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New study shows fortified “doogh” improves inflammatory markers in patients with type 2 diabetes

Newswise — Chevy Chase, MD— Daily intake of vitamin D-fortified doogh (Persian yogurt drink) improved inflammatory markers in type 2 diabetics and extra calcium conferred additional anti-inflammatory benefits, according to a recent study accepted for publication in The Endocrine Society’sJournal of Clinical Endocrinology and Metabolism (JCEM).

Inflammation is known to have a central role in the development of type 2 diabetes and its further complications like coronary heart disease and stroke. Vitamin D carries benefits for skeletal health but evidence of an anti-inflammatory effect from clinical studies in humans remains scarce.

“Our previous research showed that improvement of vitamin D status by regular daily intake of a fortified yogurt drink resulted in lowered blood glucose levels in diabetic patients,” said Tirang Neyestani, PhD, of Shahid Beheshti University of Medical Sciences in Tehran, Iran and lead author of the study. “The current study found that consuming a vitamin D-fortified yogurt drink also decreased serum substances like highly sensitive C-reactive protein (hsCRP) which are known to have an inflammatory role.”

In this study, researchers conducted a double-blind, randomized, controlled trial over 12 weeks in 90 patients with type 2 diabetes. Study participants were randomly allocated to one of three groups to receive two 250mL bottles a day of either plain doogh, vitamin D-fortified doogh or calcium plus vitamin D-fortified doogh. Vitamin D levels, insulin resistance, and inflammatory markers such as hsCRP, fibrinogen and adiponectin were measured in blood samples taken from study participants.

“Our study showed for the first time that adiponectin, a substance secreted by fat tissue that has an anti-inflammatory effect, increased when calcium and vitamin D-fortified doogh was consumed,” said Neyestani. “Our findings may offer interesting therapeutic options for diabetic patients.”

Other researchers working on the study include: Bahareh Nikooyeh, Hamid Alavi-Majd, Nastaran, Shariatzadeh, Ali Kalayi, Nima Tayebinejad, Soudabeh Heravifard, Shabnam Salekzamani and Malihe Zahedirad, all with Shahid Beheshti University of Medical Sciences.

The article, “Improvement of vitamin D status via daily intake of fortified yogurt drink either with or without extra calcium ameliorates systemic inflammatory biomarkers, including adipokines, in the subjects with type 2 diabetes,” appears in the June 2012 issue of JCEM.

A new study of older diabetes patients has found that well-controlled blood sugar levels were associated with a lower risk of major complications such as heart attacks, amputation and kidney disease, but the very lowest blood sugar levels were associated with a small but significant increased risk of death. The study published in the June 2011 issue of the journal Diabetes Care, followed more than 70,000 type 2 diabetes patients from Kaiser Permanente who were over 60 years of age for four years.

Because these findings come from an observational study and not a randomized clinical trial, more research needs to be done to fully understand their clinical implications.

“We saw increased mortality and complications, as anticipated, among those with very high blood sugars, but we also saw a modestly increased risk of death among those with very low levels of blood sugar,” said the study’s lead author Elbert Huang, MD, associate professor of medicine at the University of Chicago. Researchers indicated that the best overall outcomes were found among those with intermediate levels of control

Huang and Andrew Karter, PhD, from Kaiser Permanente Division of Research in Oakland, CA, jointly lead the Diabetes & Aging Study, the largest observational study to assess diabetes in older adults in the United States. The 5-year, NIH-funded study investigates care and health outcomes in older patients with type 2 diabetes in a typical community setting.

Most current guidelines suggest keeping glucose levels for patients with diabetes quite low. For people without diabetes, the normal glucose level—measured by a test called hemoglobin A1C, which reflects the average blood glucose level over the previous three months—is between 4 percent and 6 percent, compared to 6 and higher for patients with diabetes.

Because higher levels are associated with complications from this chronic disease, most recommendations for people with diabetes suggest maintaining an A1C less than 7 percent

“We need more evidence regarding how well the 7-percent guideline, which was based on a 1998 British trial that excluded older patients, applies to patients over the age of 60,” said study co-author Andrew J. Karter, PhD, and the study’s principal investigator at the Kaiser Permanente Division of Research.

Recent studies have raised concerns. In 2008, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was halted after it showed a higher rate of mortality in older patients who received very intensive glucose-lowering treatments.

“In our study,” said Huang, “we found the best overall outcomes among those with the intermediate levels of control, those with A1Cs below 8 percent but above 6 percent. We observed similar patterns for those in their 60s, 70s, and over 80.”

Finding the optimal A1C target is a balancing act, the authors note. The risk of all complications rose with blood sugar levels, but those with an A1C between 6 and 8 percent had the lowest death rates. While those with very poorly controlled blood sugars—A1C over 10 percent—had the highest rates of death, those with an A1C below 6 were also at a somewhat higher than those with an A1C between 6 and 8 percent.

“We cannot say whether this unexpected finding is due to the very low blood sugar itself, the treatments used to control blood sugars, or to some other factors not directly related to the care of diabetes,” Karter explained. “It may be that the sickest patients at high risk of dying simply had low blood sugars to start with, rather than anything directly associated with the care of diabetes increasing the risk of death.”

“Further research, he added, “will be focused on identifying the mechanisms that underlie the somewhat increased mortality among those with very low A1C.”

NEW YORK (March 30, 2011) — In the longest study of its kind, bariatric surgery has been shown to reduce the risk of heart attack and stroke in patients with diabetes. These results and other groundbreaking research were presented at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes, hosted by NewYork-Presbyterian Hospital and Weill Cornell Medical College.

“This is a watershed moment for diabetes care. With 20 years of data, we can really see how the surgery can improve a spectrum of health measures — notably cardiovascular risk,” says Dr. Francesco Rubino, director of the Congress and director of gastrointestinal metabolic surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

While Type 2 diabetes is not technically a cardiovascular disease, experts say it might as well be one, given the corrosive effects of unregulated blood sugar on the heart. According to the American Heart Association, at least 65 percent of people with diabetes die of some form of heart disease or stroke.

Dr. Lars Sjöström, professor at the Institute of Medicine in Göteborg, Sweden, presented new data gleaned from the Swedish Obese Subjects (SOS) study. He reported on 20 years of data comparing 2,010 bariatric surgeries with 2,037 non-surgical patients who received medical treatment or lifestyle modification for obesity.

“Type 2 diabetes has always been considered a chronic, lifelong disease, but the long-term data show remission in 70 percent of patients after two years of follow-up,” he says. “Thirty percent are still in remission 15 years after bariatric surgery. Even more remarkable, 20 years out, we have seen that bariatric surgery has reduced new cases of diabetes by 80 percent among obese patients who did not have the disease at the start of the study.”

Dr. Sjöström concludes that the surgery’s preventive effect seems to be even stronger and more long-lasting than its ability to sustain long-term remission. Equally striking, the incidence of new cardiovascular events — either heart attack or stroke — has been at least 30 percent lower among postsurgical patients than their conservatively treated counterparts.

A Utah-based study presented similar clinical outcomes. After gastric bypass surgery, patients were seen to have greater reductions in blood pressure, heart rate, triglycerides, low-density lipoprotein (LDL) cholesterol, and insulin resistance than did patients in the group of severely obese patients who were treated via medication and lifestyle modification. The surgical group also experienced favorable changes in heart function and “geometry” — a subtle remodeling of the heart’s components leading to greater efficiency. The study’s principal investigator, Dr. Ted Adams of the University of Utah School of Medicine, believes the new data support the use of bariatric surgery to prevent the cardiovascular complications associated with obesity and Type 2 diabetes.

The GI Tract: A New Target for Treatment and Research

“The idea that the gastrointestinal tract can be targeted for the treatment of diabetes is highly promising. It also represents an entirely new way to treat and think about a disease that is notoriously difficult to control,” says Dr. Rubino, who also serves as associate professor of surgery at Weill Cornell Medical College.

Bariatric surgery, especially procedures that involve the rerouting as opposed to restriction of the gastrointestinal (GI) tract, appears to change the hormonal secretions of the gut, explains Dr. Rubino. These changes may be responsible for the surgery’s impressive success in improving or even resolving the disease in a majority of patients.

In bypassing portions of the jejunum or duodenum — the upper part of the small intestine right below the stomach — rerouting procedures such as gastric bypass seem to work via a mechanism of action that occurs too quickly to be related to weight loss. Although scientists are still engaged in lively debate around how and why the surgery works, there is growing consensus that anatomical changes in the GI tract play a far greater role in the control of diabetes than was previously believed.

Dr. Lee Kaplan, a renowned authority on obesity medicine and Congress presenter, elaborates: “The pharmaceutical and biotechnology industries have been developing novel diabetes drugs that target the GI tract, but the process is still at a relatively early stage.

“Recently, for example, we have seen the emergence of a new class of drugs designed to alter the action of gut-based hormones such as incretins, which play an important role in the production of insulin. However, the molecular character of the upper intestine still remains to be mapped and understood,” adds Dr. Kaplan, who is associate professor of medicine at Harvard Medical School and director of the Obesity Research Center at Massachusetts General Hospital.

The Congress also featured presentations by Nobel laureates Michael S. Brown and Joseph L. Goldstein. Their keynote lecture focused on the role of the gastrointestinal hormone ghrelin in regulating key biochemical processes implicated in energy metabolism. Ghrelin has been linked to obesity, mainly because of its ability to stimulate growth hormone release.

Beyond the details of that discussion, adds Dr. Rubino, the entire idea of the GI tract as an endocrine organ — one that could be responsible for the hormonal misfiring seen in diabetes — is still being tested, both in academic medical circles and by industry. At stake are new drugs, new devices and improved surgical methods for people living with and all too often dying from diabetes. “Some of us anticipate a paradigm shift in our understanding of the disease while others question such a shift,” says Dr. Rubino. “But there can be no doubt of how much we’re learning at this Congress about the clinical benefits of diabetes surgery and the basic science that underpins its success.”