Link Between Obesity and Diabetes

It's recognized that people who are obese have a higher risk for developing type 2 diabetes. Now, researchers reporting in the July 21 issue of Nature have found a link between the two, in the form of a protein - specifically, retinol binding protein 4 (RBP4) - that's secreted by fat cells.

RBP4 has a known function as a transporter of Vitamin A in the body. These investigators found that high levels of the protein can also cause cells to be more resistant to insulin - a condition that precedes diabetes.

This knowledge may lead to the development of drugs that can lower levels of this protein, adding to the arsenal of diabetes' therapies.

________
For a summary of the study:
Study identifies fat-secreted protein linked to insulin resistance

For the study itself:
Serum retinol binding protein 4 contributes to insulin resistance in obesity and type 2 diabetes

More on Exercise

With the warmer temperatures and extended hours of daylight (hours that may become more available if Congress passes its energy bill with the proposed daylight savings extension - a plan to start daylight savings time three weeks earlier and end it a week later), summer is a great time to begin or expand your exercise program.

The NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) has an informative site that summarizes the how-to's of exercise when you have diabetes.

It describes different types of exercises (aerobics, strength training, stretching), what exercises to avoid, and what to do if your blood sugar dips too low (a condition known as hypoglycemia).

"Hypoglycemia can happen while you exercise, right afterward, or even up to a day later. It can make you feel shaky, weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. If your blood glucose drops too low, you could pass out or have a seizure."

It's a good idea to check your blood sugar during and after any extended period of activity. For more on exercising with diabetes visit the NIDDK's What I Need to Know About Physical Activity and Diabetes

Metformin for Type 2 Diabetes

A group of researchers in Spain recently performed a meta-analysis, or a systematic review, of 29 studies that investigated metformin's effectiveness when compared to other oral medications, insulin, or dietary changes.

They found metformin used as a single therapy was the best first-line treatment for controlling blood glucose long-term, especially for overweight patients.

Metformin (Brand name: Glucophage) was approved by the FDA for use in type 2 diabetes in December, 1994. A generic form became available in January 2002.

________
For a summary of the study:
Diabetes drug controls blood glucose, cardiac risk

For the study itself:
Published in The Cochrane Library, July 2005 (abstract only, subscription required for full article)
Metformin monotherapy for type 2 diabetes mellitus

The Prospects for Inhaled Insulin

... Are getting better and better.

Researchers reporting in the July issue of Diabetes Care found that for their Type 1 patients, inhaled insulin was comparable to injected insulin for meal-time doses. Subjects still injected a basal dose twice a day, but used an inhaler when bolus insulin was needed.

The inhaled insulin used in the study was Exubera^TM, a short-acting, dry powder, human insulin developed in a joint venture by Sanofi-Aventis and Pfizer. The inhalation device (shown) was developed by Nektar Therapeutics.

Exubera is not currently available. It was submitted to the FDA for approval in March of this year and could be approved before the end of the year. It's planned to be marketed for patients with either type 1 or type 2 diabetes.

________
For a summary of the study:
Study: Inhaled insulin works for type 1

For the study itself (abstract only, subscription required for full article):
Use of Inhaled Insulin in a Basal/Bolus Insulin Regimen in Type 1 Diabetic Subjects

Pfizer's news releases:
Data Presented at American Diabetes Association Scientific Sessions Support Exubera® Efficacy and Safety Profile in Type 1 and Type 2 Diabetes

also:
Pfizer and the Sanofi-Aventis Group Seek Approval to Market Exubera® in the United States

Patient Navigators

On June 29, President Bush signed into law the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005.

It sets aside $25 million through the year 2010 to be used on programs that will "recruit, assign, train, and employ patient navigators who have direct knowledge of the communities they serve" to:

• Act as a contact for healthcare services
  
• Involve community organizations to improve access to high quality healthcare services
  
• Involve eligible individuals in clinical trials
  
• Assist individuals in overcoming healthcare barriers
  
• Provide information about health insurance
  
• Seek out and provide services to underserved populations: uninsured, rural, at risk for or have chronic disease

This legislation should help people who may be at risk for, or have, diabetes to obtain healthcare services, especially if they're in a medically underserved group or area.

________
For a summary of the legislation:
“Patient Navigator” Legislation Will Help Expand Access to Diabetes Prevention and Treatment, USA

For the text of the legislation:
Visit Congress's online legislation database and enter "Patient Navigator" in the search box.

Photo of President Bush signing the Patient Navigator Act thanks to White House News Releases

Genes and Your Cholesterol

If you're active, watch your diet, and have been successful at maintaining a healthful weight, you may have managed to keep your cholesterol levels under control ... or not. Lifestyle wields control over your cholesterol response but so do your genes. It's quite possible that no matter how hard you work to keep your cholesterol levels down, the influence of your family's genes could thwart it.

A study due out in the July 8 issue of the American Journal of Clinical Nutrition found just that. Researchers tested the cholesterol response in identical twins (with identical genes), and found their levels were about the same - even though one exercised regularly while one was relatively sedentary, even though one ate a low-fat diet while the other ate a high-fat one.

Lifestyle matters, but it's always a good idea to monitor and manage your lipid levels with your healthcare provider.

________
For a summary of the study:
Bad Cholesterol: Genes Make the Difference

For the study itself:
Concordant lipoprotein and weight responses to dietary fat change in identical twins with divergent exercise levels

Burn More Calories

Walking is beneficial for weight loss, but what if that walk is a leisurely stroll?

One study found that for overweight individuals, the stroll may be even more effective at shedding pounds.

Researchers from the University of Colorado found that obese women who walked slowly over a given distance burned more calories than if they stepped it up.

The lead author of the study, Ray Browning:

The results show that people who walk a mile at a leisurely pace burn more calories than if they walk a mile at their normal pace. In addition, those who walk at 2 miles per hour rather than 3 miles per hour reduce the loads on their knee joints by up to 25 percent.

One caveat: Walking slowly may burn more calories than walking briskly, but it doesn't improve cardiovascular health. For that you need to complement your routine with something that will get your heart pumping such as cycling, swimming, or stair climbing.

________
For a summary of the study:
Walk Slowly For Weight Loss, According To CU-Boulder Study
or
Study: Slow Walking May Be Best for Obese

For the study itself:
Obesity Research, May, 2005 (Abstract only, subscription required for full article)
Energetic Cost and Preferred Speed of Walking in Obese vs. Normal Weight Women