A ‘paradigm shift’ in the diagnosis of diabetes: study

Updated 02 March 2018
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A ‘paradigm shift’ in the diagnosis of diabetes: study

PARIS: Scientists on Friday unveiled a revised classification for diabetes, one they said could lead to better treatments and help doctors more accurately predict life-threatening complications from the disease.
There are five distinct types of diabetes that can occur in adulthood, rather than the two currently recognized, they reported in The Lancet Diabetes & Endocrinology, a leading medical journal.
The findings are consistent with the growing trend toward “precision medicine,” which takes into account differences between individuals in managing disease.
In the same way that a patient requiring a transfusion must receive the right blood type, diabetes sub-types need different treatments, the study suggested.
Similarly, scientists have also identified distinct kinds of microbiome — the bacterial ecosystem in our digestive tract — that can react differently to the same medication, rendering it more or less effective.
“This is the first step toward personalized treatment of diabetes,” said senior author Leif Groop, an endocrinologist at Lund University in Sweden, adding that the new classification is a “paradigm shift” in how the disease is viewed.
People with diabetes have excessively high blood glucose, or blood sugar, which comes from food.
Some 420 million people around the world today suffer from diabetes, with the number expected to rise to 629 million by 2045, according to the International Diabetes Federation.
Currently, the disease is divided into two sub-types.
With type-1 — generally diagnosed in childhood and accounting for about 10 percent of cases — the body simply doesn’t make insulin, a hormone that helps regulate blood sugar levels.
For type-2, the body makes some insulin but not enough, which means glucose stays in the blood.
This form of the disease correlates highly with obesity and can, over time, lead to blindness, kidney damage, and heart disease or stroke. Acute cases may also require limb amputations.
It has long been known that type-2 diabetes is highly variable, but classification has remained unchanged for decades.
For the study, researchers monitored 13,270 newly diagnosed diabetes patients ranging in age from 18 to 97.
By isolating measurements of insulin resistence, insulin secretion, blood sugar levels, age, and the onset of illness, they distinguished five distinct clusters of the disease — three serious and two milder forms.
Among the severe types, a group of patients with insulin resistence — in which cells are unable to use insulin effectively — was at far higher risk of kidney disease.
“This group has the most to gain from the new diagnostics as they are the ones who are currently most incorrectly treated,” Groop said.
Another group facing serious complications was composed of relatively young, insulin-deficient patients.
The third “severe” group were people with auto-immune diabetes corresponding to the original “type-1” diagnosis.
The two other groups have milder types of the disease including one, which includes about 40 percent of the patients, beset with a form of diabetes related to advanced age.
“This will enable earlier treatment to prevent complications in patients who are most at risk of being affected,” said lead author Emma Ahlqvist, an associate professor at Lund University.
The results were checked against three other studies from Sweden and Finland.
“The outcome exceeded our expectations,” said Groop.
The researchers plan to launch similar studies in China and India.
 


Gaming addiction classified as mental health disorder by WHO

Updated 18 June 2018
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Gaming addiction classified as mental health disorder by WHO

  • Addiction to video games has been recognized by World Health Organization as a mental health disorder
  • The International Classification of Diseases now covers 55,000 injuries, diseases and causes of death

GENEVA: Obsessive video gamers know how to anticipate dangers in virtual worlds. The World Health Organization says they now should be on guard for a danger in the real world: spending too much time playing.
In its latest revision to a disease classification manual, the UN health agency said Monday that compulsively playing video games now qualifies as a mental health condition. The statement confirmed the fears of some parents but led critics to warn that it may risk stigmatizing too many young video players.
WHO said classifying “gaming disorder” as a separate addiction will help governments, families and health care workers be more vigilant and prepared to identify the risks. The agency and other experts were quick to note that cases of the condition are still very rare, with no more than up to 3 percent of all gamers believed to be affected.
Dr. Shekhar Saxena, director of WHO’s department for mental health and substance abuse, said the agency accepted the proposal that gaming disorder should be listed as a new problem based on scientific evidence, in addition to “the need and the demand for treatment in many parts of the world.”
Dr. Joan Harvey, a spokeswoman for the British Psychological Society, warned that the new designation might cause unnecessary concern among parents.
“People need to understand this doesn’t mean every child who spends hours in their room playing games is an addict, otherwise medics are going to be flooded with requests for help,” she said.
Others welcomed WHO’s new classification, saying it was critical to identify people hooked on video games quickly because they are usually teenagers or young adults who don’t seek help themselves.
“We come across parents who are distraught, not only because they’re seeing their child drop out of school, but because they’re seeing an entire family structure fall apart,” said Dr. Henrietta Bowden-Jones, a spokeswoman for behavioral addictions at Britain’s Royal College of Psychiatrists. She was not connected to WHO’s decision.
Bowden-Jones said gaming addictions were usually best treated with psychological therapies but that some medicines might also work.
The American Psychiatric Association has not yet deemed gaming disorder to be a new mental health problem. In a 2013 statement, the association said it’s “a condition warranting more clinical research and experience before it might be considered for inclusion” in its own diagnostic manual.
The group noted that much of the scientific literature about compulsive gamers is based on evidence from young men in Asia.
“The studies suggest that when these individuals are engrossed in Internet games, certain pathways in their brains are triggered in the same direct and intense way that a drug addict’s brain is affected by a particular substance,” the association said in that statement. “The gaming prompts a neurological response that influences feelings of pleasure and reward, and the result, in the extreme, is manifested as addictive behavior.”
Dr. Mark Griffiths, who has been researching the concept of video gaming disorder for 30 years, said the new classification would help legitimize the problem and strengthen treatment strategies.
“Video gaming is like a non-financial kind of gambling from a psychological point of view,” said Griffiths, a distinguished professor of behavioral addiction at Nottingham Trent University. “Gamblers use money as a way of keeping score whereas gamers use points.”
He guessed that the percentage of video game players with a compulsive problem was likely to be extremely small — much less than 1 percent — and that many such people would likely have other underlying problems, like depression, bipolar disorder or autism.
WHO’s Saxena, however, estimated that 2 to 3 percent of gamers might be affected.
Griffiths said playing video games, for the vast majority of people, is more about entertainment and novelty, citing the overwhelming popularity of games like “Pokemon Go.”
“You have these short, obsessive bursts and yes, people are playing a lot, but it’s not an addiction,” he said.
Saxena said parents and friends of video game enthusiasts should still be mindful of a potentially harmful problem.
“Be on the lookout,” he said, noting that concerns should be raised if the gaming habit appears to be taking over.
“If (video games) are interfering with the expected functions of the person — whether it is studies, whether it’s socialization, whether it’s work — then you need to be cautious and perhaps seek help,” he said.