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Beyond birthmarks and beta blockers, to cancer prevention

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Drying up the HIV reservoir

Wnt is one of those funky developmental signaling pathways that gets re-used over and over again, whether it’s in the early embryo, the brain or the Read more

Venkat Narayan

Exercise, changes in diet alter course for pre-diabetics

The D-CLIP Study staff in Chennai, India

A type 2 diabetes intervention program developed by researchers from Emory and the Madras Diabetes Research Foundation (MDRF) in India is showing promising results in improving risk factors, such as lowering weight and decreasing blood pressure and glucose levels.

The ongoing study, called the Diabetes Community Life Improvement Program, (D-CLIP) was designed to test the benefits of a low-cost community program for people at increased risk for type 2 diabetes, most commonly associated with obesity. The curriculum integrates exercise, nutrition education and dietary changes. The study is being conducted in Chennai, India with hopes of expanding the program into other parts of South Asia.

Six-hundred participants with prediabetes were randomly assigned to either a standard of care control treatment or weekly D-CLIP classes for six months, where they learned about making healthy choices in real life situations such as restaurants and grocery stores. They also learned how to incorporate exercise into their daily routines with the goal of completing 150 minutes of physical activity a week.

Of the 200 participants who have completed the course to date, 83 percent have lost between five and 13 pounds. There also was improvement in blood glucose, serum cholesterol and blood pressure levels in participants.

“This initial research is quite encouraging because it shows we can turn the tide of type 2 diabetes onset by promoting simple lifestyle changes through well-structured community programming,” says Venkat Narayan, MD, Hubert Professor in Emory’s Rollins School of Public Health and a professor in Emory School of Medicine. “Attendance at the lifestyle classes is 85 to 90 percent, with lifestyle changes strongly evident. More than anything, we have formed strong partnerships with the local community that will ultimately lead to the implementation of more successful programs like this.”

The study is conducted by the Global Diabetes Research Center, a collaboration between Emory University and MDRF in Chennai, India. The center received its initial support from the Emory Global Health Institute, with funding from BRiDGES (Bringing Research in Diabetes to Global Environments and Systems), an International Diabetes Federation program supported by an educational grant from Eli Lily. Currently, the 17th session of D-CLIP classes is in progress, with the study set to close in early 2013.

Participants in the D-CLIP study learned to incorporate exercise into their lives to stave off type 2 diabetes.

“We have always known that the right diet and exercise can improve health,” says V. Mohan, MD, president of the Madras Diabetes Research Foundation. “But there has been no scientific community-based program to quantify this until now. We hope this is just the beginning of efforts to reduce the incidence of the type 2 diabetes epidemic worldwide.”

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Number of diabetic Americans could triple by 2050

As many as 1 in 3 U.S. adults could have diabetes by 2050, federal officials recently announced.

The Centers for Disease Control and Prevention (CDC) estimate that 1 in 10 have diabetes now – approximately 24 million Americans – but that number could grow to 1 in 5 or even 1 in 3 by mid-century if current trends continue.

The report was published in the Oct. 22 issue of Population Health Metrics. Edward Gregg, Emory adjunct professor of global health, and David Williamson, Emory visiting professor of global health, were co-authors.

The CDC’s projections have been a work in progress. The last revision put the number at 39 million in 2050. The new estimate takes it to the range of 76 million to 100 million.

The growth in U.S. diabetes cases has been closely tied to escalating obesity rates. A corresponding rise in diabetes has even prompted researchers to coin a new hybrid term: diabesity.

“There is an epidemic going on that, if left unchecked, will have a huge effect on the U.S. population and on health care costs,” says K. M. Venkat Narayan, MD, MSc, MBA, professor of global health and epidemiology at the Rollins School of Public Health, who came to Emory from the CDC’s Division of Diabetes Translation. “The numbers are very worrying.”

K. M. Venkat Narayan, MD, MSc, MBA

Narayan also heads the Emory Global Diabetes Research Center, which aims to find solutions to the growing global diabetes epidemic. The Center serves as the research leader and hub for population-based research and large intervention trials throughout South Asia and globally.

“Whatever we do, the fruits of our research have to be available to people everywhere,” says Narayan.

Read more about Dr. Narayan’s global efforts and diabetes research underway at Emory.

Hear Dr. Narayan talk about the Global Diabetes Research Center.

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Managing heart disease and diabetes in South Asia

Illnesses such as diabetes and heart disease are affecting increasing numbers of young people in developing countries. In light of this worrisome trend, K. M. Venkat Narayan, MD, and his colleagues are launching a new center of excellence aimed at preventing and controlling heart disease and diabetes in India and Pakistan.

K.M. Venkat Narayan, MD

K.M. Venkat Narayan, MD

It’s essentially a center of excellence for cardiac metabolic disease prevention and control in South Asia with Emory playing a very important role in the project, says Narayan, professor of global health and epidemiology at Emory’s Rollins School of Public Health and professor of medicine in Emory School of Medicine.

The primary partner of this grant will be the public health foundation of India, New Delhi. Emory is the developed country academic partner working with other network partners, namely, the Madras Diabetes Research Foundation in Chennai, India and the Aga Khan University in Karachi, Pakistan.

The center will focus on surveillance, prevention of mortality stemming from cardiovascular disease and diabetes, and training young investigators in the field of diabetes and cardiovascular disease prevention and control.

It’s estimated that by 2030, the number of people with diabetes will reach 400 million worldwide, double today’s number, says Narayan. Cardiovascular disease is a major cause of death among people with diabetes with 80 percent of deaths from chronic diseases worldwide occurring in low and middle-income countries.

What is particularly worrying about developing countries is that diseases like diabetes are hitting younger people, says Narayan. The implications, he says, are young people who would otherwise be economically productive must leave the labor market. In addition, in India, one person having diabetes uses 25 percent of the family’s income just for his own treatment. The economic impact and the health impact are enormous, says Narayan. Read more in Emory Public Health magazine.

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