Health
ANN ARBOR, Mich. – If you’re diabetic or prone to diabetes, having a steady job appears to be good for your health, and not just because of the insurance coverage.
A new University of Michigan study found that that jobless working-age people with diabetes are less likely to adhere to their oral anti-diabetic medications than diabetics who are employed.
Further, people of working age with diabetes are more likely to be unemployed than those who do not have diabetes.
The lack of a clear-cut, cause-and-effect relationship between insurance and medication adherence surprised lead researcher Rajesh Balkrishnan of the U-M College of Pharmacy and School of Public Health.
“Improved use of medications is more than just a facet of having medical insurance. It is linked to bigger issues such as being employed, periods of joblessness or a personal financial strain,” said Balkrishnan, who believes that a healthier, active lifestyle and access to medical care resources through employers that want employees to remain productive play a big role in adherence.
Other factors that account for lack of medication adherence include lack of financial resources, stress due to unemployment and lack of access to health care.
Researchers looked at diabetes because it is one of the most commonly present chronic conditions in working-age adults in the United States, Balkrishnan said.
Globally, diabetes is the seventh-leading cause of death and the eighth-most costly disease to treat.
In 2007, total health care costs for diabetes were estimated at $174 billion.
Policy changes would help, Balkrishnan said.
“Workforce participation for adults with diabetes and other chronic conditions command the attention of public policymakers, particularly when prioritizing resource allocation,” he said. “As a starting position, health care providers and systems need standard processes to identify individuals facing financial pressure and their vulnerability to lower medication adherence.”
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Cytomegalovirus (CMV) is one of the viruses that most infected people carry without ill effects. Once infected you are infected for life and, although it normally is dormant, it can become active again at any point in time.
New research published in BioMed Central’s open access journal Immunity and Ageing shows that CMV infection is a significant risk factor for the type 2 diabetes in the elderly.
Obesity, inactivity and aging are known to be associated with insulin resistance, one of the first signs of incipient diabetes. However only a third of those with insulin resistance go on the develop type 2 diabetes.
So what marks these people as different? Why do their pancreas’ fail? Genetic and environmental factors are thought to play a part but so also does inflammation. People with type 2 diabetes usually have raised levels of biological markers for inflammation such as elevated CRP and larger numbers of active white blood cells.
Chronic infections including CMV can “stress” the immune system and when researchers from Leiden University Medical Centre and University of Tubingen Medical School compared glucose regulation with antibodies to CMV (or CMV seropositivity) in over 500 participants of the Leiden 85-plus Study they found that having CMV was associated with type 2 diabetes.
The researchers suggest that CMV could be either acting directly on pancreatic cells or indirectly by causing the immune system attacking the pancreas.
Dr Andrea Maier, who led the investigation explained, “ In our study we realized that although CMV seropositivity was associated with type 2 diabetes, higher levels of HnA1c and high non-fasting glucose the actual level of antibodies against CMV was not.”
This study is looking at the effect of CMV on the very old.
By their very nature these people have had longer to become infected with CMV and have low risks for other factors which are linked to diabetes or to cardiovascular disease.
While it may not be possible to extrapolate these findings to the general population it seems likely that finding a way to overcome CMV infections may reduce diseases, such as diabetes, later in life.
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