Saturday, January 25, 2014

Consuming High Levels of Flavonoids Linked to Lower T2D Risk in Women

Medscape reports that research “in healthy women suggests that consuming high levels of flavonoids, including compounds found in berries, tea, grapes, and wine, could potentially lower the risk of type 2 diabetes.” Investigators found that “greater intake of these dietary compounds is associated with lower insulin resistance and better blood glucose regulation.” The research, published in the Journal of Nutrition, “also found that those who ate the most anthocyanins were least likely to suffer chronic inflammation, which is associated with diabetes, obesity, cardiovascular disease, and cancer.”

Spouses of Patients with Type 2 Diabetes Have Increased Risk of Developing the Disease

Individuals who have a spouse with type 2 diabetes have a 26% increased risk of developing the disease themselves, according to a systematic review and meta-analysis of studies that included nearly 75,500 couples. The studies were conducted from January 1997 through February 2013. TheBMC Medicine findings point to the importance of socioenvironmental factors in diabetes risk. They may also help improve diabetes detection and motivate couples to work together to adopt healthy lifestyles.

Monday, January 20, 2014

Chinese Herbs Reduce Progression to Diabetes by a Third

Medscape link:

Becky McCall

January 17, 2014

A combination of 10 Chinese medicinal herbs in a capsule, known as Tianqi, reduced progression to type 2 diabetes in people with impaired glucose tolerance (IGT) in a randomized controlled trial in China.

This is the first study to show that a Chinese herbal medicine can "reduce the progression of prediabetes to diabetes," says study author Chun-Su Yuan, MD, PhD, from the Tang Center for Herbal Medicine Research at the University of Chicago, Illinois. Tianqi "could provide a new option for diabetes management, using herbal medicine alone or as an adjuvant to currently used therapies," he noted.

The results are published online January 16 in the Journal of Clinical Endocrinology & Metabolism, and Dr. Yuan said robust data such as these are needed to help promote the use of Chinese herbal medicine by physicians in different countries.

Most significantly, the researchers found that taking Tianqi reduced the risk for diabetes by almost a third (32.1%) compared with placebo, after adjustment for age and gender. The proportion of participants who had normal glucose tolerance after 12 months of receiving either Tianqi or placebo was 63.1% (n=125) and 46.6% (n=89), respectively (= .001). A total of 36 participants in the Tianqi group (18.18%) and 56 in the placebo group (29.32%) developed diabetes (= .01).

A Role for Chinese Medicine in Diabetes Prevention?

The findings show that the Chinese herbal medicine was comparable to some pharmaceuticals in reducing progression to type 2 diabetes, say the researchers. For example, the results seen with Tianqi were similar to those found with acarbose, at 25%, and metformin, at 31%.

"Although no direct comparison has been made between Tianqi and antidiabetic prescription drugs, our data indicate that this Chinese herbal medicine had similar effects to metformin," reported Dr. Yuan.

Asked to comment on whether diabetes prevention was regularly practiced in the United States, he remarked that unacceptable adverse effects limited regular use of conventional therapies in the prevention of type 2 diabetes, with reports showing that long-term administration of acarbose or metformin had often been associated with unfavorable gastrointestinal events.

Around 79 million individuals in the United States aged over 20 years have prediabetes, a state in which blood glucose levels are higher than normal but do not meet the diagnostic criteria for type 2 diabetes.

Dr. Yuan added that their data also show that after a period of cessation of the Tianqi treatment, the preventive effects on type 2 diabetes development remained significant. "Moreover, the safety profile of this herbal medicine is very good without obvious adverse effects," he commented.

Chinese Herb Combination and Study Design

The Chinese medicine comprises several herbs that have been shown to lower blood glucose levels after meals. The Tianqi capsule is manufactured by Heilongjiang Baoquan Pharmaceutical and consists of 10 Chinese herbal medicines: Astragali Radix, Coptidis Rhizoma, Trichosanthis Radix, Ligustri Lucidi Fructus, Dendrobii Caulis, Ginseng Radix, Lycii Cortex, Ecliptae Herba, Galla Chinensis, and Corni Fructus. The quality of these herbs and decoction preparation was in accordance with the Chinese Pharmacopoeia, the researchers note.

Dr. Yuan said the key herb in the combination was Huanglian (Coptidis Rhizoma). "The critical component of this herb is berberine, which has been reported to have good antidiabetic effects," he toldMedscape Medical News in an interview. "Huanglian has been used traditionally in Chinese medicine in treating diabetic symptoms."

A total of 420 participants with IGT recruited from 11 research sites in China underwent double-blind randomization to receive either Tianqi (n=210) or a placebo (n=210) for 12 months. Participants had IGT with a 2-hour plasma glucose concentration of 7.8–11.1 mmol/L after a 75-g oral glucose tolerance test and fasting plasma glucose greater than 7.0 mmol/L.

Oral glucose tolerance tests were conducted every 3 months to assess the development of diabetes or restoration to normal glucose tolerance. In addition, all participants received similar lifestyle education.

The primary end point was the conversion of IGT to type 2 diabetes; body weight, body mass index, and adverse effects were monitored.

Need For More Controlled Trials of Chinese Medicinal Herbs

"Although the results of the present study need to be confirmed in future larger clinical trials, Tianqi holds promising potential as an effective and practical means to prevent type 2 diabetes, particularly in places in which herbal medicines are culturally accepted and widely used," say the authors.

They note that treating diabetes with Chinese herbal medicines is popular in China, particularly in rural areas.

"Our encouraging data should initiate further studies, both in China and in the West, to evaluate the role of Chinese herbal medicine in preventing and treating diabetes," said Dr. Yuan. "We are currently conducting several studies in this field."

This work was supported in part by the Ministry of Science and Technology of the People’s Republic of China, National Key Technology R&D Program. The authors have reported no relevant financial relationships.

J Clin Endocrinol Metab. Published online January 16, 2014. Abstract

Friday, January 17, 2014

High Potassium Intake Blunts the Effects of High Sodium on Blood Pressure

Among 1285 adults providing overnight urine samples, potassium excretion and the sodium to potassium ratio were related to systolic and diastolic blood pressure (BP) only in individuals consuming more than 6 g/day of salt. According to the Journal of the American Society of Hypertension study, individuals in the highest sodium-to-potassium ratio quartile had 8 mm Hg and 7 mm Hg higher systolic and diastolic BP, respectively, compared with those in the first quartile. Individuals in the fourth quartile of urinary potassium excretion had 6 mm Hg and 4 mm Hg lower systolic and diastolic BP, respectively, than those in the first quartile.

Cyst Growth Important for ADPKD Pathogenesis

Research in mice indicates that growth of renal cysts likely plays a central role in early-stage ADPKD-associated hypertension, with activation of the intrarenal renin–angiotensin system as a key mechanism. Cyst growth may also be the main determinant in renal concentrating deficit, an early finding in ADPKD, because maximum urine osmolality and urine nitrite excretion were reduced in young cystic mice but not in noncystic controls. The findings, published in Kidney International, were discovered by researchers who bred a Pkd1 floxed allele with a nestin-Cre expressing line to generate cystic mice with preserved GFR.

Are Home Hemodialysis and High-Dose Hemodialysis Better for Patients? Many Nephrologists Say Yes

Among 324 nephrologists from Europe, Canada, and the US who managed more than 25 adult dialysis patients, in-center hemodialysis was the most common type of dialysis used by patients (90%), followed by peritoneal dialysis (8%), and home hemodialysis (2%). Most nephrologists in the study believed home hemodialysis provides better quality of life, increasing the frequency of dialysis beyond 3 times per week significantly improves clinical outcomes, and longer dialysis sessions performed nocturnally would lead to significantly better clinical outcomes than traditional in-center hemodialysis. The findings, based on survey results, are published in BMC Nephrology.

Study: Cigarettes increased nicotine content over last 15 years.

The Boston Globe (1/16, Kotz) reports a Massachusetts Department of Public Health and University of Massachusetts Medical School study published online in the journal Nicotine and Tobacco Research indicates that particular cigarette manufacturers have increased the nicotine in their product. Researchers found the average cigarette contained 1.65 milligrams of the substance in 1999, but increased 15% to 1.89 milligrams in 2011. Study leader Thomas Land believes the increase may have resulted from redesigning several brands with alterations on filters or product length.

        The Springfield (MA) Republican (1/16, Flynn) also quotes Land as saying, “Cigarettes are getting more efficient at delivering nicotine to smokers. This could make it more difficult for a current smoker who is trying to quit, and easier for a young smoker to become addicted.”

Wednesday, January 15, 2014

FDA advisory panel backs orthostatic hypotension medication.

Bloomberg News (1/14, Edney) reports that “Chelsea Therapeutics International Ltd. won the backing of” an FDA advisory panel “for its drug to prevent sudden drops in blood pressure, a boost for the company’s effort to bring its first product to market.” The piece notes that “many panel members who voted in favor of approval said Chelsea showed the drug works short-term, and that initially is enough for such a rare, devastating disease with no other treatment options.”

        Reuters (1/15, Clarke) reports that the drug, Nothera (droxidopa), is for patients with neurogenic orthostatic hypotension (NOH), a rare, chronic type of low blood pressure that is linked with certain neurological disorders such as Parkinson’s disease.

        The AP (1/14) and MedPage Today (1/15) also report this story.

Green Tea Compounds May Decrease Effectiveness of Blood Pressure Drug

A compound in green tea may prevent the body from absorbing nadolol, a β-blocker used to treat high blood pressure, researchers have found. The study followed 10 adults who drank 3 cups of green tea for 2 weeks before taking nadolol. Participants then switched to drinking water before taking nadolol. After drinking green tea, blood levels of nadolol were 76% lower than levels measured after drinking water. Urine levels were about 80% lower. Additional experiments suggest that EGCG, an antioxidant in green tea, inhibits proteins that transport nadolol into cells. The findings are published in Clinical Pharmacology & Therapeutics.

Wednesday, January 1, 2014

Research Findings Question the Use of Buttonhole Cannulation in Routine Clinical Practice

In a CJASN analysis of clinical outcomes in 90 home hemodialysis patients, buttonhole (blunt needle) cannulation of vascular arteriovenous fistulae was associated with higher rates of infectious events, increased staff support requirements, and no reduction in surgical fistula interventions compared with traditional rope ladder (sharp needle) cannulation. Initially, patients were trained in rope ladder; then from 2004, all incident patients were started on buttonhole, and prevalent patients were converted to this cannulation method. The investigators also performed a systematic review of the published literature, finding that buttonhole cannulation is associated with a higher risk of arteriovenous fistula–related infections.