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New Ways to Identify the Diabetes-Prone Before Pre-Diabetes
New marker sialic acid can predict the onset of diabetes even before weight gain or abnormal blood sugar levels occur.

In a promising new field of diabetes research, scientists are finding new ways to help identify diabetes-prone patients early, potentially averting complications such as limb amputation, blindness and heart disease.

Researchers have found that signs of inflammation can help explain and predict the onset of diabetes, according to studies presented last summer at the American Diabetes Association's annual scientific conference.

Most of us think of inflammation as the swelling and redness that may surround an insect bite or infection. But this type of inflammation, caused by a malfunctioning immune system, has no obvious symptoms and occurs deep in the body.

More than 17 million Americans have diabetes, a disease caused when the body cannot produce enough insulin.

Diseases like arthritis and lupus have long been characterized as inflammatory illnesses. New research shows that diabetes and heart disease also may be associated with an inflammatory response.

Doctors have long known that obesity and high blood sugar are risk factors for diabetes, but new studies show that markers of inflammation can predict the onset of diabetes even before weight gain or abnormal blood sugar levels occur.

Scientists know that obese people - those most at risk for diabetes - also appear to have higher inflammation levels than those who are not overweight. They also have learned that insulin - which diabetics cannot produce - can reduce inflammation.

Because the inflammation associated with diabetes cannot be measured directly, scientists look for markers associated with it, such as high levels of certain proteins or acids in the blood. And they still are not sure whether these markers influence diabetes risk or simply point the way to it.

In one study of about 10,000 American patients who were already participating in a large heart-disease study, scientists found that patients with high levels of a marker known as sialic acid were about 75 percent more likely to develop diabetes than those who had much lower levels of sialic acid.

The researchers measured other markers but found little correlation between those levels and increased risk of diabetes when controlling for other factors such as diabetes, said Dr. Bruce Duncan, affiliated with both the University of North Carolina and the Federal University of Rio Grande do Sul in Brazil.

In another study, researchers reviewed the prescription drug use of 11,000 diabetics from the Canadian province of Saskatchewan. They found that diabetics who took statins - cholesterol-lowering drugs commonly prescribed to forestall heart disease - were able to delay the progression of diabetes. On average, statin patients were able to delay their use of insulin by 10 months, compared with diabetics who did not take statins.

However, the patients on statins were not able to put off insulin injections permanently, in part because diabetes is a progressive disease that is difficult to control even with aggressive medical treatment, said Jeffrey A. Johnson, a public health expert at the University of Alberta.

Researchers do not know why the statins worked, but they theorize that the drugs may reduce inflammation, allowing insulin to work more effectively in the body, Johnson said. He cautioned that it is too early to tell whether statins should be prescribed to delay the onset of diabetes in addition to heart disease and that more study is needed.

A third study of 11 patients showed that a drug known as rosiglitazone, prescribed to lower blood sugar in diabetic patients, also helped reduce markers of inflammation by 20 to 40 percent in six weeks.

Scientists are still trying to determine the nature of the markers and how they work. They theorize that inflammatory responses may restrict circulation in an area, making it difficult for insulin to get where it is needed in the body, Duncan said.

Some scientists also theorize that adipose tissue (fat) may secrete these inflammatory markers, and that these markers may block the release of insulin. In one example, fat tissue produces a marker known as tumor necrosis factor alpha (TNF alpha), which blocks certain insulin receptors, said Dr. Paresh Dandona, lead author of the rosiglitazone study.

"In our bodies, there is an inherent tension between growth and defense," Duncan said, describing the clash between food metabolism and the immune system. Inflammation research is important because it focuses directly on the question of what causes diabetes.

"We're getting closer to what goes wrong," he said.

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