Clinical Updates: Novel Insights in Diabetes

Clinical Updates: Novel Insights in Diabetes

Last week, in my first article, I wrote about novel insights in Cardiology – more precisely about a study on how the combination of 2 lowering therapies (cholesterol and TG) may affect the medical costs in patients with Type 2 Diabetes Mellitus. On this subject, our reader Mr. Rob Padmore sent me an email where he remarked some interesting points of 2 DM. Therefore, I decided to go forward with novel insights in diabetes this week.

For obvious reasons, the importance of diabetes research doesn’t need complex grounds: the number of people affected is rising at such a rate that now we can cal it as a global pandemic. According to a report by WHO, the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. It is the major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Unlike Type 1, the prevention and delay of 2 DM depends entirely on healthy diet, regular physical activity, maintenance of a normal body weight and avoidance of tobacco use.

Other factors are being studied and that’s why I bring to you the work of Kathrin Wolf and her team with for the main American Diabetes Association publication. This work studied the association between long-term exposure to air pollution and biomarkers related to insulin resistance, subclinical inflammation and adipokines.

It is known that insulin resistance (IR) is present long before the unset of type 2 diabetes and results not only from inherited and lifestyle factors but also likely from environmental conditions. So the group analyzed associations between individual air pollution concentration estimated by land use regression and HOMA-IR, glucose, insulin, hemoglobin A1C, leptin and high-sensitivity C-reactive protein levels from fasting samples using multivariable linear regression models. There were multiple subgroups of individuals who did not have diabetes, had prediabetes or had diabetes.

Among all participants, a 7.9 μg/m3 increment in particulate matter of <10 μm was associated with higher HOMA-IR (15.6% [95% CI 4.0; 28.6]) and insulin (14.5% [3.6; 26.5]). Nitrogen dioxide was associated with HOMA-IR, glucose, insulin, and leptin. Effect estimates for individuals with prediabetes were much larger and highly statistically significant, whereas individuals who did not have diabetes or had diabetes showed rather weak associations. No association was seen for HbA1c level. These results suggested an association between long-term exposure to air pollution and IR in the general population was attributable mainly to individuals with diabetes.

This is not the first and will not be the last research on how air pollution consitutes a risk factor for diabetes, heart disease, obesity and IR in children. These would be bad news for industrialized countries (such as U.S.) if published two weeks ago, but I’m afraid to announce that are terrible news since the election of a president who does not believe in climate change.

Just like last week, I finsih with some WHO tips on how can the burden of diabetes be reduced:

  • achieve and maintain healthy body weight;
  • be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
  • eat a healthy diet, avoiding sugar and saturated fats intake; and
  • avoid tobacco use – smoking increases the risk of diabetes and cardiovascular diseases.

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