A completely new classification of diabetes that also predicts the risk of serious complications and provides treatment suggestions. The Swedes are now seeing the first results of ANDIS – a study covering all newly diagnosed diabetics in southern Sweden.
The major difference from today’s classification is that type 2 diabetes actually consists of several subgroups, the results indicate.
“This is the first step towards personalised treatment of diabetes”, says Leif Groop, physician and professor of diabetes and endocrinology at Lund University in Sweden.
“Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment”, explains Professor Leif Groop, who initiated the study. He believes that the results represent a paradigm shift in how to view the disease in the future. “Today, diagnoses are performed by measuring blood sugar. A more accurate diagnosis can be made by also considering the factors accounted for in ANDIS (All New Diabetics In Skåne).”
Since 2008, the researchers have monitored 13 720 newly diagnosed patients between the ages 18 and 97. By combining measurements of, for example, insulin resistance, insulin secretion, blood sugar levels (BMI, HbA1c, GADA, HOMA-B and HOMA-IR) and age at onset of illness, the researchers were able to distinguish five distinct clusters that differ from today’s classification.
In addition to a more refined classification, the researchers also discovered that the different groups are more or less at risk of developing various secondary diseases.
“This will enable earlier treatment to prevent complications in patients who are most at risk of being affected”, says Emma Ahlqvist, associate professor and lead author of the publication.
The ANDIS classification:
Group 1, SAID (severe autoimmune diabetes): essentially corresponds to type 1 diabetes and LADA (latent autoimmune diabetes in adults), and is characterised by onset at young age, poor metabolic control, impaired insulin production and the presence of GADA antibodies.
Group 2, SIDD (severe insulin-deficient diabetes): includes individuals with high HbA1C, impaired insulin secretion and moderate insulin resistance. Group 2 had the highest incidence of retinopathy.
Group 3, SIRD (severe insulin-resistant diabetes): is characterised by obesity and severe insulin resistance. Group 3 had the highest incidence of kidney damage – the secondary disease producing the highest costs to society.
Group 4, MOD (mild obesity-related diabetes): includes obese patients who fall ill at a relatively young age.
Group 5, MARD (mild age-related diabetes): is the largest group (about 40%) and consists of the most elderly patients.
“The most insulin resistant patients (Group 3) have the most to gain from the new diagnostics as they are the ones who are currently most incorrectly treated”, says Professor Leif Groop.
The researchers subsequently repeated the analysis in a further three studies from Sweden and Finland.
“The outcome exceeded our expectations and highly corresponded with the analysis from ANDIS. The only difference was that Group 5 was larger in Finland than in Skåne. The disease progression was remarkably similar in both groups”, says Leif Groop.
Lund University Diabetes Centrewww.ludc.lu.se/article/paradigm-shift-in-the-diagnosis-of-diabetes

To win the battle against heart disease, cardiologists need better ways to identify the composition of plaque most likely to rupture and cause a heart attack. Angiography allows them to examine blood vessels for constricted regions by injecting them with a contrast agent before X-raying them. But because plaque does not always result in constricted vessels, angiography can miss dangerous buildups of plaque. Intravascular ultrasound can penetrate the buildup to identify depth, but lacks the ability to identify some of the finer details about risk of plaque rupture.
This new catheter probe combines intravascular ultrasound (IVUS) with fluorescence lifetime imaging (FLIm) to image the tiny arteries of a living heart.
Professor Laura Marcu’s lab in the Department of Biomedical Engineering at UC Davis has now combined intravascular ultrasound with fluorescence lifetime imaging (FLIm) in a single catheter probe that can image the tiny arteries of a living heart. The new catheter can simultaneously retrieve structural and biochemical information about arterial plaque that could more reliably predict heart attacks.
An optical fibre in the catheter sends short laser pulses into surrounding tissue, which fluoresces with tiny flashes of light in return. Different kinds of tissue (collagen, proteins, lipids) emit different amounts of fluorescence.
At the same time, an ultrasound probe in the catheter records structural information about the blood vessel.
The combination FLIm-IVUS imaging catheter provides a comprehensive insight into how atherosclerotic plaque forms, aiding diagnosis and providing a way to measure how plaques shrink in response to therapy.
The new catheter has been tested in living swine hearts and samples of human coronary arteries.
The catheter used in the study is flexible enough to access coronary arteries in a living human following standard procedures. It does not require any injected fluorescent tracers or any special modification of the catheterization procedures.
The new technique could not only improve understanding of mechanisms behind plaque rupture – an event with fatal consequences- but also the diagnosis and treatment of patients with heart disease.
Marcu’s group is currently working to obtain FDA approval to test this new intravascular technology on human patients.

UC Davishttps://tinyurl.com/y7we7uva

Although digital breast tomosynthesis (DBT), or 3-D mammography, costs more than a digital mammography (DM) screening, it actually may help rein in cancer screening costs, according to preliminary findings (PD7-05) presented by researchers from the Perelman School of Medicine. The group analysed 46,483 screening episodes – a single screening mammogram and all subsequent breast diagnosis related costs for the following year – in two hospitals within the University of Pennsylvania Health System in 2012 and 2013.
“Early detection is critical to saving lives and lowering costs,” said senior author Emily F. Conant, MD, chief of Breast Imaging at Penn Medicine. “Fortunately, breast imaging is more precise than ever thanks to DBT. Despite its higher initial cost, DBT is increasingly being embraced by radiologists nationwide. If you look at expenses associated with breast diagnosis in the following year after initial screening, DBT is more cost effective in terms of health system or population level screening.”
Previous studies modelling outcomes have demonstrated that DBT can be cost effective. In this study, the authors analysed actual costs and patient outcomes within a single health system where both DM and DBT screening occurred. They excluded any episodes in which the patient had a prior breast cancer diagnosis or reached 90 years of age before the end of the follow-up period. DM represented 53 percent of the episodes and DBT represented 47 percent. Fifty three percent of women studied received DM and 47 percent received DBT.
They tested DBT and DM according to four outcomes – true positive (TP), true negative (TN), false positive (FP), and false negative (FN) rates – by comparing the Breast Imaging Reporting and Data System (BI-RADS) score (assigned at screening with data about subsequent cancer diagnosis).
DBT was a more effective screening method. Compared to DM episodes, DBT episodes had lower FP (8.6% vs. 10.8%) and higher TN (90.9% vs. 88.7%, p<0.001) rates. (There were no statistically significant differences between DBT and DM episodes with respect to TP and FN rates.)
Although it screened more effectively, DBT did cost more than DM. Overall, average episode costs were higher for DBT compared to DM ($378.02 vs. $286.62). This difference was driven by higher average screening costs ($215.94 vs. $155.76), which approximated the additional charge for DBT, as well as follow-up costs ($23.67 vs. $12.11). There was no significant difference in costs between DBT and DM episodes within the diagnosis or cancer treatment windows.
DM and DBT episodes had roughly the same average episode costs per woman screened for FP ($67.75 vs. $65.71), FN ($4.63 vs. $5.60) and TP ($85.80 vs. $65.15) outcomes despite the higher cost per individual DBT study. The higher costs for TN ($219.84 vs. $150.16) outcomes approximated the higher CMS (Centers for Medicam and Medicinal Services) charge for DBT.
Penn Medicinehttps://tinyurl.com/y7nemu7g

Researchers from the Black Dog Institute and UNSW Sydney have questioned the efficacy and safety of intranasal ketamine for depression, with their pilot trial stopped early due to poor side effects in patients.
Nasal spray devices have been touted as a promising way to deliver ketamine to patients with treatment-resistant depression, with this application easier to use and less invasive than other clinical delivery methods such as injections.
Yet contrary to previous trials, this latest study reveals the unpredictable nature of intranasal ketamine tolerance from one person to the next.
“It’s clear that the intranasal method of ketamine delivery is not as simple as it first seemed,” said lead author UNSW Professor Colleen Loo, who is based at Black Dog Institute.
“Many factors are at play when it comes to nasal spray ketamine treatments. Absorption will vary between people and can fluctuate on any given day within an individual based on such things as mucous levels in the nose and the specific application technique used.”
The pilot trial aimed to test the feasibility of repeated doses of ketamine through an intranasal device amongst 10 participants with severe depression, ahead of a larger randomised controlled trial.
Participants were first given extensive training in proper self-administration techniques before receiving either a course of eight ketamine treatments or an active control over a period of four weeks, under supervision at the study centre.
Following initial reactions to the nasal spray, the dosage was adjusted amongst study patients to include longer time intervals between sprays.
However, the pilot study was eventually suspended after testing with five participants due to unexpected problems with tolerability. Side effects included high blood pressure, psychotic-like effects and motor incoordination that left some participants unable to continue to self-administer the spray.  
“Intranasal ketamine delivery is very potent as it bypasses metabolic pathways, and ketamine is rapidly absorbed into the bloodstream,” said Professor Loo.
“But as our findings show, this can lead to problems with high peak levels of ketamine in some people causing problematic side effects.
“Other recent studies have questioned whether changes to ketamine’s composition after being metabolised into derivative compounds may actually deliver useful therapeutic effects.
“It remains unclear whether ketamine nasal sprays can be safely relied upon as a treatment for patients with severe depression.”
University of New South Walesnewsroom.unsw.edu.au/news/health/study-casts-doubt-ketamine-nasal-sprays-depression

When a soldier sustains a traumatic eye injury on the battlefield, any delay in treatment may lead to permanent vision loss. With medical facilities potentially far away and no existing tools to prevent deterioration, medics are in a high-stakes race against the clock.
A multidisciplinary team of scientists and engineers at USC are close to solving the problem. They have developed a reversible, temperature-sensitive temporary seal that changes from a fluid to a super-strong semi-solid when applied to the eye. When the patient is ready for surgery to permanently close the injury, doctors can remove the seal by adding cool water.
“If you look at historical data over the last several decades, the rate of war-related ocular injuries has steadily increased from a fraction of a percent to as high as 10 to 15 percent. Some of that can be attributed to changes in warfare, especially with the use of improvised explosive devices,” said corresponding author John Whalen, assistant professor of research ophthalmology at the USC Roski Eye Institute and member of the USC Institute for Biomedical Therapeutics. “When the Department of Defense asked the scientific community to develop novel approaches to treating ocular injuries, we immediately thought of an advanced material we had previously worked with as a possible adhesive for a retinal implant.”
The material the group was working with for retinal implants was a hydrogel called PNIPAM, poly(N-isopropylacrylamide), which had a unique attribute that made it a natural fit for this application: when cooled, the hydrogel became a liquid for easy application, and when heated, it became a viscous semi-solid with strong adhesion. All that was needed was some tailoring.
“Since the initial hydrogel’s transition temperature was very close to the temperature of the human eye, we had to modify its properties to ensure that it would form a solid seal as soon as the gel was applied to the eye by a soldier or medic,” said lead author Niki Bayat, a doctoral candidate in the Mork Family Department of Chemical Engineering and Materials Science at USC Viterbi. “Providing a perfect, yet reversible seal, the smart hydrogel shows promise for the next generation of tissue adhesives.”
When an ophthalmologist is ready to repair the eye, the hydrogel can be extracted by applying cool water and converting it back to a less adhesive state.
The research team also developed a special syringe for the hydrogel that would be easy to use on the front lines and capable of quickly cooling the hydrogel before application. The syringe has a cooling chamber filled with calcium ammonium nitrate crystals — the type used in instant ice cold packs. By adding water to the chamber, the crystals activate and cool the hydrogel to operating temperatures within 30 seconds.
“We were able to optimize the delivery device so that it not only rapidly cools the hydrogel but also holds it at that temperature, giving users a 10-minute window to fill penetrations in the eye,” Whalen said. “It’s very simple to use — almost like caulking a bathroom seal.”
The customized seal and delivery device will also reduce the amount of time it takes to close penetrating eye injuries overall.
“This temporary intervention could decrease repair time from 30 minutes or longer to less than five minutes, freeing up valuable time for first responders and trauma units,” said principal investigator Mark Humayun, University Professor of Ophthalmology and co-director of the USC Roski Eye Institute, director of the USC Institute for Biomedical Therapeutics and a professor of biomedical engineering at USC Viterbi.
University of Southern Californiahttps://tinyurl.com/y8eurz42