Diabetes and race. A historical perspective

Emergence versus Reductionism in Science Publications

Just a few years after the U.S. government's decision to fully fund the Human Genome Project (HGP) in 1990, an important harbinger of things to come was the publication of the controversial 1994 book The Bell Curve by Richard J. Herrnstein and Charles Murray. The authors' most controversial claim was that human intelligence was at least 60 percent genetic. At that time, the national advisory group to the HGP, the Ethical Legal and Social Implications committee (ELSI) requested that the American Journal of Human Genetics critique and respond to the authors' claim. The editorial board of the journal refused on the grounds that "this book was about behavioral genetics" while the HGP was about human molecular genetics. Members of ELSI committee argued vigorously that this distinction between different forums and platforms used to explain human genetic variation would soon collapse and merge. However, it was only a matter of time before behavioral geneticists would claim the legitimacy of being under the mantle of molecular genetics. In this address, I show just how prescient the ELSI group had been. Much of the answer lies in the reward structure for science publications that strongly favor reductionism versus emergence.

Classification and identification of risk factors for type 2 diabetes

The risk factors for type 2 diabetes mellitus (T2DM) have been increasingly researched, but the lack of systematic identification and categorization makes it difficult for clinicians to quickly and accurately access and understand all the risk factors, which are categorized in this paper into five categories: Social determinants, lifestyle, checkable/testable risk factors, history of illness and medication, and other factors, which are discussed in a narrative review. Meanwhile, this paper points out the problems of the current research, helps to improve the systematic categorisation and practicality of T2DM risk factors, and provides a professional research basis for clinical practice and industry decision-making.

Prevalence of diabetes in the USA from the perspective of demographic characteristics, physical indicators and living habits based on NHANES 2009-2018

Objective

To determine differences in DM in the U.S. population according to demographic characteristics, physical indicators and living habits.

Methods

23 546 participants in the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES) who were 20 year of age or older and not pregnant. All analyses used weighted samples and considered the stratification and clustering of the design. Specific indicators include length of leg (cm), BMI (kg/cm2), TCHOL (mg/dL), fasting plasma glucose (mg/dL) and comparison of means and the proportion of participants with DM.

Results

The prevalence of DM in the USA has been rising modestly in the past decade, and were consistent and robust for the observed differences in age, sex, and ethnicity. Compared with white participants, black participants and Mexican-American were both more likely (P<0.001) to have diabetes: 14.6% (CI, 13.6% to 15.6%) among black participants, 10.6% (CI, 9.9% to 11.3%) among white participants, and 13.5% (CI, 11.9% to 15.2%) among Mexican-American participants. The prevalence of diabetes is increasing with age, males peaked around the 60s, and women around the 70s. The overall mean leg length and TCHOL was lower in diabetics than in non-diabetics (1.07 cm, 18.67 mg/dL, respectively), while mean BMI were higher in diabetics than in non-diabetics (4.27 kg/cm2). DM had the greatest effect on decline of TCHOL in white participants (23.6 mg/dL), less of an effect in black participants (9.67 mg/dL), and the least effect in Mexican-American participants (8.25 mg/dL). Notably, smoking had great effect on percent increment of DM in whites (0.2%), and have little effect on black and Mexican-Americans.

Conclusions

DM is more common in the general population than might be clinically recognized, and the prevalence of DM was associated to varying degrees with many indicators of demographic characteristics, physical indicators, and living habits. These indicators should be linked with medical resource allocation and scientific treatment methods to comprehensively implement the treatment of DM.

Harnessing the language of overdose prevention to advance evidence-based responses to the opioid crisis

Language has significant implications for how we view and respond to public health issues. Conventional moralistic messaging around drug use stigmatizes people who use drugs and inhibits the implementation of evidence-based harm reduction interventions that do not condemn drug use. However, within the context of the unprecedented North American opioid overdose crisis, we argue that shifting conventional moral messaging around overdose prevention and response strategies is key to supporting the rapid roll-out of evidence-based harm reduction interventions. Reframing overdose prevention to highlight the imperative to address the ongoing public health emergency is an important first step in implementing urgently needed response strategies.

Caloric Intake on the Sabbath: A Pilot Study of Contributing Factors to Obesity in the Orthodox Jewish Community

The American Orthodox Jewish community has specific cultural factors that may contribute to overweight and obesity. This study aimed to look at caloric intake on the Sabbath and its contribution to overweight and obesity. Twelve married or previously married women who identify themselves as Orthodox Jews were recruited to do 24-h food recalls over the phone. The participants were divided into three weight groups (normal, overweight, and obese) based on their BMI. The overweight and obese participants' data were combined into one group for the purposes of statistical testing. Paired t tests looking at the data for all participants showed significantly great caloric intake during an average Sabbath day than an average weekday [t(4) = 7.58, p < 0.001]. A repeated-measures ANOVA showed significantly greater energy intake on the Sabbath for the overweight-obese women compared to the normal weight women [F(1) = 7.83, p = 0.02]. No statistical difference was seen between the weekday energy intake of the normal weight women as compared to the combined group of overweight-obese women [F(1) = 0.501, p = 0.499]. These results support the hypotheses that all groups eat significantly more on the Sabbath than on weekdays, and overweight and obese individuals eat significantly more on the Sabbath than normal weight individuals. This supports the theory that caloric intake on the Sabbath is a contributing factor to overweight and obesity within the American Orthodox Jewish community.

Musculoskeletal pain in people with and without type 2 diabetes in Taiwan: a population-based, retrospective cohort study

Background

Musculoskeletal pain in people with type 2 diabetes is a common issue even to this day. The study aimed to explore the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location in people with type 2 diabetes, compared with respective values for people without diabetes.

Methods

The study utilized a population-based retrospective cohort study design. The subjects were randomly obtained from the Taiwan National Health Insurance Research Database. The diabetic group included 6586 people with type 2 diabetes aged 18–50 years, while the non-diabetic group consisted of 32,930 age- and sex-matched people. Based on the medical records of individuals with musculoskeletal pain in the two groups from 2001 to 2010, the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location were calculated and compared, with the aim of identifying differences between the two groups.

Results

Showed that people in the diabetic group had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group (p < 0.05). The relative risk (RR) of the 10-year cumulative incidence of musculoskeletal pain in the two groups was the highest (RR = 1.39) for people between 30 and 39 years of age. The mean number of doctor visits for musculoskeletal pain by location was significantly different between the two groups. However, the mean number of doctor visits for limb pain registered the largest difference between the two groups.

Conclusion

People with type 2 diabetes aged 18–50 years had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group. Musculoskeletal pain might directly or indirectly interfere with or decrease the physical activity levels of people with diabetes. Therefore, it is important to detect and treat musculoskeletal pain early in order to promote physical activity and optimize blood sugar control.

Changing social and scientific discourses on type 2 diabetes between 1800 and 1950: a socio-historical analysis

Since the emergence of type 2 diabetes as a public health threat around the middle of the 20(th) century, accounts of disease causation have focused predominately on lifestyle or genetics, or both, while the role of broader structural issues such as psychosocial distress has been downplayed. Yet in the years prior to this emergence, when diabetes remained the preserve of the upper classes, medical experts drew upon multiple narratives when considering the condition, the most popular of which being the role of social organisation and the interplay between mind, body and environment. This article is based on a discourse analysis of the writings of the most prominent diabetes experts between 1800 and 1950 about both the causes and management of the illness. It highlights how, although the connection between lifestyle and diabetes was well established among physicians, individual-level explanations only fully supplanted the emphasis on social organisation as diabetes began to make the transition from being a disease of the rich to one of the poor. It argues that this discursive shift was shaped by the dynamics of class relations rather than any new forms of scientific evidence developed at the time.

A post-genomic surprise. The molecular reinscription of race in science, law and medicine

The completion of the first draft of the Human Genome Map in 2000 was widely heralded as the promise and future of genetics-based medicines and therapies - so much so that pundits began referring to the new century as 'The Century of Genetics'. Moreover, definitive assertions about the overwhelming similarities of all humans' DNA (99.9 per cent) by the leaders of the Human Genome Project were trumpeted as the end of racial thinking about racial taxonomies of human genetic differences. But the first decade of the new century brought unwelcomed surprises. First, gene therapies turned out to be far more complicated than any had anticipated - and instead the pharmaceutical industry turned to a focus on drugs that might be 'related' to population differences based upon genetic markers. While the language of 'personalized medicine' dominated this frame, research on racially and ethnically designated populations differential responsiveness to drugs dominated the empirical work in the field. Ancestry testing and 'admixture research' would play an important role in a new kind of molecular reification of racial categories. Moreover, the capacity of the super-computer to map differences reverberated into personal identification that would affect both the criminal justice system and forensic science, and generate new levels of concern about personal privacy. Social scientists in general, and sociologists in particular, have been caught short by these developments - relying mainly on assertions that racial categories are socially constructed, regionally and historically contingent, and politically arbitrary. While these assertions are true, the imprimatur of scientific legitimacy has shifted the burden, since now 'admixture research' can claim that its results get at the 'reality' of human differentiation, not the admittedly flawed social constructions of racial categories. Yet what was missing from this framing of the problem: 'admixture research' is itself based upon socially constructed categories of race.

The effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2: A Systematic Review

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to synthesise the best available evidence on the effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2.The specific review question is:What is the effectiveness of physical leisure time activities on glycaemic control in patients with diabetes type 2?

BACKGROUND

Type 2 diabetes results from the body's ineffective use of insulin. Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. According to 2011 National Diabetes Fact Sheet, diabetes affected 25.8 million people of all ages of United States population during 2005-2008, include 18.8 million diagnosed people and seven million undiagnosed people. Among United States residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010. Recent World Health Organization (WHO) calculations indicate diabetes kills more than one million people annually, almost 80% of which occur in low- and middle-income countries. Almost half of diabetes deaths occur in people aged under 70 years; 55% of diabetes deaths are in women. WHO projects that diabetes deaths will double between 2005 and 2030.Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race. It is a common outcome of uncontrolled blood sugar and over time leads to serious complications including hypertension, blindness, kidney damage, lower-limb amputations, heart disease, and stroke. Good glycaemic control is a major goal in the treatment of type 2 diabetes mellitus to prevent and delay those severe long-term complications. Physical activity is considered to be a substantial part of the treatment of type 2 diabetes mellitus, as well as diet and medication. Physical activity is a common physiological stressor that causes perturbation to glucose homeostasis and energy needs.Several studies have reported the effects of physical activity on improving insulin sensitivity, cardio-respiratory fitness, glycaemic control, and psychosocial well-being. The American Diabetes Association suggests that people with type 2 diabetes spend at least 150 minutes a week on moderate-intensity physical activity (50-70% of maximum heart rate), or at least 90 minutes a week on vigorous physical activity (>70% of maximum heart rate). Recent studies also indicate that moderate-intensity aerobic physical activity could help type 2 diabetes patients to maintain ideal glycaemic control. Boule et al found physical activity training could reduce haemoglobin A1c (HbA1c) (control group vs. exercise group: 8.31% vs. 7.65%) by 0.66%. This is close to the effect of intense glucose-lowering pharmacological treatment found in the United Kingdom Prospective Diabetes Study. A 1% absolute decrease in the HbA1c value is associated with a 15% to 20% decrease in major cardiovascular events and a 37% reduction in microvascular complications.According to Zhao, Ford, Chaoyang's report (2011), only 25-42% of older adults with diabetes mellitus met recommendations for total physical activity based on the 2007 American Diabetes Association and 2008 Department of Health and Human Services guidelines. Various barriers to regular physical activity had been described, such as health problems, lack of time or energy, no exercise partner, lack of family support, and motivation and working time. An active lifestyle does not require complex exercise programmes. Instead, regular daily physical activity is believed to enable individuals to reduce the risk of chronic diseases and may enhance their quality of life. Recently, it has been thought that, instead of structured physical activity, lifestyle physical activity is a better alternative for diabetes patients. Moderate or vigorous lifestyle or leisure time physical activities included jogging, walking, gardening, tai chi chuan, and qigong (an ancient Chinese breathing exercise that combines aerobics, isometric and isotonic movements and meditation). According to data from recent studies, moderate physical leisure time activities for at least 60 minutes every week can effectively improve glycaemic control in patients with diabetes type 2.Those measure indicators of glycaemic control including glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) were used to assess glycaemic control in diabetic patients. HbA1c value reflects the mean plasma glucose concentration over two to three months. Fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) reflect short-term plasma glucose change. Glycated haemoglobin is a form ofhaemoglobin that is measured primarily to identify the averageplasmaglucoseconcentration over prolonged periods of time. The fasting plasma glucose test measures fasting blood sugar levels and the postprandial plasma glucose test is often used to test the effectiveness of the body's carbohydrate metabolism and the ability to produce insulin. In 2010, Psaltopoulou et al gathered current information from meta-analyses on dietary and lifestyle practices concerning reduction of risk to develop type 2 diabetes. In 2009, Thomas et al completed a systematic review in which fourteen randomised controlled trials involving a total of 377 participants comparing exercise against no exercise in type 2 diabetes were identified. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6%. This systematic review will differ from these two previously published reviews in that it aims to explore the effectiveness of different kinds of moderate or vigorous physical leisure time activities in improving glycaemic control in patients with diabetes type 2. A search of MEDLINE, DARE database, CINAHL, the Cochrane Library of Systematic Reviews and Joanna Briggs Institute Library of Systematic Reviews found no existing reviews or review underway on this topic.