New aid to help identify and manage patients with diabetes at increased risk of fracture

Fragility fractures are a serious yet neglected complication of both type 1 and type 2 diabetes, with enhanced risk of fragility fractures in individuals with diabetes reaching out across the life span.

This is a concern as, globally, the prevalence of diabetes in adults is expected to increase from very nearly 425 million today, to around 629 million by 2045. In the meantime, many clinicians who treat patients with diabetes are not aware of their patients' heightened risk of disabling and potentially life-threatening fractures.

Specialist stated the link between diabetes and skeletal health is complex and the optimal approach to the management of bone health in patients with diabetes is not yet definitive and may change after some time as discoveries of new clinical studies become available. This new review will inform clinicians about the present state of knowledge, and, importantly, the clear algorithm will facilitate the clinical assessment and management of fragility fracture risk in their patients according to current best practice. 

The review outlines the clinical characteristics of bone fragility in adults with diabetes, and highlights recent studies that have evaluated bone mineral density, bone microstructure and biochemical markers, material properties, and fracture prediction (FRAX). It also looks at the effect of diabetes drugs on bone, and additionally the efficacy of osteoporosis treatments in these patients.

Key messages incorporate:

• FRAX and BMD T-score predict fracture risk in those with type 2 diabetes; however both require modification for diabetes to avoid underestimation of risk.
• The pathophysiology of bone delicacy in diabetes is likely multifactorial.
• If a patient has sign for treatment in view of criteria produced for non-diabetes patients, these patients should be treated with osteoporosis drugs. Without built up osteoporosis, these pharmaceuticals might be utilized, despite the fact that with caution as the impacts of these medications in situations where bone fragility is mostly because of alterations in bone quality remain to be thoroughly evaluated.
• Future studies should continue to evaluate the structural determinants (material properties, microstructure etc.) of bone fragility and refine fracture prediction algorithms by including disease-specific determinants of fracture.
• New trials will have to prospectively investigate the efficacy and safety of osteoporosis treatment in diabetics with and without low a bone mineral density.

Contact details:
Tiffany Hales
Program Manager | Diabetic 2018
Email id: diabetes@mehealthevents.org

New biomarkers of inflammation identified as risk of polyneuropathy

Polyneuropathy is one of the most common complications in individuals with diabetes. However, it can likewise happen with certain risk factors or diseases before the beginning of diabetes. First symptoms are frequently pins-and-needles sensations in the feet. Although polyneuropathy is present in about 30% of people with diabetes, it frequently remains undiagnosed. Researchers have now been able to show for the first time that six biomarkers of inflammation show the risk of polyneuropathy.   

Although many patients suffer from polyneuropathy, relatively little is currently known about its development, which additionally limits the therapeutic options. It is known that inflammatory processes add to other diabetic complications such as stroke or heart attack. The aim of this new examination was therefore the extensive analysis of biomarkers that describe inflammatory processes as a risk factor for distal sensory polyneuropathy (DSPN).  The two individuals with type 2 diabetes and people in the elderly general population were analysed.

In their study, they identified novel biomarkers that show the risk of polyneuropathy. For the first time, researchers were also able to find indications that in addition to the innate immune system, the adaptive immune system could be involved in the development of the disease. These findings could open new therapeutic perspectives. The aim could be to impact the immune system accordingly and thus ultimately prevent the development or progression of neuropathy.

Study -- Procedure and Design

The examination included 513 men and women of the population-based KORA F4/FF4 cohort aged 62 to 81 years who had no distal sensory polyneuropathy at the beginning of the study. Of these people, 127 developed a distal sensory polyneuropathy during the 6.5 year follow-up period. The serum level of 26 of these 71 biomarkers was higher in individuals who developed polyneuropathy during the study than in people without polyneuropathy. After statistical correction for multiple testing, higher concentrations of six biomarkers remained related with the distal sensory polyneuropathy risk.   

The chemokines indicates neurotoxic effects in a cell culture model, which showed their involvement in the development of neuropathy. When the data for these six biomarkers were added to a clinical risk model, the predictive quality of the model enhanced significantly. Further pathway examinations showed that different cell types of innate and adaptive immunity are likely to be involved in the development of DSPN. Overall, this examination has therefore been able to reveal novel relationship between biomarkers of inflammation and the risk of polyneuropathy and to give evidence suggesting a complex interaction of adaptive and innate immunity in the development of this complication.  

Conclusion

This examination significantly improves understanding of the role of inflammatory processes in the improvement of DSPN in the elderly both with and without type 2 diabetes. The primary findings must now be replicated in other cohorts. In addition to biochemical examinations, examinations of immune cells are also important. The long-term aim of this work is to clarify whether and how modulation of inflammatory processes can supplement the options for prevention and therapy of DSPN.

Contact details:
Tiffany Hales
Program Manager | Diabetic 2018
Email id: diabetes@mehealthevents.org

Crash diets can cause a transient deterioration in heart function

Crash diets, also called meal replacement programmes, have turned out to be progressively elegant in a previous couple of years. These eating methodologies have a low-calorie substance of 600 to 800 kcal every day and can be compelling for getting more fit, decreasing circulatory strain, and turning around diabetes. Yet, the impacts on the heart have not been considered as of not long ago. This examination utilized attractive reverberation imaging (MRI) to research the effect of a low calorie consume fewer calories on heart work and the appropriation of fat in the stomach area, liver, and heart muscle. The investigation included 21 stout volunteers. The normal age was 52 years, normal weight list (BMI) was 37 kg/m2, and six were men. Members devoured a low-calorie eating regimen of 600 to 800 kcal every day for two months. X-ray was performed at the beginning of the investigation and following one and two months. Following one week, add up to muscle versus fat, instinctive fat and liver fat had all essentially fallen by a normal of 6%, 11%, and 42%, separately. This was joined by critical upgrades in insulin protection, fasting all out cholesterol, triglycerides, glucose, and pulse. Nonetheless, following one week, heart fat substance had ascended by 44%. This was related with a weakening in heart work, 3 including the heart's capacity to pump blood. By two months, heart fat substance and capacity had enhanced past what they had been before the eating routine started and every single other estimation including muscle to fat ratio and cholesterol were proceeding to make strides. The metabolic upgrades with a low-calorie count calorie, for example, a lessening in liver fat and inversion of diabetes, would be required to enhance heart work. Rather, heart work deteriorated in the main week before beginning to make strides. The sudden drop in calories makes fat be discharged from various parts of the body into the blood and be taken up by the heart muscle. The heart muscle likes to pick between fat and sugar as fuel and being overwhelmed by fat declines its capacity. After the intense period in which the body is acclimating to emotional calorie limitation, the fat substance and capacity of the heart progressed.

Contact details:

Tiffany Hales 

Program Manager | Diabetic 2018

Mail id: diabetes@mehealthevents.org

Brain activity helps explain diabetics negative feelings, risk for depression

Study suggests those negative feelings may originate from problems regulating blood sugar levels that impact emotional response in the brain. The examination found people with Type 2 diabetes and prediabetes will probably focus on and have a strong emotional response to threats and negative things, which influences quality of life and increases risk for depression.  

Specialist says gauging the startle response allowed researchers to measure central nervous system activity using tiny electrodes placed below the eye. Study participants viewed a progression of negative, positive and neutral images intended to evoke an emotional response. The electrodes captured the rate of flinch or startle, a contraction we cannot control, associated with each image, researchers said.

Individuals with more elevated amounts of insulin resistance were more startled by negative pictures. By expansion, they might be more reactive to negative things in life. It is one piece of evidence to suggest that these metabolic problems are related to issues with how we perceive and deal with things that stress all of us out.

The specialists say the evidence is even more compelling when combined with the results of EEG tests recording activity when the brain is at rest. Study participants with prediabetes and Type 2 diabetes had greater activity on the right side of the brain, which is associated with depression and negative emotions. If someone is predisposed to focusing on negative things, it may become a barrier for getting thinner and switching medical problems.

Individuals with prediabetes and diabetes also recorded lower cortisol levels, a potential indicator of chronic stress and cognitive test scores, providing giving extra help to the discoveries.

For people with blood sugar problems, being more stressed and responsive can cause blood sugar to spike. If people with diabetes and prediabetes are trying to treat or reverse the disease, stressful events may hinder their goals. Frequent negative reactions to stressful events can prompt to a lower quality of life and create a vicious cycle that makes it hard to be healthy.

Contact details:
Tiffany Hales
Program Manager | Diabetic 2018
Mail id: diabetes@mehealthevents.org