New hor­monal link sus­pected in type 2 di­a­betes

When we use spirono­lac­tone (a drug that can treat high blood pres­sure and re­duce al­dos­terone lev­els), we don’t see a re­duc­tion in in­sulin re­sis­tance or an im­prove­ment in in­sulin sen­si­tiv­ity.

The Borneo Post - Nature and health - - Vital Signs -

TWO dis­or­ders that of­ten oc­cur to­gether – type 2 di­a­betes and high blood pres­sure – may have a com­mon link in a hor­mone called al­dos­terone, re­searchers sug­gest. Al­dos­terone has al­ready been im­pli­cated in the de­vel­op­ment of high blood pres­sure (hy­per­ten­sion). Now, a new study re­ports that peo­ple with higher lev­els of al­dos­terone had more than twice the odds of de­vel­op­ing type 2 di­a­betes. Re­searchers also found that the link be­tween al­dos­terone and di­a­betes was stronger among some racial groups.

Al­dos­terone is a hor­mone that helps the body hold onto sodium. It also helps reg­u­late the body’s fluid lev­els, ac­cord­ing to the re­searchers. “The hor­mone al­dos­terone is one po­ten­tial link be­tween the de­vel­op­ment of hy­per­ten­sion and di­a­betes,” said the study’s lead au­thor, Dr Joshua Joseph, en­docri­nol­o­gist at Ohio State Wexner Med­i­cal Cen­tre, in Colum­bus. Joseph ex­plained that al­dos­terone can in­crease how much sodium the kid­neys take in. When this hap­pens, over­all fluid lev­els in the body in­crease and blood ves­sels con­strict. These fac­tors can lead to high blood pres­sure.

In type 2 di­a­betes, he said, al­dos­terone can af­fect how the body uses another hor­mone – in­sulin. In­sulin ush- ers su­gar from foods into the body’s cells so it can be used as fuel to pro­vide en­ergy. “The two ma­jor causes of type 2 di­a­betes are an in­abil­ity to utilise in­sulin – ‘in­sulin re­sis­tance’ – or im­paired in­sulin se­cre­tion from the pan­creas,” Joseph ex­plained. “Al­dos­terone has been shown to cause in­sulin re­sis­tance in mus­cle, and im­pair in­sulin se­cre­tion from the pan­creas.” Dr Joel Zon­szein, di­rec­tor of the Clin­i­cal Di­a­betes Cen­tre at Mon­te­fiore Med­i­cal Cen­tre, in New York City, is not con­vinced that al­dos­terone plays a sig­nif­i­cant role in type 2 di­a­betes.

“When we use spirono­lac­tone (a drug that can treat high blood pres­sure and re­duce al­dos­terone lev­els), we don’t see a re­duc­tion in in­sulin re­sis­tance or an im­prove­ment in in­sulin sen­si­tiv­ity,” Zon­szein said. “If al­dos­terone plays of role in the de­vel­op­ment of type 2 di­a­betes, it’s a very min­i­mal role,” he added. Joseph and his col­leagues are al­ready plan­ning a clin­i­cal trial to show whether there is a cause-and-ef­fect re­la­tion­ship be­tween al­dos­terone and type 2 di­a­betes. They’ve re­ceived a grant from the US Na­tional In­sti­tutes of Health for the fu­ture re­search.

The cur­rent study looked at data on al­most 1,600 peo- ple from a pre­vi­ous study de­signed to track hard­en­ing of the blood ves­sels over time. Par­tic­i­pants were from di­verse pop­u­la­tions in the United States. Dur­ing 10.5 years of fol­low-up, just over 100 peo­ple de­vel­oped type 2 di­a­betes. Over­all, the study found that peo­ple who had el­e­vated al­dos­terone lev­els were more than twice as likely to de­velop type 2 di­a­betes. Black peo­ple with higher al­dos­terone lev­els had al­most triple the risk. Chi­nese-Amer­i­cans were al­most 10 times more likely to de­velop di­a­betes if they had high al­dos­terone, the find­ings showed.

Joseph said, “We still don’t know why there are dif­fer­ences among di­verse pop­u­la­tions.” He sug­gested that dif­fer­ences in ge­net­ics or salt sen­si­tiv­ity might play a role. Zon­szein said the study find­ings were in­ter­est­ing, but he doesn’t think al­dos­terone will be shown to have a sig­nif­i­cant role in the way the body uses and con­trols blood su­gar. Al­though it’s too early to ap­ply these find­ings to clin­i­cal care, Joseph said peo­ple can lower their al­dos­terone lev­els through a healthy life­style. That in­cludes eat­ing healthy foods, main­tain­ing a healthy weight, ex­er­cis­ing reg­u­larly and not smok­ing. The study find­ings were pub­lished on­line in the Jour­nal of the Amer­i­can Heart As­so­ci­a­tion.

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