Eat More Brown Rice to Lower Diabetes Risk Latest Research on New Risk Factors, Diabetes Drugs and More

Advances in diabetes research bring some promising news. Learn how rice could lower your diabetes risk and get an update on an oral drug used to treat diabetes in youth and a blood test that could predict diabetes... Type of Rice Linked to Diabetes Risk Summary: People who eat more white rice are at increased type 2 diabetes risk, and those who eat more brown rice have less risk, according to a large diabetes study conducted by Harvard School of Public Health (HSPH) and Brigham and Women’s Hospital (BWH) in Boston. Type 2 diabetes is one of the fastest-growing health problems in Americans of all ages. Being overweight or inactive boosts diabetes risk. So does a family history of diabetes, being older and of certain ethnicities. Earlier studies have hinted that increased consumption of refined carbohydrates, including sugary foods and white breads, might also raise the risk. Research suggests that whole-grain foods like brown rice could reduce the likelihood of diabetes. To create white rice, brown rice must be milled and polished, which removes most of its vitamins and minerals. Milling also strips away most of its fiber – a compound that might help to deter diabetes by slowing the rush of glucose into the bloodstream. In the study, researchers analyzed rice consumption and diabetes risk among nearly 200,000 people who had participated in three large studies of nurses and other health professionals. Every 2-4 years, the participants completed questionnaires about their diet, lifestyle and health conditions. During 14 to 22 years of follow-up, about 5,500 cases of type 2 diabetes were diagnosed among participants. Frequently eating white rice increased the risk of type 2 diabetes, the researchers found. Those who reported eating at least five weekly servings of white rice had a 17% higher risk than those who ate less than one serving per month. In contrast, those eating at least two weekly servings of brown rice had an 11% lower risk of developing type 2 diabetes than those eating less than one serving per month. The findings held even after scientists adjusted for several factors that might influence the results, including age, weight and family history of diabetes. The researchers calculated that replacing just one-third of a typical daily serving of white rice with the same amount of brown rice might reduce the type 2 diabetes risk by 16%. The same replacement with other whole grains, such as whole wheat and barley, could lead to a 36% reduced risk, the scientists estimated. The researchers noted a potential limitation of the diabetes study: The analyses were based on participants’ self-reported intake of brown and white rice, which may not be accurate. But the large number of people studied and consistent results across all three study groups add validity to the findings, the scientists say. “Rice consumption in the U.S. has dramatically increased in recent decades,” says lead author Qi Sun, M.D., Sc.D., of the HSPH. “We believe replacing white rice and other refined grains with whole grains, including brown rice, would help lower the risk of type 2 diabetes.” Intensive Blood Sugar Control in Type 2 Diabetes Summary: A combination of 2 diabetes drugs, metformin and rosiglitazone, was more effective in treating youth with type 2 diabetes than metformin alone, according to a new diabetes study, funded primarily by NIH's National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) and published in an April 2012 online edition of the New England Journal of Medicine. Rising childhood obesity in the U.S. has brought more cases of type 2 diabetes in youth. Type 2 diabetes heightens the risk for various health conditions, including coronary artery disease, stroke, nerve damage and kidney and eye disease. Diabetes is marked by unusually high levels of blood sugar. The sugar is normally converted into energy with help from the hormone insulin. Diabetes occurs when the body can’t properly produce or use insulin. To fend off these complications, it's critical for young people with type 2 diabetes to control their blood glucose levels. However, because type 2 diabetes has been primarily an adult illness and was previously known as adult-onset diabetes, information about how to effectively treat youth has been limited. Several diabetes drugs are available to treat adults with type 2 diabetes. But only one oral diabetes medication – metformin – is approved by the Food and Drug Administration (FDA) for young people with type 2 diabetes. The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study set out to test additional approaches to controlling blood glucose levels in youth. The researchers enrolled 699 youth, ages 10 to 17, who had type 2 diabetes for less than two years. All were considered overweight or obese with an average body mass index (BMI) at the 98th percentile. The 85th percentile is considered overweight and 95th percentile, obese. The youth were randomly assigned to three treatment groups: Metformin alone Metformin plus rosiglitazone (sold as Avandamet) Metformin plus intensive lifestyle changes aimed at weight loss and increased physical activity The researchers were surprised to find that, over an average follow-up of 46 months, metformin alone maintained acceptable, long-term blood glucose control in only about half the youth. Also unexpected was the failure rate in the metformin plus lifestyle group, which was little better than metformin alone. In contrast, the failure rate was under 39% in the metformin and rosiglitazone group, a 25% reduction from metformin alone. The use of rosiglitazone in adults has been restricted because studies linked it to a higher risk of heart attack and stroke in adults. After a careful examination of the safety data, the TODAY Data and Safety Monitoring Board recommended that the diabetes study continue to test rosiglitazone in youths. There were no cardiac events such as heart attack during the study. “The results of this study tell us it might be good to start with a more aggressive drug treatment approach in youth with type 2 diabetes,” says TODAY study chair Philip Zeitler, M.D., a pediatric endocrinologist at Children's Hospital Colorado, Aurora. “We’re learning that type 2 diabetes is a more aggressive disease in youth than in adults and progresses more rapidly, which could be why metformin alone had a higher than expected failure rate,” he says. Further diabetes study will be needed to see if more aggressive therapy will yield long-term benefits for youths with type 2 diabetes as they move into adulthood. Another question to be studied is why the rigorous lifestyle intervention didn’t bring the benefits that similar strategies have produced in adults. More research also will be needed to design approaches that produce effective lifestyle changes for young people with type 2 diabetes. Blood Test May Predict Diabetes Risk Summary: Scientists have identified five molecules in the blood that can foretell diabetes risk years before typical signs of the disease appear. The finding might help to identify at-risk people who could take steps to delay or halt the disease. Type 2 diabetes, the most common form of the disease, develops gradually over many years. By the time it’s diagnosed, the insulin-producing cells in the pancreas may already be damaged. Several factors are known to raise the diabetes risk, including excess weight and inactivity. But a more accurate indicator, such as molecular biomarkers in the blood, could lead to more targeted interventions. Thomas J. Wang, M.D., and Robert E. Gerszten, M.D., and their colleagues at Massachusetts General Hospital and Boston University analyzed blood samples gathered as part of the Framingham Offspring Study, a long-term community-based study sponsored by NIH’s National Heart, Lung and Blood Institute (NHLBI). The new analysis was funded in part by NIDDK. The results were reported in a 2011 edition of Nature Medicine. Of more than 2,400 participants with no signs of diabetes in the early 1990s, about 200 developed type 2 diabetes during the 12 years of follow-up. The original blood samples from this latter group were analyzed and compared to samples from age-matched participants who didn’t develop diabetes but had similar risk factors. The scientists used an approach called metabolomics, which focuses on the unique mix of chemicals, called metabolites, substances left behind from bodily reactions. These chemical fingerprints can provide clues to health. Using new technologies to rapidly measure the levels of 61 amino acids and other metabolites in blood samples, the researchers found that elevated levels of five amino acids – isoleucine, leucine, valine, tyrosine and phenylalanine – seemed to predict a diagnosis of diabetes. High levels of these amino acids were detected as early as 12 years before onset of disease. Further analysis showed that a combination of three amino acids was an even better predictor of diabetes risk. The scientists confirmed their results by analyzing blood samples from more than 300 participants in an independent study of cancer and diet. Even in participants closely matched for traditional diabetes risk factors, such as obesity, these amino acid levels could help differentiate people at greatest risk. Participants with the highest levels of the three most predictive amino acids were 4-5 times more likely to develop diabetes than those with the lowest levels. "These findings could provide insight into metabolic pathways that are altered very early in the process leading to diabetes," Wang says. "They also raise the possibility that, in selected individuals, these measurements could identify those at highest risk of developing diabetes so that early preventive measures could be instituted." For more information and expert advice, visit Lifescript's Diabetes Type 2 Health Center. Myth vs. Fact: How Much Do You Know About Diabetes? In the United States alone, 23.6 million people have diabetes. And 5.6 million of them don’t even know it. Unfortunately, misinformation about diabetes is rampant – and mixing up the facts about this disease can have dire consequences.