Men 'develop diabetes more easily'

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Category: News & Research

Created on Saturday, 19 May 2012 00:00

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Men 'develop diabetes more easily'

Researchers may have discovered why men may be more likely to develop type 2 diabetes than women, BBC News has reported. The broadcaster said that a new study has found men are biologically more susceptible and need to gain far less weight than women to develop the condition.

{sidebar id=11}In the study, Scottish researchers examined the records of 95,057 men and women with type 2 diabetes (a condition caused by too much glucose, a type of sugar, in the blood), looking at their ages and body mass index (BMI) scores at the time of diagnosis. A clear trend was found in their results, with men developing type 2 diabetes at a lower BMI than women of a similar age.

The researchers have speculated on why this may be the case, and have offered theories that men may be less sensitive to insulin than women or that males tend to store fat around their organs rather than under the skin as women do. However, the proposed reasons are only theories and cannot be confirmed by this study, which examined a limited range of factors at a single point in time.

Overall, the observation that men seem to develop type 2 diabetes at a lower BMI than women of the same age is worthy of further exploration. As Dr Victoria King, Head of Research at Diabetes UK, told the BBC: "It is worrying that men develop type 2 diabetes at a higher rate than their female counterparts. Research like this will help us understand reasons why and provide greater insight into what we can do to improve prevention of type 2 diabetes."

Where did the story come from?

The study was carried out by researchers from several Scottish research institutes, including the Scottish Diabetes Research Network Epidemiology Group at the University of Glasgow. The research received funding from the Wellcome Trust.

The study was published in the peer-reviewed medical journal Diabetologia. BBC News provided balanced coverage of this research.

What kind of research was this?

This was a cross-sectional study that looked at the associations between age, gender and BMI in men and women at the time of diagnosis of type 2 diabetes. The researchers wanted to test the hypothesis that men diagnosed with type 2 diabetes tend to have a lower average BMI than women diagnosed at a similar age, in other words, it that it takes less excess weight to trigger the condition in men than in women. The researchers said that this hypothesis was based on the fact that several recent studies have observed that European middle-aged men are at higher risk of diabetes than European middle-aged women. To test their theory they examined data on a large group of men and women from a population-based diabetes register in Scotland.

While this sort of study can observe trends in age and BMI at time of diagnosis and compare differences between men and women, it cannot tell us a great deal more than this. For example, it is not possible to determine the biological reasons why the men and women developed diabetes at the time they did, and the researchers' interpretations of their data are only theories at this stage. These theories provide an interesting discussion of the results and highlight areas for further study, but cannot be proven by this particular set of results.

What did the research involve?

The researchers looked at a 2008 snapshot of data held in the Scottish Care Information Diabetes Collaboration (SCI-DC) dataset, a population-based register holding information on people diagnosed with diabetes in Scotland. They were specifically interested in individuals with diabetes who had had their BMI measured within one year of diagnosis. Information on smoking status and blood glucose levels was also collected.

The researchers excluded data on individuals with a BMI of less than 25 and those diagnosed with diabetes before the age of 30 in order to try and limit inclusion of people with type 1 diabetes. They also excluded any remaining individuals who were missing data on key measures such as BMI, leaving them with a sample of 51,920 men and 43,137 women – representative of only 35.1% of the entire eligible dataset.

The researchers then used graphical models to plot BMI at the time of diagnosis against age at the time of diagnosis. Plotting separate graphs for men and women allowed them to compare whether associations between age and BMI at the time of diagnosis were different in men and women.

What were the basic results?

In the included sample of 95,057 individuals, men were on average significantly younger than women (average age 59.2 years versus 61.6 in women). The mean BMI recorded within a year of diagnosis of type 2 diabetes was 31.83kg/m2 in men and 33.69kg/m2 in women (a BMI of 25-29.9 indicates a person is overweight, and a BMI of 30 or above indicates obesity).

When the researchers plotted a graph of the relationship between average BMI and age at time of diagnosis, they observed clear trends: people with a higher BMI tended to develop type 2 diabetes at a younger age, and the BMI of women at the time of their diagnoses was consistently greater than that of men. This indicates that at a comparable age, men are developing diabetes at a lower BMI than women.

The researchers also adjusted their analysis to account for other factors that could have influenced the relationship. When they made adjustments to account for participants’ smoking they found it had no effect on their results. Men and women also had comparable blood glucose levels at the time of diagnosis, suggesting that these findings were not a consequence of men being diagnosed at an earlier stage of their condition.

The BMI gap between men and women was most significant at younger ages. According to the researchers’ graph, men who developed diabetes at age 40 had a BMI of around 34-35 versus 38-39 in women who developed diabetes at age 40. The gap gradually diminished as people got older, until eventually men and women who developed diabetes around the age of 80 of older had comparable BMI scores.

How did the researchers interpret the results?

From their analysis of a Scottish population of people with type 2 diabetes the researchers conclude that men are diagnosed with the condition at lower BMI than women of the same age. They suggest this observation could explain why type 2 diabetes is more common among middle-aged men in European populations.

Conclusion

This study is of scientific and medical interest and uses a large and reliable dataset to examine the associations between gender, age and BMI at the time of development of type 2 diabetes. The trend in the results is quite clear and supports previous studies which have observed that, despite higher prevalence of obesity in women, the prevalence of diabetes in middle-aged men exceeds that of women in some populations.

The study prompts further speculation about why this may be the case. For example, the researchers consider that for any given BMI, men may be less sensitive to insulin than women are. They also consider that it may be something to do with fat distribution, as men tend to distribute fat more readily around the liver and other body organs, while women tend to deposit fat under the skin (for example, around the hips and middle).

With regard to this latter theory, the researchers note a limitation of their study in that they did not have information on waist circumference. They say a previous study has suggested that women develop diabetes at a higher waist circumference than men.

However, the theories put forward cannot be proven by this study, which provides a snapshot of certain factors at the point of diagnosis but not an analysis of key factors that may have caused the condition to occur. In short, it is not possible to determine the reasons why these individuals developed diabetes when they did: to do so, other aspects of the individuals’ medical, lifestyle and family history would need to have been examined. The study paper also does not mention any analyses of dietary habits or alcohol consumption, which may be a key difference between males and females and also influence the way that individuals gain weight.

Also, it is not known whether the same findings would be observed in other populations. In particular, as the researchers note, it is not known whether the same pattern would be observed in people of other ethnic groups, as the Scottish sample included predominantly people of white European ancestry.

It is also worth noting again that, despite the large size of this Scottish sample it is still representative of only 35% of the total eligible dataset (the remainder being excluded as they were missing relevant data), and examining the whole sample could have given different findings.

Overall, the observation that men seem to be diagnosed with type 2 diabetes at a lower BMI than women of the same age is important, and warrants further study to establish why this may be the case.

Source: NHS UK

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Ghana's children given hope by rollout of new rotavirus vaccine

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Category: News & Research

Created on Wednesday, 09 May 2012 00:00

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Gavi and Ghana's government are rolling out vaccines against diarrhoea and pneumonia, a major threat to children under five”

Afua Hirsch, West Africa correspondent

In Accra's Independence Square, a baby cries as a few drops of liquid are squeezed into its mouth, watched closely by a jostling crowd of journalists and officials. The child is the first in Ghana to receive a new rotavirus vaccine – designed to protect children from a major cause of deadly diarrhoea and dehydration. The woman administering the vaccine is not a nurse or health worker, but Ghana's first lady, Ernestina Naadu Mills.

{sidebar id=11}Mills was keynote speaker at the highly choreographed launch of the latest achievement by Gavi – the Global Alliance for Vaccines and Immunisation – which brings together the World Health Organisation, the UN Children's Fund, the World Bank, civil society, the vaccine industry, research and technical agencies, the Bill & Melinda Gates Foundation and other private-sector philanthropists.

Gavi, which raises funds and stimulates the development of new vaccines for the developing world, has worked with Ghana's government to organise the rollout of the rotavirus vaccine and, to much acclaim, a new vaccine against pneumococcal infections, making Ghana the first country in sub-Saharan African to introduce two new vaccines at the same time.

The two vaccines are expected to save thousands of lives. Rotavirus, which causes gastroenteritis, can lead to severe dehydration and causes the deaths of more than 2,000 Ghanaian children each year, accounting for 40% of all diarrhoea-related deaths. Diarrhoea and pneumonia, the most common form of serious pneumococcal disease, each account for 10% of deaths among Ghana's under-fives.

"Ghana is showing the way. Here we have the capacity, a degree of self-confidence, and locally grown and maintained infrastructure that is needed," said Lord Paul Boateng, a member of the UK House of Lords who was born in Ghana and travelled to the country to witness the vaccine launch.

That Gavi has deemed Ghana able to introduce rotavirus and pneumococcal vaccines together is a vote of confidence in the country's ability to establish a "cold chain". The cold chain is central to the ability to administer vaccines, requiring a seamless system to keep vaccines at a temperature of 2-8C.

In Koforidua, the capital of Ghana's eastern region, the regional vaccine cold storage facility has been upgraded from a room crammed full of fridges to a hi-tech walk-in cold room – a donation from the Japan International Co-operation Agency. Emelia D Okai, the regional disease control officer, who looks after the facility, says all that is missing now is a cold van, so they can deliver the vaccines to sub-district health centres.

But power outages cause problems. "We have outages every week, sometimes twice a week," says Okai. "We have a generator that has a manual switch. So we are always ready – if there is [an outage] there is always someone responsible for switching on the standby generator."

Access to healthcare

Despite the new vaccines, access to healthcare remains a major problem for rural communities, with only about 50% of under-fives who contract pneumonia taken to an appropriate healthcare provider, and only 60% of infants under six months exclusively breastfed.

The Asenema community health planning services unit, in Akuapim North district just outside Accra, has no electricity and has to store its vaccines in fridges powered by gas. A solar panel unit sits on the floor beside the gas cylinders – the nurses explain it was provided by a Dutch company but no one has ever come to connect it.

At nearby Awukugu Nyensi village, where Asenema health unit conducts a monthly vaccination programme, 18-year-old Phyllicia's two-month-old daughter is getting the rotavirus vaccine. "I'm happy – I want my child to be strong and fit. I want her to be a nurse when she grows up," she says.

Women come to the monthly gathering in the village when told a vaccination day is approaching. Rebecca Ahiabu knows only too well the effects of the diseases being vaccinated against. She buries her head in her hands as she describes how she lost her 18-month-old daughter Emmanuella to pneumonia. For Ahiabu, the new immunisation programme means the difference between life and death. But it is far from a catch-all solution to the problems of poverty.

Seth Berkley, the chief executive of Gavi, is quick to dismiss suggestions that persistent problems associated with poverty make vaccination any less meaningful. "If you trace a baby that gets measles, you will see that as it gets sick it gets more malnourished, its growth may be stunted, it may suffer some brain damage," he says. "The family will have spent a lot of money – that could have been spent on school fees – on medical treatment. It is a huge issue for families when kids get sick."

One problem of developing the pneumococcal vaccine has been that the strains prevalent in the developing world were different from those being vaccinated against in richer countries. To develop the vaccine, GlaxoSmithKline and Pfizer got an advanced market commitment (AMC), a method of stimulating the development of vaccines needed in low-income countries. Gavi mobilises donors to make a legally binding commitment to subsidise buying vaccines at predetermined terms, creating an artificial market for the vaccine industry so they increase investment in these products.

But working with the private sector to create artificial markets, forming buying consortiums, and making massive purchase orders from the world's largest pharmaceutical companies has led to accusations that Gavi is encouraging business to profit from the poorest.

"Could the price be cheaper?" Berkley asks. "Probably. But there are children today who are alive because that vaccine was developed. Do you wait for other companies to come, and would the other companies have been interested if it wasn't for those big guys? I would love to use the AMC again."

Source: The Guardian UK, 03 May 2012

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Rice 'diabetes risk' overstated

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Category: Dine & Wine

Created on Thursday, 10 May 2012 00:00

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Rice 'diabetes risk' overstated

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Walking 'may ease depression'

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Category: News & Research

Created on Monday, 07 May 2012 00:00

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Walking 'may ease depression'

Going for a brisk stroll could play an important role in fighting depression,” BBC News has reported.

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