TAG: "Diabetes"

Solution to helping teens with chronic disease may be at fingertips


Study shows technology improves transition into adulthood for teens with chronic disease.

Adolescents with chronic diseases (ACD), such as cystic fibrosis, gastrointestinal disorders (including Crohn’s disease) and Type 1 diabetes, often find the transition of managing their health care needs into adulthood to be challenging. Preparations for this transition are often clinic-based, costly and do not fully or effectively engage with this patient population. A new study by researchers at the UC San Diego School of Medicine found the answer to developing independent, self-management skills in ACD could be right at the patient’s fingertips.

The study is published in the June issue of Pediatrics.

Eighty-one patients, ranging from 12-to-20-years-old, participated in the eight-month study. Those assigned to the intervention group received an Internet and mobile phone system. Patients were asked to use a secure website weekly to receive theme-based materials and lifestyle tips. Automated text messages were also sent three to five times a week to help patients perform a variety of tasks, such as monitoring symptoms, keeping appointments and interpreting medical bills.

“Parents usually take a leading role when treating adolescents with chronic disease, but we want teenage patients to have a voice and become advocates for their own health,” said principal investigator Jeannie Huang, M.D., with the Department of Pediatrics at UC San Diego School of Medicine and Rady Children’s Hospital-San Diego. “The goal of the program is ultimately to improve communications between affected teens and their doctors.”

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Diabetes linked to a third of state’s hospitalizations


UCLA study highlights impact the disease is having on California’s health care costs.

Patients with diabetes account for one in three hospitalizations in California, according to a comprehensive new study on the prevalence of diabetes in hospitals and its impact on providers and spiraling health care costs.

The study of hospital discharge records, conducted by the UCLA Center for Health Policy Research with support from the California Center for Public Health Advocacy, found that among all hospitalized California patients aged 35 or older — the age group that accounts for most hospitalizations — 31 percent had diabetes.

Although diabetes may not be the initial reason for these hospitalizations, the disproportionate share of patients with diabetes highlights the impact this disease is having on California’s health care costs.

The research also showcases the percent of hospitalizations of patients with diabetes and related costs by county.

“If you have diabetes, you are more likely to be hospitalized, and your stay will cost more,” said Ying-Ying Meng, lead author of the study and a researcher at the UCLA Center for Health Policy Research. “There is now overwhelming evidence to show that diabetes is devastating not just to patients and families but to the whole health care system.”

Diabetes is one of the nation’s fastest-growing diseases and one of the most costly. It adds an extra $1.6 billion every year to hospitalization costs in California, with hospital stays for patients with diabetes costing nearly $2,200 more than stays for non-diabetic patients, according to the study. Three-quarters of that care is paid through Medicare and Medi-Cal, the study authors found, including $254 million in costs that are paid by Medi-Cal alone.

The disease is responsible for a long list of complications, including blindness, kidney disease, cardiovascular disease, amputations and premature death. Since 1980, diabetes cases have more than tripled nationally to 20.9 million. In California alone, diabetes cases have increased by 35 percent in 10 years.

“For far too many families, diabetes has become a common and painful reality,” said Dr. Harold Goldstein, executive director of the California Center for Public Health Advocacy. “In very stark terms, this study shows local health care providers and policymakers the enormity of the diabetes epidemic in their counties.”

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Study aims to boost health of immigrant Latino farmworkers


UC Davis, UC Berkeley participate in $3M study.

A new, collaborative study aimed at designing and evaluating worksite-based health programs to lower the risk of obesity and diabetes among immigrant Latino farmworkers has been launched under the leadership of UC Davis.

The new five-year study, to be carried out through a partnership between UC Davis; Reiter Affiliated Companies, a large California berry grower; and the Health Initiative of the Americas at UC Berkeley; was recently funded with more than $3 million in grant funds from the National Institute of Diabetes, Digestive and Kidney Diseases.

“Latino farmworkers harvest much of our fruit and vegetables, yet they face obesity and diabetes rates much higher than the general population,” said lead investigator Marc Schenker, director of the UC Migration and Health Research Center and the Western Center for Agricultural Health and Safety, and a distinguished professor in UC Davis’ Department of Public Health Sciences.

He noted that the prevalence of obesity and diabetes has rapidly increased during the past decade in the United States. Among Latinos, the prevalence of overweight and obesity is now an alarming 78 percent, markedly higher than in the general population. Furthermore, the prevalence of diabetes among Latinos in the U.S. is almost twice that of non-Latino whites.

“To address that problem, we have created and are evaluating an obesity and diabetes prevention program that can be delivered to workers in the field,” Schenker said.

The study will include food and nutrition educational programs at the participants’ on-farm worksites, as well as exercise activities such as Zumba classes. All programs are led by community health workers or “promotoras.”

The study focuses on ranches in Salinas and Watsonville, but the ultimate goal is to disseminate the intervention program to farms throughout the state and country.

The program is designed to improve health outcomes among the farmworkers participating in the study and to evaluate those outcomes, as well as the economic impact for the employer.

“We hope that the economic benefits — which we anticipate will be demonstrated and quantified through this study — will help convince other companies in the agricultural industry to adopt similar programs,” Schenker said.

He added that Reiter Affiliated Cos. is a model industry partner for this study because it is already invested in the health of its workers.

Co-investigators on the study include Daniel Sumner, a professor of agricultural and resource economics at UC Davis and director of the UC Agricultural Issues Center; Nancy Keim, an adjunct professor in the UC Davis Department of Nutrition; Heejung Bang, a professor of biostatistics at UC Davis; and Xochitl Castaneda, director of the Health Initiative of the Americas at UC Berkeley.

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Community-based weight loss program aids diabetes management


Majority of participants in trial lost weight and reduced medication use.

Cheryl Rock, UC San Diego

Weight loss and control of blood sugar can reduce the risk of complications in patients with diabetes, but this is difficult for many to achieve. A UC San Diego School of Medicine randomized controlled trial of obese adults with type 2 diabetes suggests that participants enrolled in a community-based structured weight loss program are able to shed more pounds, improve blood sugar control and reduce or eliminate insulin use and other medications compared to a control group.

“Support and a tailored lifestyle intervention have been shown to reduce cardiovascular disease risk factors and adverse outcomes in people with diabetes,” said Cheryl L. Rock, Ph.D., R.D., professor of family and preventive medicine and principal investigator of the study. “However, most overweight individuals with type 2 diabetes do not receive this degree of support for changes in diet and physical activity to promote weight loss in their clinical care, due in part to constraints of time and training for most health care providers and clinicians.”

The results of the study, published in today’s (April 23) online issue of Diabetes Care, found that 72 percent of participants on the weight loss program that included portion-controlled foods and personalized counseling were able to change their insulin use compared with 8 percent of the control group. Similarly, other diabetes, cholesterol and blood pressure drugs were decreased or discontinued more often among the weight loss program enrollees.

According to the Centers for Disease Control and Prevention, 35 percent of adults in the United States are obese and 8 percent of adults are affected by diabetes.

“Weight loss is a primary strategy for successful management of type 2 diabetes due to its impact on glycemic control and improvements in cardiovascular disease risk factors,” said Rock. “These study results suggest that patients not only lose weight on structured commercial weight loss programs that include behavioral modification and individual support, but that this weight loss translates to significant improvements in diabetes control and cardio-metabolic parameters.”

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Saving diabetics from blindness in Libya


UC Berkeley grad student, professor, alum join forces in international public service project.

UC Berkeley optometry student Fatima Elkabti and professor Jorge Cuadros discuss a magnified digital image of a healthy retina.

A UC Berkeley graduate student in optometry, one of her professors and a Berkeley alumnus have joined forces to build a long-distance diagnostic project that has the potential to keep a large number of people in crisis-torn Libya from going blind.

The public service project involves training Libyan doctors to take detailed digital photographs inside patients’ eyes, of their retinas, as part of routine health care and put the images online for remote diagnosis of damage caused by diabetes before it’s too late. Too often, diabetes-related retinopathy isn’t caught until it causes symptoms, when treatment can no longer save vision.

The first 11 Libyan doctors underwent training for three days in February in Istanbul, in a seminar organized by the Avicenna Group and taught by Berkeley optometry professor Jorge Cuadros. Turkey was chosen as the training site for security reasons and because it is easily accessible from Libya.

If all goes according to plan, many more doctors will be trained over the next year, both in Libya and out — all because of a project that developed rapidly from a seed planted in a Diabetic Health Clinic class in Berkeley’s School of Optometry.

In the class, Cuadros taught students how to analyze photos of diabetic retinopathy as part of EyePACS, the California-based online initiative he co-founded to train people working in diabetes care to screen patients’ vision for remote diagnosis by certified eye doctors.

In his class was third-year optometry student Fatima Elkabti, who knows firsthand the toll that diabetes is taking in Libya, where the disease is rampant but greatly underdiagnosed. Elkabti’s father, a Libyan, has diabetes, as do about half of her many aunts and uncles.

“I walked out of the class and asked Dr. Cuadros, ‘Can we do this in Libya?’ “ Elkabti relates. Do some research, the professor told her.

Elkabti got to work and within an hour found Ethan Chorin, who earned his Ph.D. at Berkeley in 2000, served in the U.S. diplomatic corps in Libya from 2004 to 2006 and has published a book about the recent Libyan revolution. He founded the not-for-profit Avicenna Group in 2011 with a Libyan-American colleague to catalyze health-related partnerships between Libyan organizations and U.S. universities. Traveling back and forth between Benghazi and Berkeley, he looked for ways to involve Berkeley in Libya’s reconstruction efforts.

“I shot Ethan an email, and within hours we were talking about how to make this happen,” Elkabti says. The Berkeley-Libya retinopathy project was off and running.

Diabetes-related retinopathy is one of the leading causes of blindness in Libya — as well as in the United States and in much of the world. EyePACS has brought retinal screenings to poor and medically underserved areas from California’s Central Valley to Peru, and the Libyan retinopathy project extends the concept to politically unstable and dangerous regions.

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New organ transplant strategy aims to better prevent rejection


UCSF approach might end lifelong drug treatment.

Qizhi Tang, UC San Francisco

Organ-transplant recipients often reject donated organs, but a new, two-pronged strategy developed by UC San Francisco researchers to specifically weaken immune responses that target transplanted tissue has shown promise in controlled experiments on mice.

The hope is that using this novel treatment strategy at the time of transplantation surgery could spare patients from lifelong immunosuppressive treatments and their side effects. The approach might also be used to treat autoimmune diseases such as type 1 diabetes, the researchers said. The study is published and commented upon in a recent issue of American Journal of Transplantation.

The study was conducted in mouse studies of islet-cell transplantation — a procedure used to restore insulin secretion and control over glucose levels in the blood in patients with life-threatening diabetes. The treatment allowed more than 70 percent of mice to accept transplants without requiring any long-term treatment with immunosuppressive drugs.

The approach, led by Diabetes Center member Qizhi Tang, Ph.D., involved using cells from donors to activate immune cells called donor-reactive effector T cells. The researchers then gave the mice a drug called cyclophosphamide, known to specifically kill activated cells.

Up to 80 percent of the donor-reactive effector T cells, which play a major role in transplant rejection, were eliminated by this treatment. However, that procedure alone did not prolong survival of transplanted tissue.

That required a second step: Some of the mice also received cell therapy — an expanded population of cells called TREGs that quell immune activity. Seventy percent to 80 percent of these mice accepted the transplants, without requiring any long-term immunosuppressive drugs.

Significantly, when the cell therapy was used only in those cells that specifically target donor tissue, only one-fifth as many cells were needed to prevent transplant rejection, the UCSF researchers found. The bigger bang per cell may bode well for clinical protocols, Tang suggested.

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Study represents important step toward a cure for type 1 diabetes


Scientists reprogram skin cells into insulin-producing pancreas cells.

Sheng Ding

A cure for type 1 diabetes has long eluded even the top experts. Not because they do not know what must be done—but because the tools did not exist to do it. But now scientists in the laboratory of Gladstone Institutes’ investigator Sheng Ding, M.D., Ph.D., harnessing the power of regenerative medicine, have developed a technique in animal models that could replenish the very cells destroyed by the disease. The team’s findings, published online today (Feb. 6) in the journal Cell Stem Cell, are an important step towards freeing patients from the life-long injections that characterize this devastating disease.

Type 1 diabetes, which usually manifests during childhood, is caused by the destruction of beta-cells (ß-cells). ß-cells are a type of cell that normally resides in the pancreas and produces a hormone called insulin. Without insulin, the body’s organs have difficulty absorbing sugars, such as glucose, from the blood. Once a death sentence, the disease can now be managed with regular glucose monitoring and insulin injections. A more permanent solution, however, would be to replace the missing ß-cells. But these cells are hard to come by, so researchers have looked towards stem cell technology as a way to make them.

“The power of regenerative medicine is that it can potentially provide an unlimited source of functional, insulin-producing ß-cells that can then be transplanted into the patient,” said Ding, who is also a professor at UC San Francisco, with which Gladstone is affiliated. “But previous attempts to produce large quantities of healthy ß-cells — and to develop a workable delivery system — have not been entirely successful. So we took a somewhat different approach.”

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Resetting the metabolic clock


Insight into mammalian circadian rhythms could lead to therapies for obesity, diabetes.

Circadian rhythms are affected by things like travel over time zones, diet and light exposure. (Illustration by Peter Allen)

Circadian rhythms are affected by things like travel over time zones, diet and light exposure.

We’ve all heard about circadian rhythm, the roughly 24-hour oscillations of biological processes that occur in many living organisms. Yet for all its influence in many aspects of our lives — from sleep to immunity and, particularly, metabolism — relatively little is understood about the mammalian circadian rhythm and the interlocking processes that comprise this complex biological clock.

Through intensive analysis and computer modeling, researchers at UC Santa Barbara have gained insight into factors that affect these oscillations, with results that could lend themselves to circadian regulation and pharmacological control. Their work appears in the early edition of the Proceedings of the National Academy of Sciences.

“Our group has been fascinated with circadian rhythms for over 10 years now, as they represent a marvelous example of robust control at the molecular scale in nature,” said Frank Doyle, chair of UCSB’s Department of Chemical Engineering and the principal investigator for the UCSB team. “We are constantly amazed by the mechanisms that nature uses to control these clocks, and we seek to unravel their principles for engineering applications as well as shed light on the underlying cellular mechanisms for medical purposes.”

“Focus is often given to metabolism, cell division and other generic cell processes, but circadian oscillations are just as central to how life is organized,” said Peter St. John, a researcher in the Department of Chemical Engineering and lead author of the study.

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Researchers explain why some wound infections become chronic


Decreasing levels of “reactive oxygen species” can break cycle of unhealing wounds.

Manuela Martins-Green, UC Riverside

Manuela Martins-Green, UC Riverside

Chronic wounds affect an estimated 6.5 million Americans at an annual cost of about $25 billion. Further, foot blisters and other diabetic ulcers or sores account for the vast majority of foot and leg amputations in the United States today.

Why does treating chronic wounds cost so much?  What complicates chronic wound infections, making healing difficult?

Manuela Martins-Green, a professor of cell biology at the University of California, Riverside, reports that two biological activities are out of control in chronic wound infections. These are reactive oxygen species (ROS), which are chemically reactive molecules formed by the partial reduction of oxygen, and biofilms that are formed by selective invading bacteria.

ROS is the natural byproduct of the normal oxygen metabolism and plays a role in cell signaling and homeostasis. However, excessive ROS can induce chronic inflammation, a key characteristic of wounds that do not heal. The biofilms are bacterial defense mechanisms. Together they create a toxic environment that can resist efforts to heal and close a chronic wound.

“By decreasing ROS levels within a chronic wound in a diabetic mouse model, my lab was able to normalize conditions and heal the wound,” Martins-Green said. “Indeed, we saw significant improvement in healing the wound.”

She announced her findings today (Dec. 17) in New Orleans at the 53rd annual meeting of the American Society for Cell Biology.

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Minorities’ health would benefit most from beverage sugar tax


UCSF research team concludes that tax would result in lower rates of diabetes, heart disease.

Kirsten Bibbins-Domingo, UC San Francisco

Kirsten Bibbins-Domingo, UC San Francisco

Taxing sugar-sweetened beverages is likely to decrease consumption, resulting in lower rates of diabetes and heart disease, and these health benefits are expected to be greatest for the low-income, Hispanic and African-American Californians who are at highest risk of diabetes, according to a new analysis led by researchers at UC San Francisco.

Over the course of the next decade, lowered incidence of these diseases would save over half a billion dollars in medical costs, concluded the research team, which includes members from Oregon State University and the Mailman School of Public Health at Columbia University.

The researchers previously modeled the national health effects of a penny-per-ounce tax over the course of 10 years and found that it would reduce consumption among adults by 15 percent, modestly lower the prevalence of diabetes and obesity and prevent tens of thousands of coronary heart events, strokes and premature deaths. The new study considered a range of reductions in sugary beverage consumption among Californians.

In the new study, assuming a decline of 10 to 20 percent in the consumption of soda and other sugary beverages from the tax, researchers concluded that new cases of diabetes and coronary heart disease would drop statewide, and those health benefits would be greatest in poor and minority communities. The analysis, published Dec. 11 in the online journal PLOS ONE, predicted that overall, one in 20,000 Californians would avoid diabetes. This estimate would double for Hispanics and poor Californians and triple for African Americans.

”Poor and minority communities in California and nationally have very high rates of diabetes, a chronic condition with potentially devastating health complications,” said Kirsten Bibbins-Domingo, M.D., Ph.D., UCSF professor of medicine and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Although many steps are needed to reverse the rising diabetes trends in the state, our study suggests that efforts to curb sugary beverage consumption can have a significant positive impact, particularly in those most likely to be affected.”

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Islet transplantation gains momentum in type 1 diabetes


UCSF experts improve treatments to prevent rejection.

A close-up of islet cells from a human pancreas. (Image courtesy of Gregory Szot, UC San Francisco)

A close-up of islet cells from a human pancreas.

For the worst cases of type 1 diabetes, islet transplantation already has freed hundreds of people from complete dependence on insulin and from life-threatening consequences of the disease.

However, the procedure still is regarded as experimental by the U.S. Food and Drug Administration (FDA).

Islets are clusters of insulin-making cells in the pancreas that are destroyed in people with type 1 diabetes. After transplanting islet cells from a donor pancreas, the new islet cells can begin to produce insulin.

“Overall the results of islet transplantation are much better than they used to be,” said UC San Francisco transplant surgeon Andrew M. Posselt, M.D., Ph.D.,  “We’re approaching results as good as we see with whole pancreas transplants.”

Posselt, who co-directs the Clinical Islet Transplant Program at UCSF, is part of an international push to bring islet transplantation into the mainstream. As part of that movement, experts gathered in Monterey in September for 14th World Congress of the International Pancreas and Islet Transplant Association (IPITA). World Congress chair, Peter Stock, M.D., Ph.D., is the other co-lead of the UCSF program.

The meeting – sponsored by IPITA, the Transplantation Society and the Department of Surgery at UCSF – included discussions on new ways to foster long-term survival of transplanted islets and to prevent their rejection by the immune system, which is the key to controlling blood sugar without reliance on precisely administered insulin injections.

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Enzyme restores function with diabetic kidney disease


Mouse findings reverse prevailing theory, point to potential treatment options.

Transmission electron micrograph of a cell mitochondrion. (Image courtesy of Thomas Deerinck, National Center for Microscopy and Imaging Research, UC San Diego)

Transmission electron micrograph of a cell mitochondrion.

Researchers at the UC San Diego School of Medicine say that while a prevailing theory suggests elevated cellular levels of glucose ultimately result in diabetic kidney disease, the truth may, in fact, be quite the opposite. The findings could fundamentally change understanding of how diabetes-related diseases develop – and how they might be better treated.

Writing in today’s (Oct. 25) issue of Journal of Clinical Investigation, Kumar Sharma, M.D., professor of medicine and director of the Center for Renal Translational Medicine (CRTM) at UC San Diego; Laura Dugan, M.D., professor of medicine and Larry L. Hillblom Chair in geriatric medicine; Young You, Ph.D., CRTM; Robert Naviaux, M.D., Ph.D., professor of medicine; and colleagues describe first-ever studies of real-time superoxide production in the kidneys of live mice with type 1 diabetes.

Current theory posits that impaired diabetic kidney function in humans as well as in mice is the result of chronically high glucose (sugar) levels which prompt energy-generating mitochondria in cells to produce an overabundance of superoxide anion – a highly reactive, toxic molecule that ultimately leads to downstream cellular damage, organ dysfunction and disease.

But Sharma, who also works for the Veterans Administration San Diego Healthcare System, and colleagues upend this theory. Rather than detecting higher-than-normal levels of superoxide in the damaged kidneys of the diabetic mice, the researchers discovered reduced superoxide production and suppressed mitochondrial activity. When they stimulated the mitochondria by activating a key energy-sensing enzyme called AMPK, superoxide production increased but evidence of diabetic kidney disease markedly declined.

“Mitochondrial superoxide does not seem to be a causative factor of diabetic kidney disease,” said Sharma. “Indeed, when mitochondrial superoxide is increased with AMPK activation, there is reduced kidney disease, suggesting that improving mitochondrial function and superoxide production is actually beneficial for diabetic complications. This idea is a sea change in the field of diabetic complications.”

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