The diabetes treatment is a success
Knut Borsch-Johnsen, Prof at the Instit of Public Health, Odense, Denmark was celebrated with the Kelly West Award. He said that even if the diabetes epidemic increase with 285 million 2010 and projected to be 439 million by 2030 – is a great challenge world wide, there is a tremendous success of public health and diabetes management at the same time. Epidemiologists should inform that the mortality from diabetes is decreasing, the risk of developing complication from diabetes has decreased markedly over the years – and the incidence of diabetes has flattened.
Better treatment do play a role.
In the past 11 years, excess mortality due to T2DM is down 37%. Life expectancy with T2DM increased by a decade from 1950 to 2000.
In Denmark there is a fall in incidence of diabetes since 2004. The incidence is increasing in US – but not for everyone. Incidence is probably up for Hispanic and African Americans but down for Asian Americans and Caucasians. In the UK the incidence flattened out around 2003, prof Borch-Johnsen said.
No matter how you spin it, prof Borch-Johnsen said, effeorts to prevent T2DM must go on – at the individual level it is very much preventable.
– Our arguments should be that diabetes is one of the few diseases in which we can demonstrate such a majour success. Diabetes care is a success – and it should be celebrated, he said in his lecture.
Apps are cool but feeling count in diabetes care
In his behavioral medicine award lectur Lawrence Fisher, prof, advised clinicians to balance the use of online and phone-based self-management technology with excellent clinical acre that addressed the entire patient, including his or her feelings, expectations and beliefs about diabetes management. Cool apps ignores broader issues patients face in making behavioural changes. What is missing in smartphone apps is an understanding of the patient´s beliefs, expectations, and feelings that drive behaviour change. They come before bahviour changes.
The broader framework also includes an understanding of the patient´s personal, family and social context, prior expectations for diabetes self-management, and current feelings and motivations for changing behaviour.
He has found in a study, REDEE study, that the distressed T2DM patients they were recruiting often dropped out of the study because they were experiencing feelings of hoplessness and being over-whelmed, demoralized and frightened.
The researchers developed a new cignitive behavioural therapy model for the trial, they call it AASAP
• Anticipate the patient´s feelings
• Acknowledge the feelings
• Standardize and normalize the feelings (”Lots of people feel that way”)
• Accept and understand where the feelings come from
• Plan how to respond to the feelings
Interestingly, those who praticipated in the AASAP did significantly better in the REDEEM than those enrolled arlie rin the study before AASAP, Dr Fisher said. We are now bringing actual feelings, beliefs and expectations into the care process.
Banting Lecture on transcriptional control of adipogenesis – toward therapeutics
Prof Bruce Spiegelman, Harvard Medical School, Boston, US, described the discovery of Irisin, the latest hormone, a key regulatory hormone in glucose metabolism, and a third type of adipose tissue – beige fat cells.
Dr Spiegelman´s lab has discovered multiple adipose tissue regulators, including UPC-1, PPAR, PDB1alpha, PDB1beta. In 2008, the group discovered that PRDM16 can control the conversion of brown fat into muscle tissue and muscle tissue into brown fat.
Then came the discovery of the third type of adipose tissue that showed chrematistics of both brown and white fat. High levels of PRDM16 can turn white fat into beige fat. And mice with white fat that has been ”browned” show increase glucose tolerance.
It has long been known that exercise induces a variety of beneficial changes, including improved glucose metabolsim, but the pathway that lead leads to these changes has been unclear. Recent work has shown that PGC-1alpha, a regulator of mitochondrial biogenesis discovered in the 1990s, play a role in the effects of exercise.
The new experimental system hinted that exercise produce a secreted molecule that increases the amount of energy-burning beige fat. That molecule turned out to be Fndc5, a commercially available protein that was annotated as an intracellular protein. The reserach group name the newly recognized hormone Irisin after the Greek goddess Iris.
In tissue culture Irisin increases uncoupled cell respiration with 300%. In obese humans circulating levels of Irisin increase by 40 to 60% efter 4 weeks of exercise training.
Irisin causes a browning reaction to protect against metabolic disease, dr Spiegelman said. It is a proof-of-concept molecule and not apropriate for use in human beings. It is possible in the future to develop a new generation of therapeutics. They can bring cell biology into the realm of diabetes prevention and treatment – a forward-thinking diabetes treatment for the future.
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