A Little Sun May Help Prevent Type 1 Diabetes

SAN DIEGO: Lack of exposure to the sun could play a role in development of type 1 diabetes, researchers here said.

The rate of type 1 diabetes was higher in countries at higher latitudes where solar irradiation per square meter per day is lower, reported Cedric F. Garland, Dr.P.H., of the University of California San Diego, and colleagues online in Diabetologia.

"This natural experiment found that 25% of the variation in incidence rates [for type 1 diabetes] among regions of the world can be accounted for on the basis of latitude, and that 42% can be accounted for on the basis of solar UVB irradiance and percentage cloud cover, the main atmospheric determinants of vitamin D biosynthesis," the researchers wrote.

They recommended a combination of brief daily exposure to sunlight and dietary vitamin D for all young children, particularly those living in northerly climes.

This study is the latest publication by Dr. Garland and his brother and co-author Frank C. Garland, Ph.D., also at the University of California San Diego, to link sun exposure and vitamin D to a major disease.

Starting in 1980, the Garlands have published a string of epidemiological studies suggesting that brief but regular sun exposure helps prevent several types of cancer, including melanoma.

Their hypothesis is that lack of adequate sun exposure leads to low levels of vitamin D biosynthesis, which in turn promotes cancer (See: Vitamin D Chemoprevention Role Now Seen for Endometrial Cancer, Boosted Vitamin D Intake for Cancer Prevention?, and AACR: High Vitamin D Serum Levels Lower Breast Cancer Risk).

The new study is their first to connect sun exposure to a non-malignant disease. Dr. Garland and colleagues said it was prompted by a series of national analyses indicating that, for example, rates of type 1 diabetes are 370 times higher in Finland than in China.

"The pattern follows a latitudinal gradient that is the inverse of the global distribution of ultraviolet B irradiance," they explained.

Additionally, several earlier studies had found higher incidence of type 1 diabetes in children with low dietary intake of vitamin D.

The Diabetologia report describes a systematic analysis of type 1 diabetes rates from 51 regions of the world from 1990 through 1994, originally collected by the Diabetes Mondial Project Group.

Because the prevalence of type 1 diabetes has also been linked to national affluence and the quality of healthcare, the researchers also included per capita health expenditures for each region in their analysis.

They confirmed that per capita health expenditures were positively correlated with diabetes rates (P=0.004), but that local UVB irradiance remained a significant predictor of diabetes rates in multivariate analysis.

They cited limitations to their analysis including lack of data on dietary vitamin D intake and on typical attire, which may affect actual skin exposure to sunlight.

It's also possible, they noted, that UVB exposure prevents type 1 diabetes by mechanisms unrelated to vitamin D. Some studies have suggested that the disease is caused by viral pathogens such as Coxsackie virus, which can be killed on surfaces by exposure to sunlight.

Nevertheless, Dr. Garland and colleagues suggested that children older than one year who live in high latitudes should take 25 to 50 mcg of dietary vitamin D3 daily, especially in winter.

The researchers defined high latitudes as beyond the 30th parallels, which covers the entire United States except for Hawaii, south Texas, and the Florida peninsula.

They added that being outdoors in sunlight for a few minutes a day can substitute for some but not all the recommended dietary vitamin D intake.

"Further epidemiological studies would be desirable on the effect of serum 25(OH)D [vitamin D's active metabolite] levels and oral intake of vitamin D on incidence of type 1 diabetes," the researchers said.

"In the meantime, public health action seems warranted based on evidence gathered to date from many studies."

A meta-analysis of earlier studies of vitamin D and type 1 diabetes, published in the June issue of Archives of Disease in Childhood by researchers in England, led its authors to offer a similar recommendation.

"Vitamin D supplementation in early childhood may offer protection against the development of type 1 diabetes," wrote Christos Zipitis, M.D., of the Stockport NHS Trust, and colleagues after reviewing five observational studies of vitamin D intake and rates of type 1 diabetes.

They pointed out that the study may be subject to unknown confounding factors and concluded that for concrete conclusions to be reached, adequately powered, randomized controlled trials with long periods of follow-up would be required to establish causality and the best formulation, dose, duration, and period of supplementation.

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News From The American Diabetes Association Conference

Tight Control and CVD: the VA Diabetes Trial

SAN FRANCISCO -- This exclusive broadcast focuses on one of the major clinical trials reporting on whether tight control of blood glucose helps prevent or slows progression of cardiovascular disease and other complications of diabetes.

ADA: Continuous Glucose Monitoring Leads to Improved Glycemic Control

SAN FRANCISCO, June 13 -- Patients with type 1 diabetes showed significant improvement in glycemic control and had fewer hypoglycemic events when they began using continuous glucose sensors regularly, a researcher said here.

Among patients who previously relied exclusively on fingerstick monitors to check blood glucose, hemoglobin A1c levels declined from 7.37% at baseline to 7.05% (P<0.001) three months later after using continuous monitors for at least one day, Samuel L. Ellis, Pharm.D., of the University of Colorado in Aurora, Colo., reported at the American Diabetes Association meeting.

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Know About Diabetic Retinopathy (Loss of Vision) Which Affects 1 in 2 People With Diabetes

If you are suffering from Diabetes then you probably know that your body cannot use or store sugar properly. When the blood sugar level becomes too high, it can damage the blood vessels in eyes, developing into a condition known as Diabetic Retinopathy.

What is Diabetic Retinopathy?

Diabetic Retinopathy is a complicated stage of Diabetes that can lead to blindness. It occurs when the tiny blood vessels are damaged inside the retina, the light-sensitive tissue at the back of the eye.

In later stages, the disease may lead to growth of new blood vessels over the retina. The new blood vessels can cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as ‘Retinal Detachment’, and it can lead to blindness if left untreated. In addition, abnormal blood vessels can grow on the iris, and can cause Glaucoma.

People suffering from Diabetic Retinopathy, at first may not notice any changes in their vision. Over the time, Diabetic Retinopathy worsens and can cause complete loss of vision, and it usually affects both the eyes.

Different Stages of Diabetic Retinopathy:

It Comprises Four Stages:

1. Mild Non-proliferate Retinopathy: At this phase, Micro aneurysms occur. These are the earliest clinically visible changes of Diabetic Retinopathy. They are localized capillary dilatations that are usually saccular (round), and appear as small red dots. They do not affect vision and are one of the features of background Diabetic Retinopathy.

2. Moderate Non-proliferate Retinopathy: As the disease progresses, some blood vessels that nourish the retina are blocked.

3. Severe Non-proliferate Retinopathy: Many more blood vessels are blocked, depriving several areas of the retina with blood supply. Those areas of the retina send signals to the body to grow new blood vessels for nourishment.

4. Proliferate Retinopathy: At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called Proliferate Retinopathy. These new blood vessels are abnormal and fragile, and grow along the retina and surface of the clear, vitreous gel that fills the inside of the eye.

Who are at the Risk of Developing Diabetic Retinopathy?

People with Type 1 and Type 2 Diabetes are at the greatest risk. They should get a comprehensive dilated eye exam done at least once a year.
Even pregnant women with Diabetic Retinopathy may face problems.

What are the Symptoms and Signs of Diabetic Retinopathy?

1.Macular Edema: A condition when it becomes difficult to read or do close work. This also indicates that fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This state is known as Macular Edema.

2. Double Vision: It occurs when the nerves controlling the eye muscles are affected.

Diabetic retinopathy often has no early warning signs. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.

How are Macular Edema and Diabetic Retinopathy detected?

Macular Edema and Diabetic Retinopathy are detected during a comprehensive eye exam that includes:

Visual Acuity test: This is an eye chart test which measures how well a patient sees from various distances.

Dilated eye exam: Drops are put in eyes to widen, or dilate, the pupils. Eye care professional uses a special magnifying lens to examine the retina and optic nerve for signs of damage and other eye problems. After the test, close-up vision may remain blurred for several hours.

Tonometry: An instrument which measures the pressure inside the eye.

How is Macular Edema treated?

Macular Edema is treated with Focal Laser Surgery. Several hundred small laser burns are placed on the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session.

A patient may need focal laser surgery more than once to control the leaking fluid.

Focal laser treatment stabilizes vision. It reduces the risk of vision loss by 50 percent.

How is Diabetic Retinopathy treated?

Diabetic Retinopathy can be treated with Laser Photocoagulation to seal off leaking blood vessels and destroy new growth. Laser photocoagulation doesn’t cause pain, because the retina does not have nerve endings.

In some patients, blood leaks into the vitreous humor and clouds vision. The eye doctor may choose to simply wait to see if the clouding will dissipate on its own, a period called “watchful waiting”. A procedure called a Vitrectomy removes blood that has leaked into the vitreous humor. The body gradually replaces lost vitreous humor, and vision improves.

Is Scatter Laser treatment and Vitrectomy effective in treating Diabetic Retinopathy?

Yes. Both treatments are very effective in reducing loss of vision. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure Diabetic Retinopathy.

What is the Latest Research Done?

The National Eye Institute (NEI) is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people afflicted with Diabetes. This research is conducted through studies in the laboratory and with patients.

Researchers are investigating on drugs that may stop the retina from sending signals to the body to grow new blood vessels. Hopefully in the near future these drugs may help people control Diabetic Retinopathy and reduce the need for Laser surgery.

How to Take Care of Your Eyes?

1. Keep your blood sugar under good control.
2. Monitor your blood pressure and keep it under good control, or seek appropriate care.
3. Maintain a healthy diet.
4. Exercise regularly.
5. Follow your doctor’s instructions to the letter.

From The Diabetes Cure Blog

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