In the study, a high-fat diet, which creates diabetes-like changes to blood sugar metabolism, was administered to both the control group and the test mice.  Typically, engaging in exercise has the ability to prevent metabolic blood sugar abnormalities, even in the presence of a high-fat diet.  The University of Texas Southwest Medical Centre researchers found that the mice that were unable to respond to exercise by increasing autophagy did not experience the benefits exercise provides on blood sugar metabolism.

The findings of the research team suggest not only that exercise is able to reduce or reverse changes in blood sugar due to a high fat diet among those with normal autophagy function, but also that autophagy is a key process that protects against diabetes by improving glucose metabolism.

In additition, the study raises the prospect that activating the autophagy process could play a key role in other exercise benefits, like reducing cancer risk, according to the senior author who leads the Centre for Autophagy Research.

Sources: Zeenews.com, 21 January 2012; He et al., Nature 481: 511-15, 18 January 2012.

Panelists at Diabetes Question Time

On Tuesday 17 January, C3 Collaborating for Health, Diabetes UK and SilverStar co-hosted a Question Time-style event in Westminster Central Hall, in front of an invited audience of around 150 people. The event was funded by Novo Nordisk. The panel was made up of Grace Vanterpool (a specialist diabetes nurse), three members of parliament – Stephen Dorrell, Keith Vaz and Adrian Sanders – the chief executive of Diabetes UK Baroness Barbara Young, and Viggo Birch, vice-president of Novo Nordisk Europe. It was facilitated by Stephen Dixon of Sky News, and closed with a short presentation from Paul Burstow, minister of state for care services.

The audience was made up of health professionals, policy-makers and others – and both panel and audience included people with type 1 and type 2 diabetes. The event was covered on Twitter (#diabetesqt).

Questions at the event included:

• Will commissioning lead to fragmented care?
• Will the Outcomes Framework work as a catalyst to help people with diabetes or not?
• How can prevention methods be improved?
• How best to care for children with diabetes
• How to encourage sharing of best practice
• The problem of limited access to pumps

Voting at Diabetes Question Time

The audience were actively involved throughout the event. First, all those attending were asked to take part in two votes during the event:

• Will people be more involved in their care in the new system envisaged by the new Bill? (which saw a small majority who felt that people will be more involved)
• Will diabetes care have improved by 2025? (which also saw a ‘yes’ majority).

On arrival, the audience were all invited to participate in a short poll to ascertain views on what should be the top three priorities for the NHS in diabetes, and the results were illustrative of the need to ensure that people with the disease should be closely consulted:

• Among people with diabetes, supporting self-management was seen as the highest priority (40%), followed by identification and prevention (23%), education (23%), and specialist nursing (10%).
• Among those without diabetes, the priorities were different: identification and prevention (43%), reducing variations in access to care and services (23%), and supporting self management (19%).
• Averaged across the audience as a whole, the top three priorities were identification and prevention (37.5%), supporting self-management (25%), and reducing variations in access to care and services (17%).

The Dutch government banned smoking at workplaces since 2004 and in most public places since 2008.  This move was particularly unpopular with small bars and innkeepers, who mounted a grassroots campaign aimed at toppling existing smoking legislation.  As a result, the primary Dutch organisation responsible for campaigning against smoking, STIVORO, will lose its €2.7 million funding by 2013 and will need to raise funs to continue operation.  In addition, pharmaceutical nicotine patches, previously dispensed through the public health services, will no longer be available fre of charge.  Although smoking rates are slightly down from 2001 when an estimated 30 per cent of the population were smokers, smoking remains popular in the Netherlands; 27 per cent of the population were smokers in 2010.

According to the International Tobacco Control Policy Evaluation Project, Netherlands Survey, smokers in the Netherlands are the least well informed or concerned about both the hazards of smoking and the dangers of second-hand smoke exposure of the 12 countries surveyed.

Sources: The Lancet 379(9811): 121-2, 14 January 2012; The International Tobacco Control Policy Evaluation Project, Netherlands Survey, March, 2011 Report on Smokers’ Awareness of the Risks of Smoking and Second-hand Smoke; STIVORO, Annual Report 2009—2010.

Recent research from Leicester University and the University of Cambridge’s Medical Research Council Toxicology unit in the UK, the Steno Diabetes Centre in Denmark, and the Massachusetts Institute of Technology in Cambridge, Massachusetts, suggests that having a poor diet during pregnancy will risk the chance of offspring developing diabetes in later life.

The research focused on the way diet in early life affects both the composition and behaviour of fat tissues.  While this laboratory study was conducted with rats, the research team cautiously suggests a generalisability to the human population, and identifies a mechanism through which poor early nutrition may impact the development and location of fat tissue. High levels of a newly identified molecule causes fat to be stored inappropriately in the muscle and liver, and is linked to both insulin resistance and high levels of diabetes.

The contemporary diet leads to storage of excess calories in fat cells, and when the cells become over-burdened they store calories in and around organs such as the liver, which can cause insulin resistance and render people more susceptible to type 2 diabetes in later life. This study lends even more credence to the early origins of health hypothesis that C3 has been exploring recently (click here >>).

Sources: NHS Choices, 9 January 2012; The Telegraph, 6 January 2012; Ferland-McCollough et al., ‘Programming of adipose tissue miR-483-3p and GDF-3 expression by maternal diet in type 2 diabetes’, Cell Death and Differentiation, 6 January 2012.

The Lancet published an article recently about the prevalence and treatment of two major chronic conditions: hypertension and diabetes.  Interestingly, though the prevalence of chronic disease like diabetes, cardiovascular disease and some cancers is higher in urban areas, the article shows evidence that control and management of chronic conditions is better in rural areas and the Behyarz workers, who are well-trained community health workers, are largely attributed with developing and maintaining low rates of hypertension and diabetes in particular.  This community health model, which involves health education training of over two years, includes an emphasis on workers identifying new cases of disease and referring the new cases.

As is the case in many nations, the causes of death in Iran have shifted from infectious agents to NCD. Cardiovascular disease accounts for almost half of all deaths in Iran and cancer rates have soared; traffic-related deaths have also increased dramatically. The Lancet study shows the higher prevalence of CVD risk factors – hypertension and diabetes – in the context of urbanisation, increasingly sedentary lifestyles, changes away from a traditional Mediterranean diet and improved infectious disease control.  This study corroborates evidence from Ethiopia, Brazil, India and Bangladesh, which suggest that trained community health care workers and well-established guidelines can, in combination, be effective in NCD prevention and management.

Sources: F. Habibzadeh, The Lancet 379(9180):  6-7, 7 January 2012; Asgari et al., Iranian Journal of  Public Health (2009) 38, Suppl. 1: 119-22.

But in what sense is this a ‘right’ to which anyone would freely wish to be entitled? Each year in the United States, 400,000 deaths are attributable to cigarette smoking alone, and another 50,000 citizens die prematurely from exposure to second-hand smoke. This number amounts to one fifth of deaths in the US and accounts for more deaths than HIV/AIDS, drug abuse and alcohol related deaths, automobile accidents, murders and suicides combined, according to the state of Virginia Department of Health.

The US Centre for Disease Control reported last year that men who smoke will become ten times more likely to die from bronchitis or emphysema and over 22 times more likely to die from lung cancer. In addition, smoking triples the risk of premature death from cardiovascular disease among middle age men.

As Peter Galuszka writes in the Washington Post, tobacco has been a powerful US industry since the first English colonies were established on her shores in Jamestown Virginia; this new effort on behalf of big tobacco extends and expands the industry battlefield in a new and insidious way.

Sources: Washington Post, 3 January 2011; CDC Factsheet, 21 March 2001 Tobacco Related Mortality (here >>); Virginia Tobacco Use Control Project Smoking Attributable Deaths in Virginia, 2008.

Tobacco, the world’s leading cause of preventable death, is estimated to be responsible for over 200,000 deaths each year in Brazil, including 45 per cent of heart-attack deaths and 30 per cent of deaths due to cancer. Smoking is the primary cause of many of the world’s preventable diseases, including cardiovascular disease, lung disease and cancers, killing 1/10 adults worldwide and is frequently the cause of the disease recorded as the cause of death, according to the WHO.  As Brazil is hosting both the 2014 Soccer World Cup and the 2016 Olympic Games, the nation has a crucial example to set through its leadership role on this issue.

Sources: The Washington Post, 15 December 2011; Campaign for Tobacco Free Kids, press release; Tobacco Free Center, Tobacco Policy Status (pre-ban) 12/2011; World Health Organization ‘Top Ten Causes of Death Fact Sheet’, June 2011.

Whether the WHO definitions or National Working Group on Obesity in China measures are used to define overweight and obesity, around 20 per cent of urban residents were overweight or obese, versus 3-7 per cent in the rural areas. The Yi are a minority national population in this area and are believed to be at higher risk.

Dramatic development of the Chinese economy during the past decades has wrought major lifestyle changes in the provinces that have led to an alarming increase in chronic disease risk factors such as  hypertension, and a major spike in diabetes rates. More sedentary lifestyles have become common and the epidemic status of obesity in this region coincides with both economic growth and rise in family income levels.  The agrarian lifestyle has given way to higher levels of education and higher income in urban areas but has not yet generated greater health. Significant among the research findings is that 60 per cent of the men participating in the study were smokers.

Researchers believe that the overall differences between the rural and urban groups may be explained in part by lifestyle and by socio-economic differences among the groups. They further add that a greater emphasis by the state on education and prevention strategies in urban settings will help to stem the tide of preventable disease that inevitably follows rising obesity levels.

Sources: Y Gao et al., ‘Prevalence of overweight and obesity among Chinese Yi nationality: a cross-sectional study’, BioMed Central Public Health, 13 December 2011; Stone Health News, 13 December 2011.

In a review the authors hail as the most comprehensive to date, evidence is presented which confirms that cancer is certainly not completely driven by either heredity or fate but rather can be influenced by our environment and behaviours.  Cancer typically has multiple causes and thus one cannot identify whether an individual’s cancer is caused by a particular disease vector, but understanding this can assist in predicting the number of potentially preventable cancers.

As the study analysed gender specific causes of cancers, the best recommendations for women are to avoid smoking, overweight and excess alcohol consumption; for men the top line recommends stopping smoking, increase consumption of fruit and vegetables and reduce alcohol intake.

Lead author is Professor Max Parkin, epidemiologist at the Wolfson Institute of Preventative Medicine, Queen Mary University, London.

An important fact to note here is that the probability of death before age 70 has been halved during the past 40 years and that during the next few decades it could be cut by half again with improvements in treatment and focusing attention on the avoidable causes of disease.

Sources: BBC Health, ‘Over 40% of Cancers Due to Lifestyle, Says Report‘, 7 December 2011; D.M. Parkin et al., ‘The fraction of cancer attributable to lifestyle and environment factors in the UK in 2010′, British Journal of Cancer 105:S2, 6 December 2011; NHS Choices, ‘Lifestyle changes could slash cancer rates, 7 December 2011; Cancer Research UK: Cigarettes, diet, alcohol and obesity behind more than 100,000 cancers (press release), 7 December 2011.

Several risk factors have been identified across populations that  contribute to CVD – smoking, blood fats, diabetes, sub-optimal nutrition and high blood pressure – but addressing these factors has had less impact in South Asian populations and researchers speculate that this group may be plagued by some additional, unidentified factors. Professor John Danesh, University of Cambridge professor of epidemiology and medicine and director  of the Department of Public Health and Primary Care, suspects that a particular combination of risk factors, including biochemical, genetic and lifestyle components impact CVD risk within this group.

Two large population studies have been developed to research this conundrum, the first focusing on Pakistan, with a population of 187 million.  PROMIS, funded through the US NIH, the Wellcome Trust and the British Heart Foundation, has already provided significant interim findings, recently published in Nature Genetics, which include identification of key genes implicated in coronary disease and type 2 diabetes.  The second study, BRAVE,  focuses on Bangladesh, which has the highest rates of CVD in the world – as well as highest rates of urbanisation and population density – but is the least studied. PROMIS seeks to explain the particular factors that  make this population more vulnerable to CVD.  The BRAVE study seeks to identify modifiable risk factors in this region – consumption of ghee and indigenous tobacco, including ‘naswar’, according to the head of  the Karachi-based Centre for Non-Communicable Diseases, Dr Saleheen. This study in particular is expected to yield novel findings, especially since that the study recruits patients with cardiac issues or diabetes.

Sources: Insight Radio, Heart Matters – South Asians and Heart Disease, 30 November 2011; University of Cambridge Research Features, ‘High-risk hearts:  a South Asian epidemic’.