhou Number 12 People’s Hospital and the Universities of Birmingham and Hong Kong. The community-based study took place in Guangzhou, China, where 19,567 participants between the ages of 50 and 93 years were recruited from 2003 to 2004 and 2005 to 2006. The sample comprised 13,972 women with a mean age of 61.4 years and 5,595 men with an average age of 64.2 years.

Participants underwent a half-day assessment, which included a structured interview on lifestyle and medical history, and a physical examination. Self-reported frequency of napping was obtained by questionnaire, and type 2 diabetes was assessed by a fasting blood glucose sample and/or self-reports of physician diagnosis or treatment. Participants were asked to describe their napping habits and daytime sleepiness.

Type 2 diabetes was identified in 13.5 percent of the sample and was more prevalent in people who reported napping daily (15.1 percent) and in those who napped four to six times per week (14.7 percent). Logistic regression models were constructed to assess the relationship between napping and diabetes and impaired fasting glucose, adjusting for demographics, lifestyle, sleep habits, health status, body fat and metabolic markers.

At least one nap per week was reported by 67.2 percent of participants, more commonly in males (76.4 percent) than in females (63.6 percent). About 59.4 percent of these people reported napping daily. Total sleep duration was longer and daytime sleepiness was reported less often in more frequent nappers than in people who never napped.

In a sub-sample of 3,822 participants who were re-contacted for additional information about sleep habits, there was a statistically significant trend of increasing risk of diabetes with longer nap duration. Compared with people who never took naps, the risk of diabetes was 41 percent higher (OR = 1.41) for people who took naps that lasted longer than 30 minutes and 35 percent higher (OR = 1.35) for people whose naps lasted 30 minutes or less.

The authors noted that the association between napping and diabetes was observed despite the fact that nappers had higher levels of physical activity, which has been shown to reduce the risk of diabetes. This suggests that the relationship between napping and diabetes might have been stronger had it not been offset by the protective effects of physical activity. The authors added that there will be profound public health implications in China if the relationship between napping and increased risk of type 2 diabetes is confirmed in longitudinal studies, as the nation is currently affected by an emerging diabetes epidemic.

Women with a diabetic sibling are at an increased risk of developing gestational diabetes much more than having one or even two diabetic parents, according to a new study in the American Journal of Obstetrics and Gynecology, Reuters reports. The study’s authors said the results seem to suggest that gestational diabetes follows a different inheritance path than Type 2 diabetes, which is typically associated with being overweight.

The study found that having two parents with diabetes increased a woman’s likelihood of having diabetes eightfold but only doubled the likelihood of gestational diabetes. When a woman has a diabetic sibling, there was a sevenfold increase in the risk of gestational diabetes but only a slightly elevated risk of Type 2 diabetes. The results were based on a study of 4,566 mothers who participated in the National Health and Nutritional Examination Survey.

“Sibling-only history may be a greater risk factor than previously documented,” study author Catherine Kim of the University of Michigan Medical School and colleagues wrote. The researchers called for further study of the patterns to identify which women with gestational diabetes have the greatest risk of later developing Type 2 diabetes

A new evidence review suggests that using a pump to deliver insulin continuously – instead of taking three or more daily injections – might result in better control of blood sugar for people with type 1 diabetes.

“The findings of this review tell us that both continuous subcutaneous insulin infusion and multiple injections correct blood glucose levels. However, [continuous infusion] may be better for reducing harmful fluctuations in blood glucose,” said lead author Marie Misso, Ph.D.

Type 1 diabetes – which used to be known as juvenile diabetes – results when the pancreas is not able to secrete enough insulin, causing the levels of glucose (or sugar) in the blood to rise.

Chronically high blood glucose can lead to heart attacks, circulation problems and blindness. Low levels can lead to unconsciousness and even death. Type 1 diabetes is one of the most common chronic diseases of childhood.

Most people with the condition control their glucose by injecting themselves with insulin three or more times per day. Others choose to use a pump, which gives continual, smaller doses of insulin without the discomfort of injections.

“There are numerous studies that evaluate these treatments, but most are of poor quality,” said Misso, a research fellow at the Monash Institute of Health Services Research in Clayton, Australia. “So there has been uncertainty about which treatment is best for maintaining consistent levels of blood glucose and reducing harmful fluctuations.”

In the new review, Misso and colleagues analyzed the results of 23 studies that assigned 976 adults and children to one of the two interventions randomly. Researchers looked at measures such as levels of hemoglobin A1c (or HbA1c), a widely used marker for assessing long-term glucose control. They also looked at the incidence of both high and low blood glucose.

The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

While participants using the insulin pump had significantly lower HbA1c levels than those using multiple daily injections, no differences existed between the two for non-severe low blood glucose levels. However, there appeared to be a reduction in severe incidents of low blood glucose among those using the pump.

“Good evidence is now available to support the use of continuous subcutaneous insulin infusion in the appropriate patient. It is essential to consider adverse events, late complications of diabetes, mortality and cost when deciding whether [a pump] is appropriate for the patient,” Misso said.

For people who likely have to deal with their condition for the rest of their lives, convenience is another consideration that comes into play.

The advantages of using the insulin pump include being able to avoid possibly painful injections several times a day. In addition, pumps administer the medication without the user having to find a private place to give the injection.

The downside to pump use includes having to wear it like a pager or cell phone throughout the day, concerns about protecting the tubing that goes into the body – although wireless pumps have recently come on the market – and worries about breaking the pump during rough play or exposure to water.

Ramin Alemzadeh, M.D., director of the Diabetes Program at the Children’s Hospital of Wisconsin in Milwaukee, cautioned that although the researchers reported pumps might improve glucose control overall, pediatric patients should not expect major changes in the longer-term control of blood glucose.

“In our experience, we don’t see a significant overall blood glucose improvement beyond six months or one year of treatment in most children and adolescents. Initially, the patient’s HbA1c levels improve, but after a while levels begin to rise and are not significantly different from where they started,” Alemzadeh said. “A patient’s diabetes management starts with them and their family. How well they do is independent of which method of insulin administration they use.”

The review discloses that one of the co-authors has received compensation for lectures and advisory board participation from companies who make insulin or insulin pumps. His department has also received funding for research and educational activities from these companies.

“Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. “