Over 350 million adults have diabetes

Following explosion in prevalence spanning three decades:

An estimated 350 million people in the world have diabetes, according to a major new international study. The study shows that diabetes prevalence has risen (in many cases sharply), or at best remained unchanged, in virtually every part of the world during the past three decades. The article authors Professor Majid Ezzati, and Dr Goodarz Danaei, say Patients with diabetes have inadequate blood sugar control. This can lead to heart disease and stroke, as well as damage to the kidneys, nerves, and the retinae. High blood glucose and diabetes cause some 3 million deaths globally each year, a number that will continue to rise as the number of people affected increases.

The researchers analysed fasting plasma glucose (FPG) data from 2.7 million participants aged 25 and over across the world, and used advanced statistical methods to estimate prevalence. They found that the number of adults with diabetes increased from 153 million in 1980 to 347 million in 2008. This is considerably higher than a 2009 study that estimated 285 million adults globally had diabetes. While 70% of this rise was due to population ageing (ageing increases the risk of diabetes), the other 30% was due to higher prevalence across different age groups, caused by increases in risk factors such as obesity.

The percentage of male adults with diabetes worldwide rose from 8.3% to 9.8% (an 18% rise) across the three decade period, with adult female prevalence increasing from 7.5% to 9.2% (a 23% increase).

To test whether or not someone has diabetes, doctors measure the levels of glucose in a patient's blood after they have not eaten for 12 to 14 hours, since blood sugar rises after a meal. FPG below 5.6 millimoles per litre (mmol/L) is considered normal, above 7 mmol/L is diagnostic of diabetes and an FPG level between 5.6 and 7 is considered pre-diabetes. This new study found mean global FPG had risen in both men and women.

Among high-income countries, the USA saw FPG rise at more than the twice the rate of Western Europe over the three decades. In these wealthy nations, diabetes and glucose levels were highest in USA, Greenland, Malta, New Zealand and Spain, and lowest in the Netherlands, Austria and France. Despite its obesity epidemic, the UK's diabetes prevalence was lower than that of most other high-income countries.

In a league of 27 western high-income countries, British men were 5th best (or had the 5th lowest diabetes rates), while British women were 8th best.

Globally, diabetes has taken off most in Pacific Island nations. In states such as the Marshall Islands, one in three women and one in four men have diabetes. Saudi Arabia also reported very high rates. Glucose and diabetes were also particularly high in south Asia, Latin America, the Caribbean, Central Asia, North Africa and the Middle East.

The region with the lowest glucose levels was sub-Saharan Africa, followed by east and southeast Asia. Eastern Europe's diabetes prevalence, while not low, changed little over the three decade period.

The authors noted a strong correlation between increasing diabetes prevalence and rising body-mass index trends worldwide - a correlation higher for women than for men. But they say: "However, genetic factors associated with ethnic origin, fetal and early life nutritional status, diet quality, and physical activity might also affect glycaemic values and trends [and therefore diabetes prevalence]."

Professor Ezzati adds*: "Diabetes is one of the biggest causes of morbidity and mortality worldwide. Our study has shown that diabetes is becoming more common almost everywhere in the world. This is in contrast to blood pressure and cholesterol, which have both fallen in many regions. Diabetes is much harder to prevent and treat than these other conditions."

Dr. Danaei adds*: "Unless we develop better programmes for detecting people with elevated blood sugar and helping them to improve their diet and physical activity and control their weight, diabetes will inevitably continue to impose a major burden on health systems around the world."

In a linked Comment, Dr Martin Tobias, Health and Disability Intelligence, Ministry of Health, Wellington, New Zealand, concludes: "Worldwide...the urgent need is to strengthen basic surveillance of dysglycaemia and diabetes, including standardised frameworks, case definitions, survey methods, tools, and reporting protocols.

The forthcoming high-level meeting of the UN General Assembly on the Prevention and Control of Non-communicable Diseases (New York, Sept 19-20, 2011), provides a welcome opportunity to strengthen global commitment to non-communicable disease surveillance."

Source The Lancet

Exercise produces positive effects on intervertebral discs

Physical exercise has a positive effect on the formation of cells in the intervertebral discs. This is shown by a study from the Sahlgrenska Academy, University of Gothenburg, presented at the annual meeting of the International Society for the Study of the Lumbar Spine (ISSLS), which is currently taking place in Gothenburg.

The study shows that physical activity has a positive effect on cells in the intervertebral discs. The result is based on rats undergoing treadmill exercise. It was subsequently studied how many new cells in the intervertebral discs were formed in rats that had run on a treadmill for about one hour a day compared with animals that had only moved around freely in a cage. "This is new knowledge showing that the intervertebral discs can be positively affected by physical activity," says spine surgeon Helena Brisby at Sahlgrenska University Hospital. Pain in the lumbar spine is common and may be due to disc degeneration, which means that the disc cells no longer have normal functions.

Based on the results of the study, the research team led by Helena Brisby and Björn Rydevik intends to go on to study whether the cells in degenerated discs respond as positively to exercise as they have now shown to do in normal discs.

"Physical exercise is already an important part of the treatment for back pain today, but there is limited knowledge about the specific effect that exercise has on the discs and what the optimal dose of exercise is," says Prof. Björn Rydevik at Sahlgrenska Academy.

The research team plan for continued studies with this animal model, which hopefully will establish whether exercise can prevent disc degeneration and could consequently prevent back pain, but also aims to study the effect of exercise when back problems have already arisen.

Sources: University of Gothenburg, AlphaGalileo Foundation

Effect of asperger syndrome noticeable in babies

People with Asperger syndrome have problems with social interaction and attentiveness, and are also sensitive to noise and light. Several of these characteristics were evident to parents during their child's first two years, reveals Petra Dewrang at Gothenburg University.

In her thesis, Dewrang investigated how individuals with Asperger syndrome aged 14-24 perceive themselves relative to their diagnosis.

The thesis is based on interviews, tests and self-evaluations. A questionnaire for parents also resulted in important descriptions of these individuals' behaviour and development from infancy onwards.

The results show first and foremost that the similarities are greater than the differences when the Asperger group and the comparison group describe their lives.

"But the differences that do exist are vital for understanding how people with Asperger syndrome stand the best chance of getting by," says Dewrang.

The Asperger group were as content with themselves and their lives as the comparison group.

But they found it harder to build relationships with other people, and their plans for the future were less "adventurous". Parents and siblings were more present in their lives than is normal for this age group, even after they had left home.

On the other hand, they were just as good at social cognition as the comparison group when they had to explain why the key person in a story reacted in a certain way.However, the ability to theoretically understand other peoples' thoughts and feelings are not always enough for making friends in real life.

Sources: University of Gothenburg, AlphaGalileo Foundation.

Scientists with new insight into the brain processes

The yellow jacket (Rocky, the mascot of the University of Rochester) appears to be expanding. But he is not. He is staying still.

We simply think he is growing because our brains have adapted to the inward motion of the background and that has become our new status quo.

Similar situations arise constantly in our day-to-day lives jump off a moving treadmill and everything around you seems to be in motion for a moment.

This age-old illusion, first documented by Aristotle, is called the Motion Aftereffect by today's scientists. Why does it happen, though? Is it because we are consciously aware that the background is moving in one direction, causing our brains to shift their frame of reference so that we can ignore this motion? Or is it an automatic, subconscious response? Davis Glasser, a doctoral student thinks he has found the answer.

In their paper, the scientists show that humans experience the Motion Aftereffect even if the motion that they see in the background is so brief that they can't even tell whether it is heading to the right or the left.

Even when shown a video of a pattern that is moving for only 1/40 of a second (25 milliseconds) so short that the direction it is moving cannot be consciously distinguished a subject's brain automatically adjusts. If the subject is then shown a stationary object, it will appear to him as though it is moving in the opposite direction of the background motion. In recordings from a motion centre in the brain called cortical area MT, the researchers found neurons that, following a brief exposure to motion, respond to stationary objects as if they are actually moving. It is these neurons that the researchers think are responsible for the illusory motion of stationary objects that people see during the Motion Aftereffect.

This discovery reveals that the Motion Aftereffect illusion is not just a compelling visual oddity: It is caused by neural processes that happen essentially every time we see moving objects. The next phase of the group's study will attempt to find out whether this rapid motion adaptation serves a beneficial purpose in other words, does this rapid adaptation actually improve your ability to estimate the speed and direction of relevant moving objects, such as a baseball flying toward you.

Source: University of Rochester

Genes influence memory and sense of orientation

How do our brains process memory and sense of orientation? Scientists are gaining insight by studying rats with implanted genes that prompt neurons to fire on command.

Researchers at the Norwegian University of Science and Technology (NTNU) in Trondheim are studying how the human brain carries out its tasks related to memory and spatial orientation.

The knowledge being generated at CBM will also apply to areas of the brain other than those involved in these specific functions.

"The brain uses the same building blocks for a variety of functions, so our findings for memory and sense of orientation will likely apply to the rest of the brain as well," says Professor Edvard Moser.

The researchers are identifying which types of neurons are found in the brain's centres for memory and sense of orientation, and their respective functions. This is essential information since different types of memories are formed and stored in different neurons and neural pathways. In order to identify the neurons, the researchers use gene technology and other molecular biological methods. CBM is one of the first research groups in the world to implement a new technique for identifying the functions of specific neurons.

"First we insert a gene for light sensitivity into the neurons we want to study," explains Professor Edvard Moser. "Then when we illuminate the neurons by laser, they send out electrical signals. By recording where these signals originate, we can see precisely where in the centres for memory and sense of orientation those neurons are located."

Sources: Research Council of Norway, AlphaGalileo Foundation

The newest AIDS drug is first to be approved in 3 years

Two decades after Rutgers scientists began working with Paul Janssen, a legendary drug developer to create new and potent drugs to fight AIDS, the FDA has approved the second anti-HIV drug that came from this collaboration. "For a drug to successfully make it to the finish line, countless obstacles must be overcome," said Board of Governors Professor of Chemistry and Chemical Biology Eddy Arnold, who led the Rutgers team of scientists. "As a researcher in biomedical sciences I can tell you that helping to create new medicines is something you always dream about."

The newest AIDS drug, (rilpivirine) Edurant- the first to be approved by the U.S. Food and Drug Administration in the last three years and manufactured by Tibotec Therapeutics, a subsidiary of J&J - was developed in 2001 and took a decade to make its way through the regulatory process and clinical trials.

"From the beginning, we knew this would be a long-term project," said Arnold, who is also a resident faculty member of the Center for Advanced Biotechnology Medicine. His research team received $20 million for the project, primarily from the National Institutes of Health, including two prestigious MERIT (Method to Extend Research in Time) NIH awards, an honor bestowed on less than 5 percent of NIH grant recipients. "Many challenges have been faced and overall it has been more like a marathon than anything else," he said.

Resistant strains of HIV are a growing medical problem because the virus is constantly mutating, and the changes can cause existing AIDS drugs from being able to work.

Arnold's team developed innovative models that explain not only why Edurant, approved by the FDA last month, and Intelence, approved in 2008, are particularly effective against drug-resistant viruses but can also be used in the development of treatments for a wide variety of other diseases. The gist of the model is that flexibility of a drug can allow it to adapt to changes in HIV.

Clinical trials for Edurant, which included more than 1,300 adults with HIV, indicated that 83 percent of those who were given this anti-AIDS drug for a 48-week period had undetected levels of HIV in their blood at the conclusion of the clinical trial. The new drug can be prescribed as a once-a-day pill to HIV-positive adults who have not received any prior treatment or therapy. Besides being available in the United States, a generic form of the drug will be made available to millions of people in Saharan Africa, India and other developing nations.

"Development of this newest AIDS drug represents a wonderful example of the biomedical power that can be harnessed by scientific collaborations and partnerships between university, government, and private sector research enterprises," said Kenneth J. Breslauer, dean of Life and Health Sciences. "No more satisfying and important outcome can result from university research."

This scientific collaboration began in 1987 when the Rutgers team entered into a partnership with Stephen Hughes, an AIDS researcher at the National Cancer Institute. Both were interested in understanding the molecular structure and function of reverse transcriptase, an essential part of the AIDS virus, not only for its fundamental significance, but also because they believed it would provide guidance for the design of more effective drugs.

Source: Robin Lally Rutgers University

How monkeys survive AIDS-like infection

Sooty mangabeys, a type of African monkey, have intrigued scientists for years because they can survive infection by SIV, a relative of HIV, and not succumb to AIDS.

Researchers have identified a way some of sooty mangabeys' immune cells resist infection: they close the gates that SIV and HIV use to get into the cell. The findings may lead to strategies to help HIV-infected individuals cope better with infection.

The results are published online in the journal Nature Medicine.

"We have shown sooty mangabeys can prevent SIV from infecting a very important part of the immune system," says first author Mirko Paiardini, PhD, senior research scientist at Yerkes National Primate Research Center, Emory University. "This protection from infection comes from reducing the levels on the cell surface of a molecule that SIV uses to enter the cell."

Co-first author is postdoctoral fellow Barbara Cervasi. The senior author is Guido Silvestri, MD, chief of microbiology and immunology at Yerkes National Primate Research Center, Emory University.

Collaborators included investigators from NIH, University of Pennsylvania, University of Pittsburgh and University Hospital Ulm.

To infect a cell, HIV and SIV need to find two molecules on the cell's surface. Scientists call these molecules co-receptors, and they can be thought of as gates. One of the co-receptors is CD4, which appears on immune cells called T cells. The other is called CCR5. Stimulating a T cell usually increases the level of CCR5, facilitating infection.

Paiardini, Cervasi and their colleagues found that in sooty mangabeys, a type of T cell called a central memory T cell doesn't turn on CCR5.

This means that even when a sooty mangabey is infected with SIV, some T cells can mostly avoid being killed by the virus.

Memory T cells help the immune system respond to an infection faster and stronger the second time around. Central memory T cells are long-lived and found in lymph nodes, in contrast to effector memory T cells, which have shorter life spans and are found mostly in tissues, such as the intestines, Paiardini says.

"Not all T cells are created equal," he says. "Some appear to be more important than others for keeping the immune system up and running.

This is why having central memory T cells resistant to infection is so valuable. By protecting central memory T cells, sooty mangabeys avoid the loss of T cells and the chronic immune activation that are the hallmarks of AIDS in humans."

Source: Lisa Newbern Emory University