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.
 


WHO: Alcohol abuse kills 3 million a year, most of them men

The logo of the World Health Organization (WHO) is pictured on the facade of the WHO headquarters on October 24, 2017 in Geneva. (AFP)
Updated 22 September 2018
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WHO: Alcohol abuse kills 3 million a year, most of them men

  • Of all deaths attributable to alcohol, 28 percent were due to injuries, such as traffic accidents and interpersonal violence
  • An estimated 2.3 billion people worldwide drink alcohol, with average daily consumption of people at 33 grams of pure alcohol a day

GENEVA: More than 3 million people died in 2016 due to drinking too much alcohol, meaning one in 20 deaths worldwide was linked to harmful drinking, the World Health Organization (WHO) said on Friday.
More than three quarters of these deaths were among men, the UN health agency said. Despite evidence of the health risks it carries, global consumption of alcohol is predicted to rise in the next 10 years.
“It’s time to step up action to prevent this serious threat to the development of healthy societies,” WHO Director-General Tedros Adhanom Ghebreyesus, said.
In its “Global status report on alcohol and health 2018,” the WHO said that globally, an estimated 237 million men and 46 million women are problem drinkers or alcohol abusers. The highest prevalence is in Europe and the Americas, and alcohol-use disorders are more common in wealthier countries.
Of all deaths attributable to alcohol, 28 percent were due to injuries, such as traffic accidents and interpersonal violence. Another 21 percent were due to digestive disorders, and 19 percent due to cardiovascular diseases such as heart attacks and strokes.
An estimated 2.3 billion people worldwide drink alcohol, with average daily consumption of people at 33 grams of pure alcohol a day. This is roughly equivalent to two 150 ml glasses of wine, a large (750 ml) bottle of beer or two 40 ml shots of spirits.
Europe has the highest per person alcohol consumption in the world, even though it has dropped by around 10 percent since 2010. Current trends point to a global rise in per capita consumption in the next 10 years, the report said, particularly in Southeast Asia, the Western Pacific and the Americas.
“All countries can do much more to reduce the health and social costs of the harmful use of alcohol,” said Vladimir Poznyak, of the WHO’s substance abuse unit. He said proven, cost-effective steps included raising alcohol taxes, restricting advertising and limiting easy access to alcohol.
Worldwide, 45 percent of total alcohol consumed is in the form of spirits. Beer is the second most popular, accounting for 34 percent of consumption, followed by wine at 12 percent.
The report found that almost all countries have alcohol excise taxes, but fewer than half of them use other pricing strategies such as banning below-cost sales or bulk buy discounts.