Saturday, August 19, 2006
DIABETES ARTICLES - Genetic Test for Diabetes May Gauge Risk, but Is the Risk Worth Knowing?
DIABETES ARTICLES.
Genetic Test for Diabetes May Gauge Risk, but Is the Risk Worth Knowing?
Like her mother and grandmother, my mother had Type 2 diabetes. For her, its most awful complication was artery disease, which caused innumerable mini-strokes, pinched off the circulation to her legs and ultimately ended her life.
My sisters and I hope to avoid her fate, or at least postpone it. Since obesity often brings on the disease in people with a family history like ours, we try to watch our weight.
Lately, I've been intrigued by the discovery of a gene variant that can predispose people to this type of diabetes, which usually develops in adults. Having the variant doesn't guarantee that you will get the disease, and lacking it doesn't guarantee that you won't. But it tells something about risk.
People who have one copy of the gene, inherited from one parent, have 1.4 times the risk of someone who lacks it, and those with two copies -- one from each parent -- have about twice the risk. People with the variants tend to make insufficient insulin, the hormone that lowers blood sugar.
The gene accounts for about 21 percent of all diabetes cases; more than a third of Americans carry one copy. Seven to 10 percent carry two.
Am I one of them? Do I want to find out? There is no way to do that yet, but Decode Genetics, the Icelandic company whose researchers found the gene variant, is planning to market a test, possibly by 2007 or 2008. It will probably cost hundreds of dollars, and be available only through doctors.
At first glance, testing doesn't seem to offer much to people like me. We already figure the deck is stacked against us. Even if the test came out negative, I would still suspect I was at risk, but from some other gene that hasn't been discovered yet.
Then again, if I tested positive, the threat would seem more real. Maybe I would eat less, exercise more, check my blood sugar more often, keep better track of risk factors for heart disease like cholesterol and blood pressure. I would also have to decide whether to inflict the information on my sons.
I'm not sure I want that straight-up shot of reality. Even with my family history, I figure there's a chance I got lucky and didn't inherit whatever my mother had. A test could erode that bit of optimism.
Dr. David Altshuler, a diabetes expert at Harvard who has studied the gene variants, said he thought offering a routine genetic test now would be premature.
He said the test would not help people who already know they are at risk because of their family histories or because they have impaired glucose tolerance, a condition that often leads to diabetes. They should already be trying to exercise and lose weight, or taking a medication to treat the glucose problem, he said.
''There may be people who would say, 'If I knew my risk was 50 percent instead of 30 percent, I would like to know that to make me try harder,' '' Dr. Altshuler said. ''You could argue that either of those is really high, and you should be trying hard already.''
He also cautioned that people who do get tested must keep in mind that a positive result does not seal their fate: their risk is higher, but not absolute. Similarly, those who test negative are not in the clear. If they have other risk factors they still have to be careful, because other genes are almost certainly involved in diabetes as well.
Dr. Richard Kahn, chief scientific and medical officer for the American Diabetes Association, had similar concerns and said the research was important, but, ''translating it into some practical action is a long ways away.''
Dr. Altshuler said another reason for his wariness is that ''there is another gold rush in this, in diagnostics.''
He praised Decode as first-rate in terms of science and ethics, but he said he worried about other companies looking to cash in on legitimate research by marketing questionable genetic tests directly to consumers.
''A lot of companies will push the idea of doing genetic testing -- 'You can have this done, we'll give you advice,' '' he said. ''I'm deeply concerned. Companies are pushing things that aren't valid, saying send us your DNA and we'll give you advice about lifestyle or diet based on your genetic profile. Very little is known, let alone anything with implications.'' But, he noted wryly, despite all his reservations he has not been able to talk his own mother out of wanting the genetic test for Type 2 diabetes.
The Federal Trade Commission is also concerned. Last month, its Web site carried a warning that there were no valid studies to support many genetic tests being marketed to consumers to gauge their disease risks or suggest they need dietary supplements or special diets.
Dr. Kari Stefansson, Decode's chief executive, said genetic tests that measure the probability of developing a disease ''are a new sort of information that our society is growing rapidly more accustomed to, but it is still not absolutely clear how we are going to use it.''
The first use of a Type 2 diabetes test, he said, would probably be in people with impaired glucose tolerance. Those who came out positive could be treated aggressively, perhaps with drugs. Those who tested negative could be offered a more conservative approach.
For people with a family history and normal glucose tolerance, Dr. Stefansson said, the best use of the test would be to test both the relative with diabetes and the concerned family member. If both tested positive, then the family member was at high risk and could try to do something about it.
What about people like me, whose diabetic relatives are long gone? I could be tested, he said, and if I had the risky variant it might be a warning sign. But if I didn't have it, I still wouldn't be out of the woods.
So what do I want to do? Right now, I'm leaning toward having the test if it becomes available. I'm not sure what I'd do with the results or whether they would mean anything for my future. But I'd like the information, and the right to decide for myself whether to act on it.
By DENISE GRADY at The New York Times
Genetic Test for Diabetes May Gauge Risk, but Is the Risk Worth Knowing?
Like her mother and grandmother, my mother had Type 2 diabetes. For her, its most awful complication was artery disease, which caused innumerable mini-strokes, pinched off the circulation to her legs and ultimately ended her life.
My sisters and I hope to avoid her fate, or at least postpone it. Since obesity often brings on the disease in people with a family history like ours, we try to watch our weight.
Lately, I've been intrigued by the discovery of a gene variant that can predispose people to this type of diabetes, which usually develops in adults. Having the variant doesn't guarantee that you will get the disease, and lacking it doesn't guarantee that you won't. But it tells something about risk.
People who have one copy of the gene, inherited from one parent, have 1.4 times the risk of someone who lacks it, and those with two copies -- one from each parent -- have about twice the risk. People with the variants tend to make insufficient insulin, the hormone that lowers blood sugar.
The gene accounts for about 21 percent of all diabetes cases; more than a third of Americans carry one copy. Seven to 10 percent carry two.
Am I one of them? Do I want to find out? There is no way to do that yet, but Decode Genetics, the Icelandic company whose researchers found the gene variant, is planning to market a test, possibly by 2007 or 2008. It will probably cost hundreds of dollars, and be available only through doctors.
At first glance, testing doesn't seem to offer much to people like me. We already figure the deck is stacked against us. Even if the test came out negative, I would still suspect I was at risk, but from some other gene that hasn't been discovered yet.
Then again, if I tested positive, the threat would seem more real. Maybe I would eat less, exercise more, check my blood sugar more often, keep better track of risk factors for heart disease like cholesterol and blood pressure. I would also have to decide whether to inflict the information on my sons.
I'm not sure I want that straight-up shot of reality. Even with my family history, I figure there's a chance I got lucky and didn't inherit whatever my mother had. A test could erode that bit of optimism.
Dr. David Altshuler, a diabetes expert at Harvard who has studied the gene variants, said he thought offering a routine genetic test now would be premature.
He said the test would not help people who already know they are at risk because of their family histories or because they have impaired glucose tolerance, a condition that often leads to diabetes. They should already be trying to exercise and lose weight, or taking a medication to treat the glucose problem, he said.
''There may be people who would say, 'If I knew my risk was 50 percent instead of 30 percent, I would like to know that to make me try harder,' '' Dr. Altshuler said. ''You could argue that either of those is really high, and you should be trying hard already.''
He also cautioned that people who do get tested must keep in mind that a positive result does not seal their fate: their risk is higher, but not absolute. Similarly, those who test negative are not in the clear. If they have other risk factors they still have to be careful, because other genes are almost certainly involved in diabetes as well.
Dr. Richard Kahn, chief scientific and medical officer for the American Diabetes Association, had similar concerns and said the research was important, but, ''translating it into some practical action is a long ways away.''
Dr. Altshuler said another reason for his wariness is that ''there is another gold rush in this, in diagnostics.''
He praised Decode as first-rate in terms of science and ethics, but he said he worried about other companies looking to cash in on legitimate research by marketing questionable genetic tests directly to consumers.
''A lot of companies will push the idea of doing genetic testing -- 'You can have this done, we'll give you advice,' '' he said. ''I'm deeply concerned. Companies are pushing things that aren't valid, saying send us your DNA and we'll give you advice about lifestyle or diet based on your genetic profile. Very little is known, let alone anything with implications.'' But, he noted wryly, despite all his reservations he has not been able to talk his own mother out of wanting the genetic test for Type 2 diabetes.
The Federal Trade Commission is also concerned. Last month, its Web site carried a warning that there were no valid studies to support many genetic tests being marketed to consumers to gauge their disease risks or suggest they need dietary supplements or special diets.
Dr. Kari Stefansson, Decode's chief executive, said genetic tests that measure the probability of developing a disease ''are a new sort of information that our society is growing rapidly more accustomed to, but it is still not absolutely clear how we are going to use it.''
The first use of a Type 2 diabetes test, he said, would probably be in people with impaired glucose tolerance. Those who came out positive could be treated aggressively, perhaps with drugs. Those who tested negative could be offered a more conservative approach.
For people with a family history and normal glucose tolerance, Dr. Stefansson said, the best use of the test would be to test both the relative with diabetes and the concerned family member. If both tested positive, then the family member was at high risk and could try to do something about it.
What about people like me, whose diabetic relatives are long gone? I could be tested, he said, and if I had the risky variant it might be a warning sign. But if I didn't have it, I still wouldn't be out of the woods.
So what do I want to do? Right now, I'm leaning toward having the test if it becomes available. I'm not sure what I'd do with the results or whether they would mean anything for my future. But I'd like the information, and the right to decide for myself whether to act on it.
By DENISE GRADY at The New York Times
Wednesday, August 09, 2006
DIABETES ARTICLES - Concern Grows Over Increase In Diabetes Around World
DIABETES ARTICLES.
Concern Grows Over Increase In Diabetes Around World
The number of people around the world suffering from diabetes has skyrocketed in the last two decades, from 30 million to 230 million, claiming millions of lives and severely taxing the ability of health care systems to deal with the epidemic, according to data released Saturday by the International Diabetes Federation.
While the growing problem of diabetes in the United States has been well documented, the federation's data show that 7 of the 10 countries with the highest number of diabetics are in the developing world.
China has the largest number over age 20, around 39 million people, or about 2.7 percent of the adult population, the federation says. The group says India has the second-largest number of cases, with an estimated 30 million people, or about 6 percent of the adult population.
Other countries have higher rates of diabetes than either China or India, but the federation says rising diabetes rates in the large, rapidly industrializing nations are especially worrisome because of the size of their populations. In some countries in the Caribbean and the Middle East, the percentage of diabetic people ranged from 12 to 20 percent.
In some of the world's poorest nations, the disease is a quick death sentence. While Americans can live for many years with the disease, a person in Mozambique who requires injections of insulin can expect to live just a year; in Mali, such people survive about 30 months.
There are many factors driving the growth in diabetes worldwide, but most experts agree that changes in lifestyle and diet are the chief culprits, in addition to genetic predisposition. As developing countries industrialize, people tend to do work involving less physical activity and eat food that is cheap but high in calories. The combination causes weight gain, which leads to greater risk of developing Type 2 diabetes, the most common form of the disease.
The other form, Type 1, is responsible for only 5 percent to 10 percent of cases, and is believed to stem almost entirely from genetic factors.
''Diabetes is one of the biggest health catastrophes the world has ever seen,'' said Dr. Martin Silink, the president-elect of the International Diabetes Federation.
To help stem the tide of the disease, the federation is seeking a United Nations resolution to recognize the seriousness of the problem. If that effort is successful, it would be the first of its kind for a noncommunicable disease.
by Marc Santora at New York Times.
Concern Grows Over Increase In Diabetes Around World
The number of people around the world suffering from diabetes has skyrocketed in the last two decades, from 30 million to 230 million, claiming millions of lives and severely taxing the ability of health care systems to deal with the epidemic, according to data released Saturday by the International Diabetes Federation.
While the growing problem of diabetes in the United States has been well documented, the federation's data show that 7 of the 10 countries with the highest number of diabetics are in the developing world.
China has the largest number over age 20, around 39 million people, or about 2.7 percent of the adult population, the federation says. The group says India has the second-largest number of cases, with an estimated 30 million people, or about 6 percent of the adult population.
Other countries have higher rates of diabetes than either China or India, but the federation says rising diabetes rates in the large, rapidly industrializing nations are especially worrisome because of the size of their populations. In some countries in the Caribbean and the Middle East, the percentage of diabetic people ranged from 12 to 20 percent.
In some of the world's poorest nations, the disease is a quick death sentence. While Americans can live for many years with the disease, a person in Mozambique who requires injections of insulin can expect to live just a year; in Mali, such people survive about 30 months.
There are many factors driving the growth in diabetes worldwide, but most experts agree that changes in lifestyle and diet are the chief culprits, in addition to genetic predisposition. As developing countries industrialize, people tend to do work involving less physical activity and eat food that is cheap but high in calories. The combination causes weight gain, which leads to greater risk of developing Type 2 diabetes, the most common form of the disease.
The other form, Type 1, is responsible for only 5 percent to 10 percent of cases, and is believed to stem almost entirely from genetic factors.
''Diabetes is one of the biggest health catastrophes the world has ever seen,'' said Dr. Martin Silink, the president-elect of the International Diabetes Federation.
To help stem the tide of the disease, the federation is seeking a United Nations resolution to recognize the seriousness of the problem. If that effort is successful, it would be the first of its kind for a noncommunicable disease.
by Marc Santora at New York Times.
Thursday, August 03, 2006
DIABETES ARTICLES - Diabetes Prevention in a Cuppa Joe?
DIABETES ARTICLES
Diabetes Prevention in a Cuppa Joe?
Drinking coffee is linked to a reduced risk for diabetes, a new study reports, and caffeine apparently has little to do with the effect.
The researchers, led by Mark A. Pereira, associate professor of epidemiology at the University of Minnesota, studied the dietary habits of more than 28,000 postmenopausal women. They found that those who drank six or more cups of regular or decaffeinated coffee a day had a 33 percent reduced risk of Type 2 diabetes, compared with those who drank none. Those with intermediate levels of coffee intake tended to have intermediate diabetes risk. Over the period of the study, from 1986 to 1997, 1,418 women developed the illness.
Coffee drinking was also associated with eating less fruit and more high-fat dairy products, higher alcohol and cigarette consumption, high blood pressure and a lower level of vigorous exercise, some of which are known risk factors for diabetes. When adjusted for these lifestyle factors, the link with a reduced risk for diabetes was weaker but still present, and the association was stronger for decaffeinated than caffeinated coffee.
"The thing about coffee that sets it apart from many other dietary factors that may protect against diabetes is that people consume a lot of it," Dr. Pereira said. "We can see the effect because we're able to study massive doses of it."
The authors acknowledge that their study, which appeared yesterday in The Archives of Internal Medicine, depends on self-reports rather than objective experimental design.
The scientists were unable to determine what ingredient in coffee might be protective against diabetes, but they pointed out that coffee was known to be a rich source of minerals and antioxidants that may delay or prevent the onset of the illness.
Diabetes Prevention in a Cuppa Joe?
Drinking coffee is linked to a reduced risk for diabetes, a new study reports, and caffeine apparently has little to do with the effect.
The researchers, led by Mark A. Pereira, associate professor of epidemiology at the University of Minnesota, studied the dietary habits of more than 28,000 postmenopausal women. They found that those who drank six or more cups of regular or decaffeinated coffee a day had a 33 percent reduced risk of Type 2 diabetes, compared with those who drank none. Those with intermediate levels of coffee intake tended to have intermediate diabetes risk. Over the period of the study, from 1986 to 1997, 1,418 women developed the illness.
Coffee drinking was also associated with eating less fruit and more high-fat dairy products, higher alcohol and cigarette consumption, high blood pressure and a lower level of vigorous exercise, some of which are known risk factors for diabetes. When adjusted for these lifestyle factors, the link with a reduced risk for diabetes was weaker but still present, and the association was stronger for decaffeinated than caffeinated coffee.
"The thing about coffee that sets it apart from many other dietary factors that may protect against diabetes is that people consume a lot of it," Dr. Pereira said. "We can see the effect because we're able to study massive doses of it."
The authors acknowledge that their study, which appeared yesterday in The Archives of Internal Medicine, depends on self-reports rather than objective experimental design.
The scientists were unable to determine what ingredient in coffee might be protective against diabetes, but they pointed out that coffee was known to be a rich source of minerals and antioxidants that may delay or prevent the onset of the illness.
