Specialized cognitive therapy improves blood sugar control in depressed diabetes patients

Addressing participants' moods and their treatment management skills may bring faster relief of depression symptoms

Although maintaining good blood sugar control is crucial for avoiding complications of diabetes, it has been estimated that only about half of patients are successful in meeting target blood glucose levels. The prevalence of depression among diabetes patients – up to twice as high as in the general population – can interfere with patients' ability to manage their diabetes. Now a group of Massachusetts General Hospital (MGH) investigators report that a program of cognitive behavioral therapy that addresses both mood and diabetes self-care led to improved blood sugar control and produced faster relief of depression in patients with poorly-controlled type 2 diabetes.
"The association between depression and type 2 diabetes is well documented, but clinical trials of either medication or psychological treatment for depression have had mixed or negative effects on adherence to treatment programs," says Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry and lead author of the report in the March issue of Diabetes Care. "In this study we adapted our approach that has improved treatment adherence among HIV/AIDS patients by addressing both depression and treatment self-management skills."
The current study enrolled 87 adults whose type 2 diabetes was poorly controlled despite treatment with oral medications and who also met criteria for a diagnosis of depression. At the outset of the trial, all participants received an enhanced version of usual diabetes self-care counseling – including meetings with a nurse educator to set goals for blood sugar monitoring, with a dietitian to set dietary and exercise goals, and with a counselor to set strategies for meeting those goals and other medical recommendations.
A subgroup of 45 randomly selected participants took part in 9 to 12 additional weekly cognitive behavioral therapy (CBT) sessions where they worked on problem-solving strategies, reviewed how well they met goals of the previous week and tracked their moods. While the sessions included typical aspects of CBT for depression – such as training in adaptive thinking, relaxation and activity scheduling – they also focused on specific elements of diabetes self-care.
Throughout the year-long study period, participants in both groups continued any previously prescribed depression treatment; but if symptoms were found to have worsened at assessment visits, they were referred for additional therapy or adjustments to antidepressant medication. Participants' adherence to their prescribed diabetes medication was tracked by an electronic monitoring system that recorded whenever the pill bottle was opened, and their adherence to glucose monitoring, by data downloaded from the monitor.
At the end of the first four months, participants receiving the integrated CBT treatment were significantly more successful than the usual-treatment group in adhering to their prescribed medications and their glucose monitoring schedule. They also showed an improvement in blood sugar control similar to what might be seen with the addition of a weak glucose-lowering medication. These differences in diabetes management and glucose control were also seen at the 8- and 12-month assessments.
While the CBT group had more rapid improvement of their depression symptoms, scoring significantly better on two depression scales at the 4-month assessment, depression symptoms in the usual-treatment group had improved by the 8- and 12-month assessments, removing any statistically significant differences between the groups at the end of the study period. It is possible, Safren notes, that participants in the usual-treatment group were more likely to be referred for additional depression treatment after the 4-month assessment, since they were less likely to show improvement at that visit.
"We are hopeful that this approach can be helpful in treating any medical illness in which patients also have depression," he says. "We need to study extending this treatment to other conditions, as well as finding the best ways to incorporate it into diabetes care. With today's emphasis on cost containment in health care, it will be important to know if the improved blood sugar control this treatment appears to confer makes it more cost effective over the long run." Safren is a professor of Psychology in the Harvard Medical School Department of Psychiatry.
Source: Diabetes Care

Acupuncture holds promise for treating inflammatory disease

Rutgers-led study suggests pathways to alleviating inflammation in disorders such as sepsis, arthritis

When acupuncture first became popular in the western hemisphere it had its doubters. It still does. But over time, through detailed observation, scientists have produced real evidence that ancient Chinese practitioners of the medical arts were onto something.
Now new research documents a direct connection between the use of acupuncture and physical processes that could alleviate sepsis, a condition that often develops in hospital intensive care units, springs from infection and inflammation, and takes an estimated 250,000 lives in the United States every year.
"Sepsis is the major cause of death in the hospital," says Luis Ulloa, an immunologist at Rutgers New Jersey Medical School who led the study, which has been published by the journal Nature Medicine. "But in many cases patients don't die because of the infection. They die because of the inflammatory disorder they develop after the infection. So we hoped to study how to control the inflammatory disorder."
The researchers already knew that stimulation of one of the body's major nerves, the vagus nerve, triggers processes in the body that reduce inflammation, so they set out to see whether a form of acupuncture that sends a small electric current through that and other nerves could reduce inflammation and organ injury in septic mice. Ulloa explains that increasing the current magnifies the effect of needle placement, and notes that electrification is already FDA-approved for treating pain in human patients.
When the electroacupuncture was applied to mice with sepsis, molecules called cytokines that help limit inflammation were stimulated as predicted, and half of those mice survived for at least a week. There was zero survival among mice that did not receive acupuncture.
Ulloa and his team then probed further, to figure out exactly why the acupuncture treatments had succeeded. And they made a discovery that, on its face, was very disappointing. They found that when they removed adrenal glands – which produce hormones in the body – the electroacpuncture stopped working. That discovery, on its face, presented a big roadblock to use of acupuncture for sepsis in humans, because most human cases of sepsis include sharply reduced adrenal function. In theory, electroacupuncture might still help a minority of patients whose adrenal glands work well, but not many others.
So the researchers dug even deeper – to find the specific anatomical changes that occurred when electroacupuncture was performed with functioning adrenal glands. Those changes included increased levels of dopamine, a substance that has important functions within the immune system. But they found that adding dopamine by itself did not curb the inflammation. They then substituted a drug called fenoldopam that mimics some of dopamine's most positive effects, and even without acupuncture they succeeded in reducing sepsis-related deaths by 40 percent.
Ulloa considers the results a double triumph.
On the one hand, he says, this research shows physical evidence of acupuncture's value beyond any that has been demonstrated before. His results show potential benefits, he adds, not just for sepsis, but treating other inflammatory diseases such as rheumatoid arthritis, osteoarthritis and Crohn's disease.
On the other hand, by also establishing that a drug reduced sepsis deaths in mice, he has provided an innovative roadmap toward developing potential drugs for people. That roadmap may be crucial, because no FDA-approved drug to treat sepsis now exists.
"I don't even know whether in the future the best solution for sepsis will be electroacupuncture or some medicine that will mimic electroacupuncture," Ulloa concludes. The bottom line, he says, is that this research has opened the door to both.
Source:Rutgers University

Health ministry issues 'National Guidelines for Stem Cell Research'

The union health ministry has issued the 'National Guidelines for Stem Cell Research' which will provide ethical and scientific directions to scientists and clinicians working in the field of stem cell research in the country. These guidelines were jointly prepared by the Indian Council of Medical Research (ICMR) and the Department of Biotechnology (DBT).

The guiding philosophy of the new guidelines is to promote scientific and ethical stem cell research while preventing premature commercialization and potential exploitation of vulnerable patients.

The guidelines reiterate that the general principles of biomedical research involving human participants shall also be applicable to all human stem cell research. The guidelines have been prepared to ensure that research with human stem cells is conducted in a responsible and ethical manner and complies with all regulatory requirements pertaining to biomedical research in general and of stem cell research in particular.

These guidelines apply to all stakeholders including individual researchers, organizations, sponsors, oversight/regulatory committees and any others associated with both basic and clinical research on all types of human stem cells and their derivatives. However, these guidelines do not apply to research using non-human stem cells or tissues. Further, they do not regulate the use of haematopoietic stem cells for treatment of various haematological, immunological and metabolic disorders which has already been established as a standard of medical care.

As per the guidelines, research is prohibited in research related to human germ line gene therapy and reproductive cloning; in vitro culture of intact human embryos, regardless of the method of their derivation, beyond 14 days of fertilization or formation of primitive streak, whichever is earlier; clinical trials involving transfer of xenogeneic cells into a human host (any clinical research on Xenogeneic-Human hybrids is also prohibited); research involving implantation of human embryos (generated by any means) into uterus after in vitro manipulation, at any stage of development, in humans or primates; and breeding of animals in which any type of human stem cells have been introduced at any stage of development, and are likely to contribute to gonadal cells.

The guidelines on stem cell research, still in its nascent stage, is of utmost importance as some clinicians have started exploiting hapless patients by offering unproven stem cell treatments prematurely. Such fraudulent practices had to be stopped urgently, while ensuring that scientifically designed and responsible research on stem cells is not hindered. It was under this background that the ICMR and DBT jointly released Guidelines for Stem Cell Research and Therapy, way back in 2007, which has now been revised to reflect new scientific and clinical findings that have significantly changed the scope of stem cell research and possible translation.

The present guidelines have retained the earlier classification of stem cell research into three categories, namely Permitted, Restricted and Prohibited categories; an additional layer of oversight, besides the Institutional Ethics Committee (IEC), in the form of Institutional Committee for Stem Cell Research (IC-SCR) and National Apex Committee for Stem Cell Research and Therapy (NAC-SCRT) has been introduced. This mechanism of additional review has been accepted by the scientific community in the country and the required NAC-SCRT has become operational. The role and functioning of these committees is being streamlined.
Source:Pharmabiz

Vitamin E, Beta-carotene Can't Help to Prevent Heart Disease, Cancer

In yet another blow to the $28 billion vitamin industry, a US task force on Monday urged against taking Vitamin E and beta-carotene to prevent heart disease or cancer.
The latest guidelines from the US Preventive Services Task Force update the 2003 edition by adding Vitamin E to beta-carotene, a supplement that was already known to be ineffective at preventing the two most fatal diseases in America. 

The findings are based on a systematic review of scientific studies which found that Vitamin E does not help -- and that beta-carotene supplements could actually do more harm than good. 

"Beta-carotene can be harmful because it increases the risk of lung cancer in people who are already at increased risk for the disease," said Task Force co-chair Michael LeFevre. 

With regard to other multivitamins, including single or paired supplements, there was not enough evidence to say whether they help or harm one's chances of getting heart disease or cancer, the task force said. 

Despite numerous warnings about the unproven effects of vitamins, consumers continue to believe in them, with about half of US adults saying they take at least one dietary supplement and one-third reporting they take a multivitamin regularly. 

The task force's recommendations apply to healthy adults who have no special medical concerns. 

Some populations, however, are urged to take certain vitamins. 

Pregnant women are advised to take prenatal vitamins with folic acid according to their doctors' advice, and seniors at risk of falling are urged to take vitamin D for bone health. 

Instead of taking supplements, the task force urged most people to simply eat a healthy diet rich in fruits, vegetables, whole grains, low-fat dairy and seafood. 

"Cardiovascular disease and cancer have a significant health impact in America, and we all want to find ways to prevent these diseases," said Task Force chair Virginia Moyer. 

"However, we found that there is not enough evidence to determine whether taking single or paired nutrients or a multivitamin helps to prevent cardiovascular disease or cancer." 

The task force is an independent panel of medical experts from across the United States. 

Source:Its recommendation statement was published in the February 24 edition of the Annals of Internal Medicine.

 

Pregnant Women Using Common Painkiller Increase Risk of ADHD in Kids

A common pain reliever Acetaminophen, considered safe for pregnant women has been linked for the first time to an increased risk of attention deficit and hyperactivity disorder in children, a study said Monday.
More studies are needed to confirm the findings, but experts said the research points to a new potential cause for the worldwide rise in cases of ADHD, a neuro-behavioral condition which has no known cause and affects as many as five percent of US children. 

Women who took acetaminophen, also known as paracetamol, while pregnant had a 37 percent higher risk of having a child who would be later given a hospital diagnosis of hyperkinetic disorder, a particularly severe form of ADHD, said the study in February 24 edition of the Journal of the American Medical Association (JAMA) Pediatrics. 

Compared to women who did not take acetaminophen while pregnant, women who did also had a 29 percent higher chance of having children who were later prescribed medications for attention deficit hyperactivity disorder, and a 13 percent higher chance of exhibiting ADHD-like behaviors by age seven. 

Previous research has suggested that acetaminophen can interfere with normal hormone function and may affect the developing fetal brain. The painkiller has also been linked to a slightly increased risk in boys of cryptorchidism, a condition in which the testicles do not descend. 

The latest research was based on survey data on more than 64,000 Danish women from 1996 to 2002. 

More than half said they took acetaminophen at least once during pregnancy. 

Outside experts cautioned that the observational findings do not prove that taking Tylenol-like pain relievers causes ADHD, only that a preliminary link between the two has appeared and would need to be confirmed by further research. 

"Findings from this study should be interpreted cautiously and should not change practice," said an accompanying editorial in JAMA Pediatrics by Miriam Cooper and colleagues at the Cardiff University School of Medicine. 

"However, they underline the importance of not taking a drug's safety during pregnancy for granted." 

The reasons the women took the painkillers could have also had a confounding effect on the outcome, they added. 

The study was led by Zeyan Liew, of the University of California, Los Angeles, and was co-authored by Jorn Olsen of the University of Aarhus in Denmark.
Source:JAMA
 

Vegetarian Diets Linked to Lower Blood Pressure

New research indicates that eating a vegetarian diet appears to be associated with lower blood pressure (BP). Furthermore, such diets can also be used to reduce blood pressure in patients.
Factors such as diet, body weight, physical activity and alcohol intake play a role in the risk of developing hypertension. Dietary modifications have been shown to be effective for preventing and managing hypertension. 

The authors analyzed seven clinical trials and 32 studies published from 1900 to 2013 in which participants ate a vegetarian diet. Net differences in BP associated with eating a vegetarian diet were measured. 

In the trials, eating a vegetarian diet was associated with a reduction in the average systolic (peak artery pressure) and diastolic (minimum artery pressure) BP compared with eating an omnivorous (plant and animal) diet. In the 32 studies, eating a vegetarian diet was associated with lower average systolic and diastolic BP, compared with omnivorous diets. 

"Further studies are required to clarify which types of vegetarian diets are most strongly associated with lower BP. Research into the implementation of such diets, either as public health initiatives aiming at prevention of hypertension or in clinical settings, would also be of great potential value." 
 

Kerala Set to Become First Complete Ayurveda Accessible State: CM

With an eye on making affordable Ayurveda treatment accessible to more people in Kerala, Chief Minister Oommen Chandy said on Thursday that the state will become the first complete Ayurveda accessible state in the next two weeks.

 He made the announcement after inaugurating the second edition of Global Ayurveda Festival.The Cabinet has given a green signal to start 25 new Ayurveda clinics in government hospitals, he said at the function.

He said, "Ayurveda will need a 'Kerala model' of development to reach greater heights." He added that the state would encourage more Ayurveda treatment centres, practitioners and production of medicinal plants.

Chief guest of the function Mauritius President Rajkeswur Purryag said that Ayurveda was also gaining popularity in his country.

State Health Minister V S Sivakumar said by 2020 Ayurveda would reach a new pinnacle by entering into genomics and nanotechnology. He said the government would support such efforts. He also inaugurated the Ayurveda Expo.

Mauritius Education Minister B K Benware said the government would introduce yoga in its curriculum soon.
Source: Global Ayurveda Festival.

 

Switch That Regulates Sleep Discovered

Scientists said that though the research was carried on fruit flies or drosophila, the system is likely to be applied to humans as well. The switch controls sleep-promoting nerve cells or neurons in the brain. Neurons start working when we're tired and haven't slept for long hours and they dampen down when we are at rest.

"When you're tired, these neurons in the brain shout loud and they send you to sleep," says Professor Gero Miesenböck of Oxford University, in whose laboratory the research was carried out.

Researchers found out that sleep is determined by two key points in the body. First, the body clock that works in both animals and humans for a 24-hour day and night cycle. The other system is 'homeostat,' that keeps a tab on the body's waking hours and makes it go off to sleep when the body needs energy and the most important thing - rest.

Researchers are trying to find out ways to activate sleep switch in order to treat sleep disorders such as insomnia. Other sleep disorders can range from snoring to sleep apnea, sleep deprivation.

Flies do not show any movement when they go to sleep and more disturbance is needed to wake them up. But there were problems noticed in sleep-deprived flies. They are more likely to nodding off and are cognitively impaired and they exhibit severe learning and memory problems. And these are some of the problems faced by humans as well in case of sleep loss.

 Source:Oxford University,

Expert Finds Muscle Stem Cell Based Method to Restore Strength in Aging and Disease

A study co-published in Nature Medicine this week by University of Toronto researcher Penney Gilbert has discusses a stem cell based method for restoring strength to damaged skeletal muscles of the elderly. Skeletal muscles are some of the most important muscles in the body, supporting functions such as sitting, standing, blinking and swallowing. In aging individuals, the function of these muscles significantly decreases.

"You lose fifteen percent of muscle mass every single year after the age of 75, a trend that is irreversible," cites Gilbert, Assistant Professor at the Institute of Biomaterials & Biomedical Engineering (IBBME) and the Donnelly Centre for Cellular & Biomolecular Research (CCBR). The study originates from Gilbert's postdoctoral research at Stanford University's Baxter Laboratory for Stem Cell Biology.

Through tracing the signaling pathways of the cells, the researchers - including lead author, Professor Helen Blau, and postdoctoral researcher Ben Cosgrove - determined that during aging, a subpopulation of stem cells begin to express a modification of a protein that inhibits their ability to grow and make new stem cells.

"But if we instead treated those cells outside the body with a drug that prevented that protein modification from occurring, in combination with culturing the cells on something soft that is reminiscent of soft skeletal tissue, like a hydrogel biomaterial, the combination allowed the aged cells to grow and make more copies of themselves," Gilbert describes.

The rejuvenated cell cultures were then transplanted into injured and aged tissues, with remarkable results: the transplanted cells returned strength to the damaged and aged tissues to levels matching a young, healthy state.

"We've now shown that muscle stem cells progressively lose their stem cell function during aging," Cosgrove said in a statement. "This treatment does not turn the clock back on dysfunctional stem cells in the aged population. Rather, it stimulates stem cells from old muscle tissues that are still functional to begin dividing and self-renewing."

"An important thing to stress here is that this is not a panacea for aging in general," warns Dr. Blau. The stem cell treatment would only be used to repair localized defects in relatively small muscles found in the hip area, the throat, or the muscles in the eye.

One of the significant challenges to elderly individuals who receive hip transplants, for instance, is the challenge of repairing skeletal muscles around the hip joint injured during surgery. The study points to the potential for future post-surgery therapies that could leave elderly hip replacement patients spry in a fraction of the time.

"Even a small, localized transplantation could have a huge impact on quality of life," Blau argues, and adds, "One big advantage is that because the cells would come from the person's own muscles there would be no problem with an immune response."

"It's a really new, exciting field," says Gilbert, who argues that the muscle stem cell field, which only began to isolate muscle stem cells for study within the last five years, is especially "wide open" in Toronto where "there are really impassioned clinician researchers who are interested in restoring strength in aging and disease.

 Source:Nature Medicine