High levels of B vitamins linked to diabetes and obesity

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Long-term exposure to high levels of B vitamins (niacin, thiamin, riboflavin) may be involved in the increased prevalence of obesity and type 2 diabetes in the United States in the past 50 years, a new study suggests.

The findings, together with the evidence that niacin may induce glucose intolerance, insulin resistance and liver injury, imply the possibility that, among the fortified B-vitamins, excess niacin consumption may play a major role in the development of obesity and 2 diabetes.

Since the high level consumption of niacin in the US is mainly due to the implementation of mandatory grain fortification, therefore, it may be of significance to carefully evaluate the long-term safety of food fortification, the study concludes.

1. Zhou S-S, Li D, Zhou Y-M, et al. B-vitamin consumption and the prevalence of diabetes and obesity among the US adults: population based ecological study. BMC Public Health 2010; 10: 746. (open access)


Improving diabetes and hypertension guidelines in Barbados

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A study has shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines.

Current hypertension and diabetes guidelines were considered by some primary health care providers to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions and kept short. Patient-oriented versions of the guidelines were welcomed.

Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines and being unable to change habits.

System barriers included lack of access to blood investigations, clinic equipment and medication; lack of human resources in polyclinics; and an uncoordinated team approach.

Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking and taking responsibility for one’s health; and difficulty getting time off work to attend a clinic.

Suggestions for how the health care system could help providers improve the health of those with diabetes and hypertension included educating both the public and persons with the condition, screening programs, providing free home monitors and adequate staffing.

Suggestions for how the wider society could help providers improve the health of those with diabetes and hypertension involved educational outreach to promote family support in managing the condition (cooking, encouraging exercise, giving insulin); a greater role for volunteer groups and retired persons in providing education, support, exercise groups and screening programs; starting associations for hypertension, hyperlipidemia and diabetes; the provision by the government of sidewalks and bicycle lanes for safe exercise; healthy food choices at schools and work places; a tax on unhealthy fast food and an attempt to bring down the cost of healthy food by the government; a requirement that fast food outlets provide healthy alternatives; labeling of all food to include fat, salt and calorie content; encouraging a kitchen garden program; time off by employers to attend appointments; and prominent persons with the disease should speak out to reduce stigma, and give hope that a good life can be had while living with chronic disease.

1. Adams OP, Carter AO. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study. BMC Family Practice 2010; 11: 96. (open access)

Famine linked to non-communicable diseases in Nigeria

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Fetal and infant undernutrition is associated with significantly increased risk of hypertension, overweight and impaired glucose tolerance or diabetes among Nigerians who were born during the famine that afflicted the Biafra region of Nigeria during its civil war (1967-1970). Of the one to three million Igbo people that are estimated to have lost their lives during the Nigerian Civil War, only about 10 percent died of military violence. The majority succumbed to starvation.

 Prevention of undernutrition during pregnancy and in infancy should therefore be given high priority in health, education and economic agendas.

1. Hult M, Tornhammar P, Ueda P, et al. Hypertension, diabetes and overweight: looming legacies of the Biafran Famine. PLoS ONE 2010; 5(10): e13582. (open access)

Medical costs of diabetes in the United Arab Emirates

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Direct treatment costs of diabetes in the United Arab Emirates (UAE) increased with the presence and progression of chronic diabetes-related complications, a study has found. Hospitalization costs constituted a large proportion and were increasingly higher with the presence and progression of diabetes-related complications.

The total annual direct treatment costs among diabetes patients without complications was US$1,605, which is 3.2 times higher than the per capita expenditure for health care in the UAE (US$497) during 2004. The cost increased 2.2 times with the presence of diabetes-related complications for patients with microvascular complications, by 6.4 times for patients with macrovascular complications and 9.4 times for patients with both micro and macrovascular complications.

The annual direct hospitalization costs of diabetic patients increased by 3.7 times for patients with microvascular complications, by 6.6 times for patients with macrovascular complications and by five times for patients with both micro and macrovascualr complications. Overall, costs increased with age, diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycemic agents or with diet control only.

1. Al-Maskari F, El-Sadig M, Nagelkerke N. Assessment of the direct medical costs of diabetes mellitus and its complications in the United Arab Emirates. BMC Public Health 2010; 10: 679. (open access)

Green leafy vegetables may reduce diabetes risk

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Healthy Spinach Salad

Studies have found that eating the recommended five daily servings of fruits and vegetables may reduce the risk of chronic non-communicable diseases such as heart disease and cancer. A recent meta-analysis of multiple studies found that eating an additional 1.15 servings a day of green leafy vegetables was associated with a 14 percent reduction in the risk of type 2 diabetes.

The results support the growing body of evidence that lifestyle modification—eating a healthier diet high in fruits and vegetables—is an important factor in the prevention of diabetes, the researchers concluded.

Read more at Suite101.

1. Carter P, Gray LJ, Troughton J, et al. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 341: c4229. (open access)

Depression linked to diabetes complications in the United Arab Emirates

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A study conducted in the United Arab Emirates (UAE) demonstrated that diabetes patients with depression or anxiety are more likely to have eye-related complications (retinopathy, glaucoma) and vascular/neurological complications in the lower limbs (peripheral vascular disease, peripheral neuropathy).

In particular, patients who are depressed tended to have poorer self-care, more severe physical symptoms and were less likely to adhere to prescribed diabetes care regimens. The study also indicated that Islam has a profound impact on the mental health beliefs and practices of people in the Arab region. For example, people tend to believe that mental illness is associated with supernatural influences, such as jinn (aka genies), the evil eye or magic, rather than physical or biomedical; some also believe that a mental illness may be divine punishment as a result of disobedience or sin, or due to weak faith. This in turn, affects a patient’s motivation to seek proper care for depression or anxiety.

“These findings raise the possibility that improving mental health as part of a comprehensive management plan for diabetes may improve the overall long term outcomes of diabetes patients,” the study concluded.

1. Sulaiman N, Hamdan A, Tamim H, et al. The prevalence and correlates of depression and anxiety in a sample of diabetic patients in Sharjah, United Arab Emirates. BMC Family Practice 2010; 11: 80. (open access)

Diabetes is a major public health problem in China

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Diabetes has become a major public health problem in China. Rapid economic growth, an increase in life expectancy and adoption of unhealthy lifestyles has contributed to the increase in diabetes among Chinese adults.

More than 92 million Chinese men and women have diabetes and 148 million have pre-diabetes, according to a study in the  New England Journal of Medicine.

The China National Diabetes and Metabolic Disorders Study is based on a nationally representative survey in which nearly 50,000 adults aged 20 years and older from 14 provinces and municipalities throughout China participated over a one-year period beginning in 2007.

Read more at Suite101.

1. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-1101. (open access)

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