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Lifting weights may protect men against Type 2 diabetes

(CBS News) Men who lift weights may have more to gain than bigger biceps: A new study finds pumping iron may protect men against Type 2 diabetes.
The study, published online August 6 in the Archives of Internal Medicine, involved 32,000 men who were followed from 1990 to 2008. Researchers from Harvard University in Boston and the University of Southern Denmark in Odense teamed up to examine the role exercise and weight training had on men's risk for the disease that affects an estimated 346 million people worldwide.
People with Type 2 diabetes can't control their blood sugar because they are resistant to insulin, possibly as a result of obesity because increased fat makes it harder for the body to use insulin properly. Previous research suggests aerobic exercise, such as jogging or running, may reduce diabetes risk.
The new study identified 2,278 people out of the participant pool who developed diabetes over the study period. After adjusting for other factors, such as television viewing habits, family history of diabetes, smoking and diet, the researchers categorized all the men into three groups according to how much weight training they engaged in each week: between 1 and 59 minutes, 60 and 149 minutes and 150 minutes or more of weekly weightlifting.
The analysis showed that lifting weights reduced men's diabetes risk by 12 percent, 25 percent and 34 percent respectively in the three groups, suggesting the more times a person worked out, the better the diabetes protection. Not surprisingly, the researchers found aerobic exercise also reduced diabetes risk by 7 percent, 31 percent and 52 percent in the three groups.
"Many people have difficulty engaging in or adhering to aerobic exercise," study author Anders Grontved, a nutrition researcher and doctoral student in exercise epidemiology at the University of Southern Denmark, said in a press release. "These new results suggest that weight training, to a large extent, can serve as an alternative to aerobic exercise for Type 2 diabetes prevention."
Subjects who combined weightlifting and aerobic exercise experienced the greatest benefits, with men who did 150 weekly minutes of aerobic exercise and 150 of lifting weights reducing diabetes risk by 59 percent.
The study only looked at men so Grontved said more research is needed to see if the effect is similar for women.
Study co-atuhor Dr. Frank Hu, professor of nutrition and epidemiology at Harvard School of Public Health said the increased muscle mass may improve the body's insulin sensitivity, to cause this effect.
"I think the benefits of weight training are real," Hu told Reuters. "Any type of exercise is beneficial for diabetes prevention, but weight training can be incorporated with aerobic exercise to get the best results."
In a commentary published in the same journal issue, Dr. Mitchell H. Katz, director of the Los Angeles County Department of Health Services said doctors should prescribe exercise to their patients to reduce their risk of dying.
"Some might question whether providing exercise prescriptions is really the job of the practicing physician, a fair question given that we are all trying to do more in our 15-minute visits," Katz wrote. But "I cannot help but note that none of the time I spend trying to decide whether to increase the dose or add a new medication for my patients with Type 2 diabetes is likely to result in a 38 percent reduction in all-cause mortality."

Diabetes risk greater in first-borns, says study: What explains link?

Being the oldest child could mean more than added pressure from parents. A new study suggests first-born children may be more likely to face Type 2 diabetes and heart problems.
Researchers looked at 85 healthy children between ages 4 and 11, recording information like height, weight and blood profiles from physical exams, in addition to giving them tests to check their blood sugar. Thirty-two of the children studied happened to be first-borns.
The study found, on average, a 21 percent drop in insulin sensitivity among the first-borns, compared to the other kids. First-born children also had an average blood pressure 4 mmHg higher than that of non-first borns.
"This finding may have important public health implications, in light of a worldwide trend toward smaller families," the researchers concluded.
Insulin in the body is made by the pancreas and is used to help regulate the amount of sugar in the blood stream. If someone becomes less sensitive to insulin, that means the body is using insulin less effectively than normal, causing blood sugar and fat levels to rise as a result, according to the National Institutes of Health.
Insulin resistance can lead to metabolic syndrome, a collection of risk factors that increase a person's risk for heart disease, stroke and Type 2 diabetes. High blood pressure, or hypertension, can lead to kidney disease, heart attack, heart failure and stroke.
The study, which appeared Feb. 12 in the Journal of Clinical Endocrinology & Metabolism, was observational and did not measure cause-and-effect.
"Although birth order alone is not a predictor of metabolic or cardiovascular disease, being the first-born child in a family can contribute to a person's overall risk," study author Dr. Wayne Cutfield, a pediatric endocrinologist at the University of Auckland in New Zealand, said in a press release.
Levels of blood lipids, such as cholesterol and fatty acids, were not affected by birth order. Also, the oldest children were found to be about 3 centimeters taller and slimmer (based on body mass index, or BMI) than later-born children, even after taking into account their parents' sizes.
The researchers weren't certain what explained their findings, but theorized that physical changes that occur in a mother's uterus from a first pregnancy to a second could lend clues. For subsequent pregnancies, nutrients tend to flow better to the fetus, which may explain these metabolic differences. They said more research is needed to find out how these findings translate into adults.
Not all experts were convinced of a link.
"As far as I know there's not a strong association between insulin sensitivity in an ... 8-year-old and an adult at 40 or 50 or 60," Tamara Wexler, an endocrinologist based in Boston, told NPR. "They're not relating this to pediatric obesity and pediatric diabetes."

Berkeley Man Fights Against Diabetes On Twitter

This Valentine’s Day a Berkeley man is using social media to encourage people around the country to save the money they would have spent on flowers and donate them instead to help fight diabetes.
Manny Hernandez already reaches audiences across the nation with his blog, “Diabetes Hands Foundation,” as a high-profile diabetes blogger. This holiday, he’s using his fame to spur an initiative driven by social media to raise money for the International Diabetes Foundation’s Life for a Child program.
“Spare a Rose, Save a Child” is a week-long initiative held until Saturday where participants will feature a banner ad on their respective web sites, blog about the event, post to Facebook, as well as tweet with #sparearose to raise awareness and gain support for this important cause.
The foundation is an umbrella organization made up of over 200 national diabetes associations and visible in over 160 countries. The organization estimates that of 366 million people in the world diagnosed with diabetes, as many as 490,000 children under the age of 15 are affected with Type 1 diabetes. The foundation's vision is simply put; ‘No Child Should Die of Diabetes.’

''High-glycemic'' foods tied to diabetes risk

NEW YORK (Reuters Health) - People who eat a lot of low-fiber and processed foods that quickly spike blood sugars may, not surprisingly, have a significantly higher risk of the most common form of diabetes, according to a new study.
"By raising blood sugar and demanding that the pancreas keep pumping more insulin, meal after meal, day after day, a high-glycemic diet can put people at risk over the edge," said Dr. David Ludwig, who studies obesity at Boston Children's Hospital but was not involved in the work.
The report analyzes 24 studies published since 1997 that tracked what 125,000 adults ate. The new study confirms links prior researchers made between those so-called high-glycemic foods - including white bread and potatoes - and diabetes.
Published in the American Journal of Clinical Nutrition, the new report from researchers at the University of California, Los Angeles, Oxford University in the UK and others found that the 125,000 studied adults daily ate an average of 139 grams of sugar or its equivalent.
According to the U.S. Centers for Disease Control and Prevention, about 8 percent of Americans have diabetes. More than 90 percent of those cases are type 2 diabetes, which prevents the body from properly using or producing the blood sugar-regulating hormone insulin.
The analysis did not pinpoint precisely how many of the 125,000 participants actually developed the disease, but for every additional 100 grams of sugar per 2,000 daily calories, people had a 45 percent higher risk of type 2 diabetes.
"It's easy to get more than 100 grams, especially if you're not being careful to choose the right kinds of foods," research dietician Heidi Silver, of Vanderbilt University Medical Center in Nashville, who was not involved in the new study, told Reuters Health.
Low-glycemic foods include fish, meat, high-fiber fruits and vegetables, nuts, cheeses and other dairy products, brown rice and other unrefined grains. The glycemic load is calculated by multiplying the total of carbohydrate grams in a given food by its assigned glycemic index, a number that can be found in online tools.
It's important for the general public to better understand what high-glycemic and low-glycemic mean, researchers said, and how to figure out their glucose intake. A very ripe banana, for example, has far more grams of sugar than one that's still green. Eaten raw, rather than cooked, sweet potatoes have a low glycemic index.
There's a "jungle of information and misinformation out there," clinical dietician Kari Kooi of Methodist Hospital in Houston told Reuters Health.
"For instance, fiber (in prepackaged energy) bars is not the same thing as natural fiber you get in fruits and vegetables," said Kooi, who was not involved in the current study. "That's deceptive to consumers, who also may not realize that just having fiber...doesn't necessarily mean the same thing as being low-glycemic."
SOURCE: American Journal of Clinical Nutrition, online January 30, 2013.
(This story was refiled to correct "glycemic index" with "glycemic load" in paragraph eighth)

Small Diabetes Organization AYUDA Teaches Self-Care and Social Change

AYUDA, run by three full-time and one part-time staff member under the leadership of co-founder and chairman Dr. Nick Cuttriss, brings diabetes education to nine Latin American countries, primarily Ecuador and the Dominican Republic. It also raises the social conscience of its volunteers.
In the countries where AYUDA works, Merith Basey, director of international operations, told me as much as 40 percent of the population live on less than $2 a day and blood glucose test strips cost approximately $1 a strip.
A Small Organization Fulfilling a Big Goal
AYUDA is different than other humanitarian diabetes organizations, and I am fascinated by its proposition. First, it brings diabetes education and human resource support, not medical supplies, to local diabetes communities in need. As Basey told me, "Providing insulin and strips alone, we know isn't going to result in healthy, happy children. A lack of education is as dangerous as a lack of insulin."
Second, its founding principle is youth helping youth. AYUDA was founded in 1996 by Dr. Cuttriss (today a pediatric endocrinology fellow in Miami as well as AYUDA's chairman of the board) and a friend when they were 16 years old and had a friend who had Type 1 diabetes. Helping their friend, they were soon helping other young people with diabetes, and they saw young patients connected more with, and were more responsive to, them than they were to adults and medical professionals. They experienced the power of peer-mentorship.
Third, AYUDA grew its mission after learning how their volunteers' experiences were affecting them.
"We set out to provide education and support to local diabetes communities in conjunction with our local partners," said Basey. "But as our volunteers began to see diabetes in a global context, which they hadn't before, their focus changed. Many college students changed their majors to global health studies, public health, pre-med or human services."
AYUDA aims now to plant a seed for social change and entrepreneurship in its volunteers.
AYUDA also saw the experience led many volunteers to take better care of their own diabetes. Plus, siblings of volunteers who participate, never having had a role to play alongside their sibling before, now do, and this benefits the family dynamic of diabetes.
I asked Basey, who does not have diabetes, what keeps her doing this work after eight years. "I'm consistently inspired by how quickly children, young people and families with diabetes change when they realize that there is hope, when they get the knowledge they need and see that they can manage this condition and live healthy normal lives."

"We estimate we've reached about 70 to 80 percent of children and youth with Type 1 diabetes in some of the countries we're working in with our partners," said Basey. "And I feel it's our responsibility to continue and to grow. We're also reaching more people more quickly after diagnosis and that means more children will suffer fewer complications."
Becoming a Volunteer
AYUDA volunteers are mostly high school and college students, and about 50 percent are living with Type 1 diabetes, but you don't have to have diabetes. Volunteers participate in online training in diabetes, global health, social entrepreneurship, advocacy, and must also fundraise to cover their own expenses and help fund the educational camps where they'll be working. AYUDA only receives some revenue from foundations and private donors.
Volunteers then congregate in Washington, D.C. over the summer to meet with AYUDA's local partners and finally go in-country where they work with those partners, and volunteer medical professionals, on local projects, including spending one to three weeks at educational diabetes camps. Volunteers may also make in-home outreach visits to families that live far from the capital cities.
Thirty percent of AYUDA's volunteers volunteer more than once, and many more stay involved in some capacity. Almost 100 percent, Basey said, find that while the experience often wasn't what they expected, it has an enormously positive impact on their life. And that's just what AYUDA wants.
"We hope while we bring change in Latin America," said Basey, "we are helping young people have a broader vision of what is possible and their capacity to create change, whether that's in the diabetes community or somewhere else."

Lucky Dogs Get Shot at Diabetes Cure

THURSDAY, Feb. 14 (HealthDay News) -- In news that might one day help humans who struggle with type 1 diabetes every day, Spanish researchers report that a single session of gene therapy injections cured five beagle puppies who had the blood sugar disease.
Even four years later, the dogs showed no signs of diabetes.
"Our data represent the first demonstration of long-term correction of diabetes in a large animal model using gene transfer," the scientists wrote in the Feb. 7 online issue of Diabetes.
However, the dogs all had a chemically induced version of diabetes that's meant to model human type 1 diabetes.
In humans, type 1 diabetes is an autoimmune disease, which means the body's own immune system mistakenly attacks healthy cells as though they were bacteria or viruses.
In the case of type 1 diabetes, the immune system destroys the insulin-producing beta cells located in the pancreas. Insulin is a hormone that's needed to transport glucose into the body's cells to be used as fuel. Glucose is sugar that comes from the carbohydrates you consume. Carbohydrates are nutrients found in a variety of foods, including fruits, vegetables, breads and sweets.
Once the beta cells are destroyed, the body no longer makes insulin (or makes very little of the hormone), and anyone with type 1 diabetes needs insulin injections or an insulin pump for the rest of their lives.
However, insulin needs change constantly, depending on the type and amount of food eaten and level of physical activity. Even emotions can affect insulin levels. Too little insulin can cause high blood sugar levels, while too much insulin can cause low blood sugar levels. Neither condition is healthy and, if severe enough, either can cause death.
In the current study, the researchers developed a gene therapy that served two purposes: one was to sense the amount of glucose in skeletal muscles and the other was to release insulin. This research group had already tested this therapy in mice, where it was found to be successful in controlling blood sugar levels.
To test the therapy, the researchers needed dogs with diabetes. However, the types of diabetes that occur naturally in dogs aren't the same as type 1 diabetes. So, the researchers induced diabetes in a group of beagle puppies between 6 and 12 months old. The dogs were then given daily insulin injections.
The gene therapy involved a single session of numerous injections in the dog's rear legs. The needles used are like those used in human cosmetic procedures.
The dogs quickly got better and maintained normal blood sugar levels without insulin. The researchers continued to measure blood sugar control and the animals' health for more than four years. The dogs stayed healthy, and seem to have no long-term problems from the gene therapy.
Lead researcher Fatima Bosch, director of the Center of Animal Biotechnology and Gene Therapy at the Universitat Autonoma de Barcelona in Spain, said the next step in their research is to test the gene therapy on dogs with naturally occurring diabetes. The dogs will also be pets, so their living conditions and glucose levels will be varied, more closely mimicking what a person with type 1 diabetes would encounter.
Dr. Camillo Ricordi, director of the Diabetes Research Institute and the cell transplant center at the University of Miami, called the new research "an important study, and a remarkable initial finding. But, this is not a type 1 model of diabetes. This is a model where you induce diabetes chemically and you may have residual [beta] cell function."
Ricordi explained that because it's not naturally occurring type 1 diabetes, there's no worry of the immune system destroying the insulin-releasing cells in the muscle. But, in a person with type 1 diabetes, the immune system could still attack and destroy these new cells.
Dr. Massimo Trucco, chief of the division of immunogenics at Children's Hospital of Pittsburgh, said the issue of autoimmunity is an important one. But, of greater concern to him is that while this therapy worked in very controlled conditions -- the dogs' diets and exercise sessions were controlled -- in real-life conditions, this therapy might not work as well.
"Dogs get the food you want them to have. They probably spent most of their time in a cage. But, kids eat what they want and play when they want, meaning their [blood sugar level] varies dramatically. If you inject this therapy into the muscles, the muscle cells don't have the same apparatus to control the insulin levels that beta cells do. This would release insulin too slow to give good control, and could cause [low blood sugar levels] when it does release," he said.
Trucco said he doesn't believe this therapy could translate to humans.
"Human beings are not clones of dogs. Beta cells are more complicated than muscle cells. Muscles just can't secrete insulin quickly and efficiently like beta cells do," he said.
But, he added that this was a very well-done gene therapy study that showed that the particular form of gene therapy used in this research appears to be safe for long-term use.

Permanent stress can cause type 2 diabetes in men

Men who reported permanent stress have a significantly higher risk of developing type 2 diabetes than men who reported no stress. This is the finding of a 35-year prospective follow-up study of 7,500 men in Gothenburg, by the University of Gothenburg, Sweden.
Since the 1970s, a large population based cohort study has been undertaken at the Sahlgrenska Academy, University of Gothenburg to monitor the health of men born in Gothenburg between 1915 and 1925.
Using this unique material, researchers are now able to show that permanent stress significantly increases the risk of type 2 diabetes.
Of the total sample, 6,828 men without any previous history of diabetes, coronary artery disease or stroke were analysed. A total of 899 of these men developed diabetes during the follow up.
Stress at baseline in this study was measured using a single item question in which they were asked to grade their stress level on a six-point scale, based on factors such as irritation, anxiety and difficulties in sleeping related to conditions at work or at home. At baseline, 15.5% of the men reported permanent stress related to conditions at work or home, either during the past one year or during the past five years.
The results show that men who have reported permanent stress had a 45 percent higher risk of developing diabetes, compared with men who reported to have no or periodic stress. The link between stress and diabetes has been statistically significant, even after adjusting for age, socioeconomic status, physical inactivity, BMI, systolic blood pressure and use of blood pressure-lowering medication.
"Today, stress is not recognized as a preventable cause of diabetes" says researcher Masuma Novak, who led the study. "As our study shows that there is an independent link between permanent stress and the risk of developing diabetes, which underlines the importance of preventive measure."
The article Perceived Stress and Incidence of Type 2 Diabetes: A 35-Year Follow-Up Study of Middle-Aged Swedish Men was published in the journal Diabetic Medicine in December 2012.

The 7,494 men who took part in the study were first examined between January 1970 and March 1973, when they were aged between 47 and 56. These men were then followed up until the end of 2008, or until they died.

UAB researchers cure type 1 diabetes in dogs

Introducing a 'glucose sensor' by gene therapy eliminates the symptoms of the disease

Researchers from the Universitat Autònoma de Barcelona (UAB), led by Fàtima Bosch, have shown for the first time that it is possible to cure diabetes in large animals with a single session of gene therapy. As published this week in Diabetes, the principal journal for research on the disease, after a single gene therapy session, the dogs recover their health and no longer show symptoms of the disease. In some cases, monitoring continued for over four years, with no recurrence of symptoms.
The therapy is minimally invasive. It consists of a single session of various injections in the animal's rear legs using simple needles that are commonly used in cosmetic treatments. These injections introduce gene therapy vectors, with a dual objective: to express the insulin gene, on the one hand, and that of glucokinase, on the other. Glucokinase is an enzyme that regulates the uptake of glucose from the blood. When both genes act simultaneously they function as a "glucose sensor", which automatically regulates the uptake of glucose from the blood, thus reducing diabetic hyperglycemia (the excess of blood sugar associated with the disease).
As Fàtima Bosch, the head researcher, points out, "this study is the first to demonstrate a long-term cure for diabetes in a large animal model using gene therapy."
This same research group had already tested this type of therapy on mice, but the excellent results obtained for the first time with large animals lays the foundations for the clinical translation of this gene therapy approach to veterinary medicine and eventually to diabetic patients.
The study was led by the head of the UAB's Centre for Animal Biotechnology and Gene Therapy (CBATEG) Fàtima Bosch, and involved the Department of Biochemistry and Molecular Biology of the UAB, the Department of Medicine and Animal Surgery of the UAB, the Faculty of Veterinary Science of the UAB, the Department of Animal Health and Anatomy of the UAB, the Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), the Children's Hospital of Philadelphia (USA) and the Howard Hughes Medical Institute of Philadelphia (USA).
A safe and efficacious gene therapy

The study provides ample data showing the safety of gene therapy mediated by adeno-associated vectors (AAV) in diabetic dogs. The therapy has proved to be safe and efficacious: it is based on the transfer of two genes to the muscle of adult animals using a new generation of very safe vectors known as adeno-associated vectors. These vectors, derived from non-pathogenic viruses, are widely used in gene therapy and have been successful in treating several diseases.
In fact, the first gene therapy medicine ever approved by the European Medicines Agency, named Glybera®, makes use of adeno-associated vectors to treat a metabolic disease caused by a deficiency of lipoprotein lipase and the resulting accumulation of triglycerides in the blood.
Long-term control of the disease
Dogs treated with a single administration of gene therapy showed good glucose control at all times, both when fasting and when fed, improving on that of dogs given daily insulin injections, and with no episodes of hypoglycemia, even after exercise. Furthermore, the dogs treated with adeno-associated vectors improved their body weight and had not developed secondary complications four years after the treatment.
The study is the first to report optimal long-term control of diabetes in large animals. This had never before been achieved with any other innovative therapies for diabetes. The study is also the first to report that a single administration of genes to diabetic dogs is able to maintain normoglycemia over the long term (more than 4 years). As well as achieving normoglycemia, the dogs had normal levels of glycosylated proteins and developed no secondary complications of diabetes after more than 4 years with the disease.
Application in diabetic patients
There have been multiple clinical trials in which AAV vectors have been introduced into skeletal muscle, so the strategy reported in this study is feasible for clinical translation. Future safety and efficacy studies will provide the bases for initiating a clinical veterinary trial of diabetes treatment for companion animals, which will supply key information for eventual trials with humans. In conclusion, this study paves the way for the clinical translation of this approach to gene therapy to veterinary medicine, and eventually to diabetic patients.
Diabetes mellitus
Diabetes mellitus is the most common metabolic disease, and a large number of patients need insulin treatment to survive. In spite of the use of insulin injections to control the disease, these patients often develop serious secondary complications like blindness, kidney damage or amputation of limbs. Moreover, in order to achieve good blood glucose control, insulin has to be injected two or three times a day, which brings a risk of hypoglycemia episodes (lowering of blood sugar): an additional problem that comes on top of the other hardships of the treatment. 

Diet sodas raise risk of type 2 diabetes MORE than those sweetened with real sugar: study

Surprising research from France found that diabetes risk increased by about a third for women who drank diet sodas, as compared to regular soda and fruit juice drinkers.
Artificially-sweetened sodas have been linked to a higher risk of Type 2 diabetes for women than sodas sweetened with ordinary sugar, according to French research unveiled on Thursday.
"Contrary to conventional thinking, the risk of diabetes is higher with 'light' beverages compared with 'regular' sweetened drinks," the National Institute of Health and Medical Research (Inserm) said.
The evidence comes from a wide-scale, long-term study, it said in a press release.
More than 66,000 French women volunteers were quizzed about their dietary habits and their health was then monitored over 14 years. The women were middle-aged or older when they joined the study.
Sugar-sweetened sodas have previously been linked with an increased risk of diabetes, but less is known about their artificially-sweetened counterparts.
Researchers led by Francoise Clavel-Chapelon and Guy Fagherazzi dug into the data mine to look at the prevalence of diabetes among women who drank either type of soda, and those who drank only unsweetened fruit juice.
Compared with juice-drinkers, women who drank either of the sodas had a higher incidence of diabetes.
The increased risk was about a third for those who drank up to 359 millilitres (12 US ounces) per week of either type of soda, and more than double among those who drank up to 603 ml (20 ounces) per week.
Drinkers of light sodas had an even higher risk of diabetes compared to those who drank regular ones: 15 percent higher for consumption of 500 ml (16.9 ounces) per week, and 59 percent higher for consumption of 1.5 litres (50 ounces) per week, Inserm said.
There was no increase in diabetes among women who drank only 100-percent fruit juice, compared with non-consumers.
The study noted that women who drank "light" sodas tended to drink more of it -- 2.8 glasses a week on average compared to 1.6 glasses among women on "regular" sodas.

The findings are published in the latest issue of the American Journal of Clinical Nutrition.
Its authors admitted the study had limitations.
"Information on beverage consumption was not updated during the follow-up, and dietary habits may have changed over time," the paper said.
"We cannot rule out that factors other than ASB (artificially sweetened beverages)... are responsible for the association with diabetes."
The authors urge further trials to prove a causal link.
The study covered women born between 1925 and 1950, who have been monitored since 1990.
The paper noted previous research which says that aspartame -- the most frequently-used artificial sweetener -- has a similar effect on blood glucose and insulin levels as the sucrose used in regular sweeteners.

Mediterranean diet may be best for diabetes -

Diets lean on meat and rich in healthy fats like olive oil were most effective at promoting weight loss and lowering blood sugar among people with diabetes in a review of evidence from the last 10 years.
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Benefits were also seen with diets low in carbohydrates, high in protein or low in simple sugars.
"If you look at different types of diets, these four can improve various aspects of diabetes control," lead author Dr. Olubukola Ajala, a diabetes specialist at Western Sussex Hospitals in the UK, told Reuters Health.
More than 24 million Americans have type 2 diabetes. People with the disease cannot store glucose in their cells effectively, and their blood sugar levels can go dangerously high. Lifestyle changes like weight loss and cutting calorie intake can improve blood sugar control and reduce the risk of complications from the disease, but it has not been clear which diet plans work best.
Ajala and her colleagues reviewed the results of 20 studies comparing the effect of seven popular diets on adults with type 2 diabetes. Mediterranean diets, low-carb diets, high-protein diets and low glycemic index diets - which rank foods by how quickly their carbs turn into glucose - all lowered participants' blood sugar.
After following the diet for at least six months, the people on a Mediterranean eating plan also lost an average of 4 pounds. No other diet had a significant impact on weight, according to the findings published in the American Journal of Clinical Nutrition.
"We were quite surprised by the Mediterranean diet in particular," Ajala said. "I would have thought that low-carb would have been the best for losing weight, but Mediterranean seems to be better."
A Mediterranean-style diet emphasizes fruits, vegetables and legumes, whole grains, fish, and using olive oil and herbs in place of butter and salt. Saturated fats from red meat and dairy products are typically less than eight percent of total calories consumed.
Other studies have linked Mediterranean diets with reduced risks of cancer, Alzheimer's disease, Parkinson's disease and death from heart attack (see Reuters Health story of November 25, 2011:
Though the review found no evidence that vegetarian, vegan or high-fiber diets aided in weight loss, they might still have promise for improving blood sugar control, the report notes.
In addition, low-carb, low-glycemic and Mediterranean diets all led to increases in markers of heart health - "good" cholesterol rose by 4 percent to 10 percent, and triglycerides fell by up to 9 percent.
The authors caution that the study could not tease apart the beneficial effects of weight loss - versus the types of foods consumed - in the results seen with some of the diets.
"One has to take this with a pinch of salt," Ajala said.
"Weight loss is important, but so is nutrient quality," Katherine Zeratsky, a registered dietician at the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
Portion control and sustainability are the most important elements of a diet plan for type 2 diabetes, according to Zeratsky, who was not involved in the study. She thinks Mediterranean diets may be more successful because they are easier to maintain than restrictive low-carb or high-protein diets.
"I think we're all still recovering from that low-fat diet phase of the 1990s," Zeratsky said. Olive oil makes food more palatable and satisfying, and may curb the urge to snack later in the day, she added.
But a Mediterranean diet is not the only way to achieve weight loss and improve heart health, Zeratsky said.
It's more important to take a balanced approach, including fruits and vegetables, eating moderate portions and talking to a doctor before embarking on a plan.
"It's not just about dumping olive oil on a salad," Zeratsky said.
SOURCE: American Journal of Clinical Nutrition, January 30, 2013.

Test strip supply linked to better diabetes care

 Frequent blood sugar testing was strongly associated with better diabetes control in a large new study that concludes public and private insurers should not be limiting test strip supplies.
Particularly for people with type 1 diabetes, who must test their own blood sugar throughout each day and inject insulin to regulate sugar levels, a cap on the number of test strips they're allowed to use may seriously affect their health, researchers say.
"On the surface it seems crazy to limit tests for people who need them," Dr. Robert Rushakoff, a diabetes expert at the University of California, San Francisco, told Reuters Health.
Roughly one million Americans have type 1 diabetes. Usually diagnosed in childhood or adolescence, it is a lifelong condition caused by the body's failure to produce insulin, a hormone that lets cells use and store glucose.
In type 2 diabetes, the body makes insulin but doesn't use it effectively. Some type 2 diabetics can manage their condition with lifestyle changes and don't require insulin.
For those who do require it, using insulin means testing a droplet of blood to determine glucose levels, then self-administering insulin to regulate them as needed.
Medicare currently pays for a maximum of three blood-testing strips daily, and private insurers only slightly more, according to Rushakoff, who was not involved in the new study. Those limits have stayed low because the strips are costly, about 60 or 70 cents per strip, he said.
According to the study's lead author Kellee Miller, a biostatistician at the Jaeb Center for Health Research in Tampa, Florida, and her coauthors, some contend there's little evidence that more testing translates to better care that would justify paying for more test strips.
So Miller's team collected data on blood sugar control and frequency of self-testing among more than 20,000 people participating in a registry of type 1 diabetics. About half were under age 18.
The researchers looked at how many times a day participants tested their blood, and also at a marker called hemoglobin A1C, which gives an indication of average blood sugar levels over the span of months.
The higher the percentage, the worse the blood sugar control. A normal A1C reading for someone without diabetes is between four percent and six percent.
In all age groups in the study, testing more frequently was linked to safer blood sugar levels, according to the results published in Diabetes Care.
Those who checked three or four times a day, for example, had 8.6 percent A1C, compared to 7.6 percent for people who checked 10 times a day. Testing more than 10 times a day didn't seem to bring any added benefit.
The American Diabetes Association (ADA) encourages people with diabetes to aim for seven percent A1C or lower to remain in a healthy range.
"One percent for A1C is a huge difference," said Miller. Poor control of blood sugar has short and long term risks, including kidney disease and nerve damage.
Getting extra test strips for patients who need them is a lengthy process involving a lot of paperwork. "On a daily basis I get faxes to justify the increased number of strips, and I have to send in chart notes for every single one of those patients," Rushakoff said.
"What's so strange and disturbing about this, it's not like people want to be doing this more often," because finger pricks are painful, he added. "If they only had to check once or twice a day, they would, but testing more is good for them."
The ADA currently recommends all people with diabetes who use insulin test themselves at least three times daily.
That minimum may need to be higher, especially for people with type 1 diabetes who are at a greater risk for low blood sugar, according to Rushakoff.
"Absolute minimum testing is every time you eat, so three times a day, but most people would want to be checking at least 4 times per day," he said. Rushakoff also recommends to his patients check that they check before they exercise and before driving a car, which soon adds up.
"We are hopeful that future guidelines will better reflect our current understanding, from this study and others," Miller said.
But just testing more frequently won't automatically help people manage their diabetes, she cautioned.
"If you check your blood sugar and don't do anything with that number, you're not going to see any difference," Miller said. The next, and most important, step is to regulate insulin dosage and timing of snack and meals.
"There's more to life than checking blood sugars," said Rushakoff. "It's what you do with that data that matters."
SOURCE: Diabetes Care, online February