Number of adults with diabetes reaches 422 million worldwide, with fastest increases in low and middle income countries

Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014, according to a new study published in The Lancet. The findings provide the most comprehensive estimates of worldwide diabetes trends to date and show that diabetes is fast becoming a major problem in low and middle income countries.

"Diabetes has become a defining issue for global public health. An aging population, and rising levels of obesity, mean that the number of people with diabetes has increased dramatically over the past 35 years" says Professor Majid Ezzati, senior author from Imperial College London, London, UK. "Rates of diabetes are rising quickly in China, India, and many other low and middle income countries, and if current trends continue, the probability of meeting the 2025 UN global target is virtually non-existent."

The study, released ahead of World Health Day (7th April), includes data from 751 studies totalling 4.4 million adults in different world regions. The study estimates age-adjusted diabetes prevalence for 200 countries -- meaning that researchers adjusted the results to account for diabetes becoming more common as a person ages and for some countries having older populations.

Between 1980 and 2014, diabetes has become more common among men than women. Global age-adjusted prevalence of diabetes doubled among men (4.3% to 9.0%) and increased by two-thirds among women (5.0% to 7.9%).

Although there was an increase in overall rates (crude prevalence) of diabetes in many countries in Western Europe, age-adjusted rates were relatively stable suggesting that most of the rise in diabetes in Western Europe between 1980 and 2014 was due to the aging population. In contrast, rates of diabetes increased significantly in many low and middle income countries -- such as China, India, Indonesia, Pakistan, Egypt and Mexico. No country saw a significant decrease in diabetes prevalence.

The study did not differentiate between type 1 and type 2 diabetes, but most (85-95%) of cases of adult diabetes are type 2 so the observed rise is likely to be due to increases in type 2 diabetes.

Professor Ezzati adds: "Obesity is the most important risk factor for type 2 diabetes and our attempts to control rising rates of obesity have so far not proved successful. Identifying people who are at high risk of diabetes should be a particular priority since the onset can be prevented or delayed through lifestyle changes, diet or medication."

National and regional findings include:

- In the UK, after adjusting for an aging population, 4.9% of women have diabetes in 2014 (compared to 4.0% in 1980). Prevalence has increased more among men, from 4.8% in 1980 to 6.6% in 2014.

- Northwestern Europe has the lowest rates of diabetes among women and men, with age-adjusted prevalence lower than 4% among women and at 5-6% among men in Switzerland, Austria, Denmark, Belgium and the Netherlands.

- Prevalence of diabetes was highest in Polynesia and Micronesia (age-adjusted prevalence is over 20% in men and women). In American Samoa, nearly one third of the adult population have diabetes.

- The greatest increases in diabetes prevalence were in Pacific island nations, followed by the Middle East and North Africa, in countries like Egypt, Jordan and Saudi Arabia.

- Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.

- Age-adjusted prevalence of diabetes has more than doubled for men in India and China (3.7% to 9.1% in India; 3.5% to 9.9% in China); and increased by 50% among women in China (5.0% to 7.6%) and 80% among women in India (4.6% to 8.3%).

- In the US, age-adjusted prevalence of diabetes in women increased by 50% (4.3% to 6.4%), and 80% in men (4.7% to 8.2%).

- Pakistan, Mexico, Egypt and Indonesia are all now in the top 10 countries with the largest number of adults with diabetes. Age-adjusted prevalence of diabetes doubled in Pakistan (4.9 to 12.6% for men and 5.9 to 12.1% for women), Mexico (6.5 to 10.9% for men and 6.5 to11.5% for women), and Indonesia (3.2 to 7.4% for men and 4.1 to 8.0% for women) and nearly tripled in Egypt (6.5 to 16.0% for men and 8.0% to 19.8% for women).

Writing in a linked Comment, Etienne Krug, Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland, says: "The prevalence estimates provided by the NCD-Risk Factor Collaboration sound the alarm for large-scale, effective action to reduce the health and economic impact of diabetes. Improvements in prevention and management, together with better surveillance, should be prioritised in response to this call."

'Game changing' stem cell repair system

Stem cell therapies capable of regenerating any human tissue damaged by injury, disease or ageing could be available within a few years, following landmark research led by UNSW Australia researchers.

The repair system, similar to the method used by salamanders to regenerate limbs, could be used to repair everything from spinal discs to bone fractures, and has the potential to transform current treatment approaches to regenerative medicine.

The UNSW-led research has been published today in the Proceedings of the National Academy of Sciences journal.

Study lead author, haematologist and UNSW Associate Professor John Pimanda, said the new technique, which reprograms bone and fat cells into induced multipotent stem cells (iMS), has been successfully demonstrated in mice.

"This technique is a significant advance on many of the current unproven stem cell therapies, which have shown little or no objective evidence they contribute directly to new tissue formation," Associate Professor Pimanda said.

"We are currently assessing whether adult human fat cells reprogrammed into iMS cells can safely repair damaged tissue in mice, with human trials expected to begin in late 2017."

There are different types of stem cells including embryonic stem (ES) cells, which during embryonic development generate every type of cell in the human body, and adult stem cells, which are tissue-specific. There are no adult stem cells that regenerate multiple tissue types.

"This technique is ground-breaking because iMS cells regenerate multiple tissue types," Associate Professor Pimanda said.

"We have taken bone and fat cells, switched off their memory and converted them into stem cells so they can repair different cell types once they are put back inside the body."

The technique developed by UNSW researchers involves extracting adult human fat cells and treating them with the compound 5-Azacytidine (AZA), along with platelet-derived growth factor-AB (PDGF-AB) for approximately two days. The cells are then treated with the growth factor alone for a further two-three weeks.

AZA is known to induce cell plasticity, which is crucial for reprogramming cells. The AZA compound relaxes the hard-wiring of the cell, which is expanded by the growth factor, transforming the bone and fat cells into iMS cells. When the stem cells are inserted into the damaged tissue site, they multiply, promoting growth and healing.

The new technique is similar to salamander limb regeneration, which is also dependent on the plasticity of differentiated cells, which can repair multiple tissue types, depending on which body part needs replacing.

The study's first author, Dr Vashe Chandrakanthan, who developed the technology, said the new technique is an advance on other stem cell therapies being investigated, which have a number of deficiencies.

"Embryonic stem cells cannot be used to treat damaged tissues because of their tumour forming capacity. The other problem when generating stem cells is the requirement to use viruses to transform cells into stem cells, which is clinically unacceptable," Dr Chandrakanthan said.

"We believe we've overcome these issues with this new technique."

Neurosurgeon and Conjoint Lecturer with UNSW's Prince of Wales Clinical School, Dr Ralph Mobbs, will lead the human trials, once the safety and effectiveness of the technique using human cells in mice has been demonstrated.

"The therapy has enormous potential for treating back and neck pain, spinal disc injury, joint and muscle degeneration and could also speed up recovery following complex surgeries where bones and joints need to integrate with the body," Dr Mobbs said.

Research shows that up to 20% of spinal implants either don't heal or there is delayed healing. The rates are higher for smokers, older people and patients with diseases such diabetes or kidney disease.

"Spinal implants currently used to replace damaged or troubled discs don't always weld with the adjacent bones, so by transplanting these reprogrammed stem cells, we hope to be able to better fuse these implants to the host bone," Dr Mobbs said.

"This represents a potential huge leap forward for spinal and orthopaedic procedures."

Along with confirming that human adult fat cells reprogrammed into iMS stem cells can safely repair damaged tissue in mice, the researchers said further work is required to establish whether iMS cells remain dormant at the sites of transplantation and retain their capacity to proliferate on demand

Taking testosterone while dieting may help lose fat, not muscle

In obese middle-aged men, losing weight while dieting normally depletes both fat and muscle. But adding testosterone treatment may help them lose only fat and retain their muscle, new research suggests. The study results will be presented in a poster Saturday, April 2, at ENDO 2016, the annual meeting of the Endocrine Society, in Boston.

Overall, 40 percent of obese men have a low testosterone. Weight loss due to calorie restriction is associated with increased circulating testosterone, and testosterone treatment reduces fat. However, researchers don't know whether adding testosterone treatment to calorie restriction reduces fat mass more than calorie restriction alone.

"There is an epidemic of obesity and related functional hypogonadism, yet testosterone treatment remains controversial," said principal investigator Mathis Grossmann, MD, PhD, FRACP, associate professor in the Department of Medicine at the University of Melbourne in Victoria, Australia. "This study shows for the first time that, among obese men with lowered testosterone, testosterone treatment augmented the diet-induced loss of total and visceral fat mass and prevented the diet-induced loss of lean mass."

Dr. Grossman and colleagues conducted a clinical trial of 100 fairly healthy obese men from the local community between 20 and 70 years of age who had low testosterone levels. Overall, 20 percent of them had diabetes and 10 percent had heart disease.

For the first 10 weeks, all participants were placed on a strict 600 kcal per day very-low calorie diet. They were also encouraged to abstain from alcohol and perform at least 30 minutes a day of moderate exercise. From the 11th through the 56th week, participants in both groups used a weight-maintenance diet based on the Australian Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet comprising of normal foods.

Every 10 weeks over the 56-week-long study, 49 men also received injections of 1,000mg of intramuscular testosterone undecanoate, and 51 took placebo.

At the end of 56 weeks, both groups lost roughly 11 kg (24.2 lb). But those in the testosterone group lost almost exclusively fat, while those on placebo lost both lean and fat. The men taking testosterone lost 3 kg (6.6 lb) more body fat than those on placebo and maintained their muscle mass, while those on placebo lost 3.5 kg (7.7 lb) of muscle mass.

Australia's National Health and Medical Research Council supported the study. Bayer Pharma AG provided testosterone, placebo and financial support but was not directly involved in the study

Study shows people are capable of multiple, simultaneous life changes

Let's say you've decided to make some changes in your life. You're out of shape, your mind wanders, your self-esteem is wavering, and you have no idea what you just read. So you decide to focus on one thing -- losing weight, maybe -- and tackle the other issues later. You don't want to take on too much at once, right?

A new paper by researchers at UC Santa Barbara, however, suggests you're selling yourself short. "Pushing the Limits: Cognitive, Affective & Neural Plasticity Revealed by an Intensive Multifaceted Intervention," published this week in Frontiers in Human Neuroscience, strongly suggests that we have seriously underestimated our ability to change our lives for the better.

Michael Mrazek, director of research at UCSB's Center for Mindfulness & Human Potential and lead author of the paper, said the six-week study from which the paper is drawn demonstrates that simultaneous, significant improvement across a broad range of mental and physical functions is possible. Participants in the intervention all showed dramatic improvements in more than a dozen different outcomes, including strength, endurance, flexibility, working memory, standardized test performance, focus, mood, self-esteem, mindfulness and life satisfaction.

"Part of what distinguishes this work is finding such broad improvements across so many different domains, particularly given that the effect sizes were so large," Mrazek explained. Large effect sizes signify that the results were not only statistically significant but also indicative of substantial changes. "Many of these effects were very large -- larger than you tend to find in studies that focus on changing only one thing."

In the study, 31 college students were recruited for an intensive lifestyle change program; 15 participated in the intervention and 16 were in the waitlist control group. Those in the intervention put in five hours a day each weekday for six weeks. They did 2.5 hours of physical exercise (including yoga and Pilates), one hour of mindfulness practice and 1.5 hours of lecture or discussion on topics such as sleep, nutrition, exercise, mindfulness, compassion, relationships or well being. The were advised to limit alcohol consumption to one drink a day, eat a diet of mostly whole foods and sleep 8-10 hours a day.

Throughout the study, the participants were tested on a variety of factors, including physical fitness, cholesterol and triglyceride levels, working memory capacity, reading comprehension and more. They also underwent magnetic resonance imaging (MRI) of their brains to examine areas known to be associated with a range of cognitive functions.

"The neuroimaging findings help us understand and contextualize the other significant results," Mrazek explained. "For instance, participants made dramatic improvements in their mindfulness, their reading comprehension, their working memory capacity. So we look to the neuroimaging data to understand what's happening in the communication between brain networks that's allowing for these changes."

Overall, the results were clear and striking, Mrazek said. Even six weeks after the intervention, participants continued to show improvement in all areas. "We predicted that the intervention would lead to substantial improvements in health, cognitive abilities and well-being, but we didn't know how long they would last. It seemed possible that some of the benefits wouldn't extend beyond the training. So I was surprised that even without any contact and support, participants maintained significant improvements at the six-week follow up."

Determining exactly why all these changes were possible will require future study, Mrazek noted, but he suspects that a comprehensive approach allows each area of improvement to reinforce the others. "Recent research suggests its often more effective to make two or more changes simultaneously, especially when those changes reinforce one another. It's easier to drink less coffee if at the same time you get more sleep. Our intervention extended this logic by helping people make progress in many ways, which can create an upward spiral where one success supports the next," he said.

Mrazek said conventional thinking about changing one's behavior focuses on working on one thing at a time. This is also the way most science is done -- manipulating just one thing and observing the effect. He and his team, however, decided to try a fresh approach. "It occurred to us that real changes in people's lives don't occur in a vacuum. We wanted to see how much change is possible if you help someone improve all these dimensions of their life simultaneously."

The study could have wide applications beyond the college campus, Mrazek noted. Although the subjects were college students, they weren't extraordinary in any way. "People showed up with all sort of different challenges, including in some cases mental illness and physical limitations. These were just college students, some of whom were doing great and others who were really struggling," he said. "More research is necessary to know if these results generalize to other populations, but there may eventually be opportunities for similarly modeled programs to be integrated into education, medicine, or social services."

Students in K-12 schools might particularly benefit from programs similar to the study's intervention, Mrazek said. "Many students spend nearly all day in school for 10 or more years of their lives," he observed. "Our intervention was fairly intensive in spending six weeks with these participants, but that's nothing in comparison to how much time kids spend in school. If future research can show similar benefits among middle school or high school students, then multifaceted programs like ours could help schools advance their priorities of improving both academic achievement and student well-being."

At the other end of the age spectrum, new retirees might also benefit from a program to kick-start the next phase of their lives, Mrazek said. "My intuition is that these things can be very helpful at any age," he said. "I think there's a big opportunity for people who are finishing up their careers and hopefully have decades of life still to enjoy. They have time, wisdom and in some cases resources to contribute to the world. Could something like this help them avoid cognitive decline and find an exciting new way forward as they transition into a later stage in their lives? I think it might, and that's something we would like to assess in future research."

Jonathan Schooler, senior author on the paper and a professor in the Department of Psychological & Brain Sciences and director of the Center for Mindfulness & Human Potential, also observed that the research has both scientific and societal relevance. "This work advances society in demonstrating a straightforward route toward realizing people's full potential, and science in elucidating the brain mechanisms that may underpin such gains," he said.

Ultimately, Mrazek said, he'd like the study to be a source of optimism. "I hope this research raises a sense of possibility, and maybe even sense of expectation, about what is possible for someone who wants to improve his or her life," he said. But he also doesn't think we have all the answers yet. "As encouraging as these results are, I think this is only a preview of what will ultimately be achieved through future interventions that draw on continual advances in science and technology," he said. "The true limits of how much a person can change is a mostly unexplored frontier of scientific understanding.

Warning: High-intensity training could hurt you if you're not an athlete

High-intensity 'sprint training' may be gaining popularity at gyms, but if you're new to this form of exercise, the workout could do more harm than good.

A study by Canadian and European researchers found signs of stress in the muscle tissues of their non-athlete, untrained subjects after ultra-intense leg and arm cycling exercises. Perhaps more concerning, researchers reported the untrained subjects had a weakened ability to fight off free radicals, molecules that can alter DNA and harm healthy cells.

"Our study raises questions about what the right dose and intensity of exercise for the average person really is," said Robert Boushel, the study's senior author and director of the University of British Columbia's School of Kinesiology. "We need to be cautious about supporting sprint training in the general population."

The researchers analyzed tissue samples from their test subjects and found that their mitochondria, the powerhouse of cells, were only firing at half-power post-training, reducing their capacity to consume oxygen and their ability to fight off damage from free radicals. High levels of free radicals in the body have been linked to a number of medical conditions, including cancer, premature aging and organ damage.

The potential long-term adverse effects of high-intensity sprint training are unknown, but Boushel and other researchers are continuing to study different levels of exercise, measuring the dosing of training against different biomarkers for health.

"If you're new to going to the gym, participating in high-intensity 'sprint' classes may increase your performance but might not be healthy for you," said Boushel.

Seasoned athletes and those who are well trained have built up antioxidant enzymes in their bodies to protect against free radicals, said Boushel. He recommended beginners start slowly and gradually increase intensity over time, under the supervision of a trained professional or kinesiologist.

Background

The study was carried out in a dozen male volunteers in Sweden, all of whom were in good health but self-identified as untrained or only moderately active. The men participated in high-intensity training over the course of two weeks that involved repeated 30-second all-out sprints, followed by rest periods.

The study, "High-intensity sprint training inhibits mitochondrial respiration through aconitase inactivation," is published in The Official Journal of theFederation of American Societies for Experimental Biology (FASEB) Journal

Poor diet and lack of exercise accelerate the onset of age-related conditions

Could an unhealthy diet and lack of exercise be making you age faster? Researchers at Mayo Clinic believe there is a link between these modifiable lifestyle factors and the biological processes of aging. In a recent study, researchers demonstrated that a poor diet and lack of exercise accelerated the onset of cellular senescence and, in turn, age-related conditions in mice. Results appear today inDiabetes.

Senescent cells are cells that contribute to diseases and conditions associated with age. Researchers from the Mayo Clinic Robert and Arlene Kogod Center on Aging found that exercise prevents premature senescent cell accumulation and protects against the damaging effects of an unhealthy diet, including deficiencies in physical, heart, and metabolic function, equivalent to diabetes.

"We think at both a biological level and a clinical level, poor nutrition choices and inactive lifestyles do accelerate aging," says Nathan LeBrasseur, Ph.D., director of the Center on Aging's Healthy and Independent Living Program and senior author of the study. "So now we've shown this in very fine detail at a cellular level, and we can see it clinically. And people need to remember that even though you don't have the diagnosis of diabetes or the diagnosis of cardiovascular disease or the diagnosis of Alzheimer's disease today when you're in midlife, the biology underlying those processes is hard at work."

In the study, researchers introduced mice to either a normal, healthy diet or a diet that they termed a "fast food diet" -- one that was high in saturated fat and cholesterol, along with a sugar-sweetened beverage. Mice on the fast food diet showed harmful changes in health parameters, including body weight and composition, increasing their fat mass by nearly 300 percent over the course of about four months. The fat mass accumulated largely in the midsection surrounding internal organs, an area that is often linked to a number of diseases related to obesity.

While the harmful effects of the fast food diet were clear, researchers found significant health improvements after introducing exercise. Half the mice, including mice on both the healthy and unhealthy diets, were given exercise wheels. Mice that had been exposed to the fast food diet but exercised showed suppression in body weight gain and fat mass accumulation, and were protected against the accumulation of senescent cells. Mice on a normal diet benefited from exercise as well.

"Some of us believe that aging is just something that happens to all of us and it's just a predestined fate, and by the time I turn 65 or 70 or 80, I will have Alzheimer's disease and cardiovascular disease and osteoporosis," says Dr. LeBrasseur. "And this clearly shows the importance of modifiable factors so healthy diet, and even more so, just the importance of regular physical activity. So that doesn't mean that we need to be marathon runners, but we need to find ways to increase our habitual activity levels to stay healthy and prevent processes that drive aging and aging-related diseases."

Older overweight and obese adults with diabetes benefit from better diet and exercise

Lifestyle changes that include healthier diet and routine physical exercise help older overweight and obese adults with Type 2 diabetes improve glucose control, body composition, physical function and bone quality, according to preliminary findings of an ongoing clinical trial. The six-month results of the one-year study will be presented Friday, April 1, at ENDO 2016, the annual meeting of the Endocrine Society, in Boston.

Diet and exercise, known to benefit patients with Type 2 diabetes, are controversial treatments for older adults due to concerns over frailty and age-related loss of muscle mass. No specific guidance is available for effectively modifying the lifestyle of adults with diabetes who are 65 years of age and above.

"Type 2 diabetes is highly prevalent in older adults due to the physical inactivity associated with advancing age as well as the obesity epidemic. Obesity worsens the metabolic and physical complications of aging that impair quality of life," said lead study author Alessandra Celli, research dietitian and predoctoral fellow in endocrinology at Baylor College of Medicine in Houston, Texas.

Celli and her colleagues are examining the effects of behavioral weight-loss diet therapy and exercise training in older overweight and obese adults with Type 2 diabetes. Over the past six months, they have been randomly assigning volunteers between 65 and 85 years of age to receive either intensive or limited interventions.

Participants in the intensive intervention group attend 90-minute aerobic and resistance exercise classes three times a week as well as a diet class once a week where they learn healthier eating habits.

They record all food, drink, calories and proteins consumed and can receive individual weight-loss counseling. Control group participants are not given any exercise program and receive only once-a-month diabetes educational sessions.

At the six-month mark, all study participants have preserved their lean body mass; but the intervention group's body weight and fat mass have dropped more than the control group's, and the intervention group's physical performance test and peak aerobic capacity have improved more.

Glycated hemoglobin (HbA1c), an indicator of blood glucose control, has improved more in the intervention group.

Trabecular bone score, a measure of bone texture that helps predict fracture risk, has improved among those receiving the intervention but not among the controls.

"If our results are confirmed, these encouraging findings may be used to formulate concrete recommendations about healthy lifestyle changes in older diabetic patients. Long-term studies involving a larger sample are needed to follow up on these results and examine underlying mechanisms," Celli said