180
VOLUME 8 NUMBER 4 • NOVEMBER 2011
EASD WATCH
SA JOURNAL OF DIABETES & VASCULAR DISEASE
risk factors, blood pressure lowering is the
most efficient way of lowering cardiovascu-
lar risk, compared to glucose lowering and
treatment for high cholesterol levels.
Another interesting statistic recently
published was that statin therapy increased
the incidence of diabetes. For every three
cardiovascular events prevented by using
statins, one new diabetic was produced.
Therefore patients with low cardiovascular
risk and high risk of developing diabetes
should not necessary be treated with stat-
ins.
Source: 46th Minkowski lecture, EASD, Prof N Sattar.
ADVANCES IN IMPLEMENTING LIFE-
STYLE CHANGES
Improving health outcomes
through peer diabetes education:
lessons for primary healthcare
Diabetes requires a life-long process of self-
care, treatment and lifestyle changes. It is
commonly accepted that diabetes patients
should be made aware of the signs, symp-
toms and consequences of the disease.
Studies relating to peer education for
improving health outcomes in diabetes are
rare in developing countries.
An exception was the presentation of
the recent Bangladesh study on the effec-
tiveness of diabetes education with pro-
fessional versus peer leaders. Among the
peer leader group, significant reductions
in systolic blood pressure, fasting blood
glucose and HbA
1c
levels were found. Edu-
cational intervention by professionals also
resulted in significant reductions in HbA
1c
levels.
Fasting blood glucose was more sig-
nificantly reduced in the peer leader group
compared to the professional group. Study
subjects of the professional group had
significantly better diastolic blood pres-
sure compared to the peer leader group.
This emphasises the value of South Africa’s
approach of using lay community workers
to support the healthcare team.
Source: Khan F,
et al
. Effectiveness of diabetes educa-
tion on improving glycaemic achievement by profes-
sionals versus peers. Presentation 66.
Improved peer education outcomes
for diabetic foot
The significance of diabetic education on
prevention and prognosis of diabetic foot
ulcers (DFU) was examined in China, where
33% of DFUs result in amputation. Find-
ings indicated that individualised diabetic
education may decrease the incidence of
DFU, retard the progress of diabetic foot
and reduce amputation rate and mortality.
Source: Zhenghua X,
et al
. Individualised diabetic edu-
cation can contribute to decrease the incidence of dia-
betic foot and avoid amputation: results of a 9-year
prospective study. Presentation 61.
BRAIN CONTROL OF SATIETY AND
APPETITE
Satiety signalling in type 2 diabetes
Altered central satiety signalling in type 2
diabetes may be a barrier to weight loss.
A surrogate marker of neuronal activation
(changes in regional cerebral blood flow) has
been used to examine the effect of type 2
diabetes on neuronal responses to feeding.
Findings indicated that altered central
satiety signalling in T2DM may be a barrier
to weight reduction and lifestyle manage-
ment in the treatment of T2DM.
Source: Lee S,
et al
. Impact of type 2 diabetes on hunger
and brain responses to eating: a continuous arterial spin
labelling functional magnetic resonance imaging study.
Presentation 135.
Brain responses to food
Eating behaviour is also controlled by cor-
ticolimbic responses to food cues, which
mature in man from childhood to early
adulthood. Changes in such higher-func-
tioning brain responses observed in obesity
and type 2 diabetes may be implicated in
their aetiology. Central control of appetite
is an attractive target for weight reduction
and diabetes control.
Considering the increased risk of obesity
and type 2 diabetes as an individual ages,
Cheah and colleagues have investigated the
effect of advancing age in adults on cor-
ticolimbic responses. It is established that
BMI influences regional brain responses to
food cues. Age may independently influ-
ence neural network responses to food
that control appetite and eating behaviour.
Reduced activation of these pathways may
result in reduced control of food intake,
which may be involved in the increased risk
of obesity with rising age.
Source: Cheah YS,
et al
. Both ageing and body mass
modulate the human brain response to food cues. Pres-
entation 133.
Gastric bypass alters central appe-
tite control
The role of the proximal intestine in the
pathophysiology of type 2 diabetes mellitus
has been the subject of growing interest.
Gastric bypass surgery has been shown to
resolve type 2 diabetes but the underlying
mechanisms are incompletely understood.
Studies have examined the improvement
in glucose metabolism after gastric bypass
surgery.
Hunt and colleagues proposed that
changes in gut-to-brain communication
following Roux-en-Y gastric bypass (RYGB)
may modulate central control of appetite.
Findings indicate that the pattern of central
neuronal deactivation in response to food
ingestion is similar in those who have had
RYGB and individuals of normal weight,
but different from obese individuals who
have not had surgery. These patterns may
explain increased satiation with eating and
the weight loss seen post-RYGB.
Source: Hunt KF,
et al
. The brain’s response to food
ingestion after Roux-en-Y gastric bypass: a [
18
F]-fluoro-
deoxyglucose positron emission tomography (FDG-PET)
study. Presentation 137.
Other consequences of bariatric
surgery: insulin sensitivity improves
only in DM patients
Svehlikova and colleagues quantified
changes in insulin sensitivity
1
before and
shortly after gastric bypass surgery in type
2 diabetic (DM) patients and non-diabetic
patients (non-DM) with severe obes-
ity. Improvement in insulin sensitivity was
marked in DM patients, independent of
duration of disease. No such post-opera-
tive changes were observed in the non-DM
group.
Despite a markedly enhanced GLP-1
response in an oral glucose tolerance test,
there was only a mild improvement in insu-
lin secretion, which still remained impaired
when compared to non-DM patients. An
unexpected enhanced rise in glucagon
levels during OGTT points to a substan-
tial stimulatory effect of gastric bypass on
alpha-cell function.
The hypothesis that intestinal insulin
resistance is an important factor in the
pathophysiology of type 2 diabetes was
investigated by Makinen and colleagues.
2
Their aim was to non-invasively quantitate
intestinal insulin-stimulated glucose uptake
(GU) in obese patients before and after
bariatric surgery.
