Diabetes sugar 'can go too low'

Diabetes disrupts blood sugar levels

Intense treatment to lower blood sugar in patients with diabetes could prove nearly as harmful as allowing glucose levels to remain high, a study says.

Cardiff researchers looked at nearly 50,000 patients with type 2 diabetes and found the lowest glucose levels linked to a heightened risk of death.

Significant differences in death rates between patients on insulin and those taking tablets are also flagged up.

But there could be various explanations for this, experts noted.

Patients taking insulin-based treatments have been urged not to stop taking their medication as a result of the Cardiff University study, which is published in The Lancet.

Changing treatments

Using data from GPs, the team identified 27,965 patients with type 2 diabetes whose treatment had been intensified to include two oral blood glucose lowering agents - metformin and sulphonylurea.

A further 20,005 patients who had been moved on to treatment which included insulin were added to the study.

Patients whose HbA1c levels - the proportion of red blood cells with glucose attached to them - were around 7.5%, ran the lowest risk of dying from any cause.

For both groups this risk went up by more than half if levels dropped to 6.4%, the lowest levels recorded. For those with the highest levels the risk of death increased by nearly 80%.

But the risks appeared to be particularly pronounced among those on the insulin-based regimen than those on the combined treatment.

Irrespective of whether their HbA1c levels were low or high, there were 2,834 deaths in the insulin-taking group between 1986 and 2008, nearly 50% more than in the combined group.

'Don't stop'

The authors acknowledged there could be various factors associated with this, such as these being older patients with more health problems, who perhaps had had diabetes for a longer period of time. They also make reference to a possible link between use of insulin and cancer progression that had been reported in a different study.

"Whether intensification of glucose control with insulin therapy alone further heightens risk of death in patients with diabetes needs further investigation and assessment of the overall risk balance," wrote lead author Dr Craig Currie.

"Low and high mean HbA1c values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum HbA1c value."

Dr Iain Frame, head of research at Diabetes UK, described the study as "potentially important" but stressed it had limitations.

"It is not clear what the causes of death were from the results reported. Furthermore, when it comes to the suggestion made in this research that insulin could increase the risk of death, we must consider important factors such as age, the duration of their diabetes and how the participants managed their condition.

"It is crucial to remember that blood glucose targets should always be agreed by the person with diabetes and their healthcare team according to individual needs and not according to a blanket set of rules."

While people would be able to manage their condition for a period with diet, exercise and even tablets, many would eventually have to move on to insulin, he noted.

"We would advise people with type 2 diabetes who use insulin not to stop taking their medication. However, if they are worried about blood glucose targets, they should discuss this with their healthcare team."

WHO defends its swine flu warning

Countries around the world offered swine flu vaccines to people

The World Health Organization (WHO) has defended its handling of the swine flu pandemic last year, after the Council of Europe cast doubt on its actions.

Countries rushed to order thousands of vaccine doses when the pandemic was declared in June, but the virus proved to be relatively mild.

The WHO's links to drug companies were questioned at a hearing by the Council of Europe's health committee.

A WHO flu expert denied there had been improper influence from drug firms.

The WHO's Keiji Fukuda told a hearing in Strasbourg: "Let me state clearly for the record - the influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry."

When a pandemic was declared last June most European countries changed their health priorities to accommodate thousands of expected patients, including spending millions of euros on vaccines for H1N1.

A number of European governments signed contracts with drug companies to buy vaccines.

But it has since become clear that although 14,000 people worldwide died from swine flu, and millions more were infected, it is a mild flu with a lower mortality than seasonal influenza.

Allegations from politicians and media about links with drug companies have prompted an internal review at the WHO and the Council of Europe hearings.

Dr Fukuda rejected comparisons between seasonal flu and swine flu - describing them as like comparing oranges to apples.

Seasonal flu figures were based on statistical models, whereas every swine flu death had been confirmed in a laboratory, he said.

He said the WHO response had not been perfect, but a range of experts - including some in the private sector - had been consulted and there had been safeguards to prevent a conflict of interest.

"We are under no illusions that this response was the perfect response," Dr Fukuda said.

"But we do not wait until [these global virus outbreaks] have developed and we see that lots of people are dying. What we try and do is take preventive actions. If we are successful no-one will die, no-one will notice anything," he added.

"We feel we should move quickly. Our purpose is to try to provide guidance, to try to reduce harm," he said.

Part of the WHO review would examine if there was a better way to define outbreaks and severity, Dr Fukuda said.

The past is the future for hi-tech

Your eyes could become a target for hi-tech hackers.

We still don't think enough about securing our technology, says regular commentator Bill Thompson

As December comes to an end journalists and pundits around the world have been telling us which devices or technologies they think are the most important from the last year.

Here on the BBC tech site Rory Cellan-Jones chooses cloud computing while Jonathan Fildes opts for smartphone applications and Maggie Shiels reveals her love for her Blackberry, to which she is clearly addicted.

Picking one innovation as the most important or as representative of a year is notoriously difficult, but it is at least retrospective.

The iTunes Application Store was one of the year's biggest successes, whatever one might think of Apple's arbitrary approvals process or the constraints placed on application authors, and Google really did launch Wave, albeit as an early, buggy alpha release.

...the sort of systems thinking that would make data security an essential part of the design process is still rare enough to be remarkable. Bill Thompson

Looking forward is much trickier. When it comes to recent innovations it is simply too early to judge their impact, so there is no way we can tell whether Wave really will bring about a revolution in collaborative working or fade away into technology history.

The rate of technological change is so fast that extrapolation simply cannot be useful guide, with new products and services appearing all the time.

Nobody can tell how the ebook market will adapt to the imminent release of Apple's tablet computer because we don't yet know what the tablet will look, feel or work like.

That doesn't stop us trying, of course, even if we get it painfully wrong.

I recall predicting the imminent death of the analogue modem several years before they even began to decline in popularity, while my final column of 2005 includes an admission that I'd failed to appreciate the disruptive impact of wireless technology in previous years.

On the up side, I did use the same column to point out the danger that the music industry would never learn to trust their customers but try "to exert even more control, and perhaps using their lobbying powers to change laws to make their systems unavoidable".

Looking ahead

However, as we enter the last year of the first decade of the 21st century I am willing to stick my neck out and make a prediction about a technology that is still in the lab and is at least 10 years from being commercially available.

I am confident that at some point around 2020 we will all be distracted by early reports that the latest display technology using smart contact lenses that draw images directly onto the retina using low-powered micro-lasers are being hacked into by unscrupulous criminals.

They will be replacing paid-for adverts with ones for their own illicit services while using the augmented reality data feeds that the lenses offer to steal personal data and infiltrate company networks.

Medical implants may be at risk in the future, says Bill.

At that point the manufacturers of the lenses will scramble to add some high-end security to the data transfer protocol used to link their lenses to the personal data networks we have all adopted by then, but doing so will break lots of applications and services and never be widely adopted.

People will prefer to live with the risk of seeing the odd pornographic image to having to reconfigure a product that was sold as being "as easy as seeing", and the criminal gangs will continue to harvest personal data and sell illicit advertising.

Digital contact lenses are one the technologies that have recently become possible thanks to some breakthrough work in the research labs.

They are under development at the University of Washington, where Babak Parvis has a prototype with a single red LED, powered by radio frequency transmissions like the passive RFID chips in Oyster cards.

Eventually he believes we will have lenses with built-in control circuits, display circuits and miniature antennae that project images directly onto the retina. Although the engineering hurdles to be overcome are enormous this one feels to me like something we will see in the mass market within a decade.

But I have a horrible feeling that in all the excitement about getting the things to actually work the developers will not bother to build encryption into the data transfer protocols, because doing so will delay bringing them to market or add too much to the cost.

Lessons to learn

The past may not always be a good guide to the technological future, but sometimes it is, and the development of medical implants offers a salutary lesson here.

Pacemakers and other devices have been implanted in people for many years, and more and more of them have some form of wireless monitoring and control.

Over the years we've looked at many on Digital Planet, the World Service radio programme I appear on as studio expert because they are an important medical advance, not least because they reduce the need for repeat surgery.

Smart contacts could help mix real and virtual

And in March 2008 researchers at the University of Massachusetts, Amherst demonstrated that you could snoop on the radio signal coming from a combination pacemaker/defibrillator and reprogram it to deliver a potentially lethal electric shock to a patient.

Their experiment required several students and some expensive equipment to monitor and decode the signals from a Medtronic Maximo pacemaker, but it prompted significant concern within the medical profession because of the danger it exposed.

Up to that point the manufacturers had been worried about possible interference with the implants from external radio sources like metal scanners or store alarms, and the potential for hacking seems not to have occurred to them.

I fear that we will see the same pattern repeat itself again and again, because the sort of systems thinking that would make data security an essential part of the design process is still rare enough to be remarkable.

The first generation of analogue mobile phones sent conversations in the clear, and it was only when they went digital that some encryption was built in, and this sort of short-sighted thinking still seems prevalent.

Experts stunned by swan 'divorce' at Slimbridge wetland

Staff were initially concerned when Sarindi arrived with a new mate

Experts have told of their surprise after witnessing a rare "divorce" between a pair of swans at a Gloucestershire wildfowl sanctuary.

The Bewick's swans have returned to winter at the Wildfowl and Wetlands Trust centre at Slimbridge - but both have brought new partners.

It is only the second time in more than 40 years that a "separation" has been recorded at the centre.

Staff have described the new couplings as "bizarre".

It is not unheard of for the birds, which usually mate for life, to find a new mate but it tends to be because one of the pair has died, they said.

During the past four decades 4,000 pairs of Bewick's swans have been studied at Slimbridge, with only one previous couple moving on to find new partners.

Normally loyal

First suspicions of the rare event were raised when male swan Sarindi turned up in the annual migration from Arctic Russia without his partner of two years Saruni and with a new female - newly-named Sarind - in tow.

The pair's arrival led conservationists to fear the worst for Saruni.

But shortly afterwards Saruni arrived at the wetlands site - also with a new mate, Surune.

And after observing them, the experts discovered the old relationship had ended and new ones had begun.

Julia Newth, wildlife health research officer at Slimbridge, said the situation had taken staff by surprise.

She said swans tended to have "real loyalties to one another" and long partnerships.

"As long as they are both still alive, they will try to stay together. If they have a change of mate it is perhaps because of mortality, not necessarily through choice," she said.

In this case, however, both swans and their new partners are now over-wintering in close proximity on the lake at Slimbridge.

Ms Newth said the old pair had not acknowledged each other with any signs of recognition or greeting - even though they are occupying the same part of the small lake.

As for why they may have split, she said: "Failure to breed could be a possible reason, as they had been together for a couple of years but had never brought back a cygnet, but it is difficult to say for sure."

Bewick's swans are the smallest and rarest of the three species found in the UK and each individual can be identified by their unique bill pattern.

Copenhagen 'fails forest people'

Deforestation is a major source of greenhouse gases

A multi-billion dollar deal tabled at the Copenhagen climate summit could lead to conflicts in forest-rich nations, a report has warned.

The study by the Rights and Resources Initiative said the funds could place "unprecedented pressure" on some areas.

Six nations offered $3.5bn as part of global plans to cut deforestation, which accounts for about 20% of all emissions from human activity.

Campaigners warn the scheme fails to consider the rights of forest people.

The money - tabled by Japan, Norway, Australia, France and the US and UK - was made available under the UN's Reducing Emissions from Deforestation and Degradation (Redd) scheme.

However, delegates in the Danish capital failed to reach agreement on the mechanisms needed to monitor and manage the framework.

Decision time

"One of the things that the world has learned over the years is that Redd is far more difficult than many people imagined," said Andy White, co-ordinator of RRI, a US-based think-tank, and one of the report's lead authors.

"The forested areas of the world - by and large - have very high levels of poverty, low levels of respect for local rights, and a very low level of control among local people to shape and control their destiny.

"So the rather simplistic notion that money from the rich North can control or limit deforestation was unrealistic."

Redd was developed as a global concept that would provide developing countries with a financial incentive to preserve forests.

The Copenhagen conference was expected to finalise an international Redd finance mechanism for the post-2012 global climate change framework.

The RRI's report, The End of the Hitherlands, said that there would be "unparalleled" attention and investment in forests over the coming year.

It asked: "But who will drive the agenda and who will make the decisions?"

The authors said studies showed that there was the potential for "enormous profits", but this would lead to increased competition for forest resources between governments and investors on one hand, and local communities on the other.

Dr White told BBC News that the UN-Redd scheme still had "tremendous potential".

"It requires, from our perspective, that the governments who tabled the $3.5bn quickly get together and decide on the standards and mechanisms that they will set up," he suggested.

"This would send the necessary signals to the private sector, as well as forest-rich nations, about what is expected from them in order to comply with the policy.

"Sorting out the institution arrangements in developing nations in order to manage the forest market is a huge undertaking."

But the report said that the "unprecedented exposure and pressure" on forest regions was being met by a rise in local groups setting up co-operatives and representative bodies.

The authors added that it gave "nations and the world at large a tremendous opportunity to right historic wrongs, advance rural development and save forests".

Leukaemia cell 'breakthrough' offers treatment hope

T-ALL is a form of childhood leukaemia

Scientists believe they have made an important breakthrough in attempts to treat a form of childhood leukaemia.

In mice tests, Australian researchers found that a cell, which plays a key role in T-cell acute lymphoblastic leukaemia, survives radiotherapy.

The Melbourne University team believes targeting this cell may help to stop this disease returning, but they warned much more research was needed.

UK experts said the findings may eventually lead to better care.

T-cell acute lymphoblastic leukaemia is a rare form of leukaemia which is most common in older children and adolescents, although adults can also be affected.

About a fifth of children suffer relapses after radiation therapy.

In the tests, the team found that 99% of cells in the thymus, a small organ in the upper chest which helps protect people from infections and as a result plays a key role in leukaemia, were killed by radiation.

Resistance

But the Lmo2 gene was able to recover because of its stem-cell like properties, suggesting it could be responsible for the disease, the Science journal reported.

Lead researcher Dr Matthew McCormack said: "The cellular origins of this leukaemia are not well understood.

"Our discovery that these cells are similar to normal stem cells explains why they are capable of surviving for long periods.

"It also explains why they are remarkably resistant to treatment."

The team is now planning to focus on novel treatment capable of killing these cells, but warns it is still many years away from clinical trials.

Ken Campbell, of Leukaemia Research, said: "This is an interesting piece of research that increases our understanding of this small sub-set of childhood leukaemia patients.

"However, while the research could reduce relapse rates in the future for this group, it is likely that current treatment regimes will continue to be used."

Microsoft patches Internet Explorer hole

Microsoft recommends that people upgrade to IE8

Microsoft has released a fix for a hole in Internet Explorer that was the weak link in a "sophisticated and targeted" cyber attack on Google.

Microsoft recommends that customers install the update as soon as possible or update to the latest version of the web browser for "improved security".

Microsoft normally issues patches monthly but the high-profile nature of the attacks led it to act more quickly.

The patch - MS10-002 - was released worldwide at 1000 PST (1800 GMT).

"It addresses the vulnerability related to recent attacks against Google and small subset of corporations, as well as several other vulnerabilities," the firm said.

"Once applied, customers are protected against the known attacks that have been widely publicised."

Microsoft has admitted that it has known about the vulnerability since "since early September" 2009 and had planned to patch it in February.

Trojan Horse

Google threatened to withdraw from the Chinese market following attacks on its infrastructure.

The hacks - thought to have originated in China - targeted the Gmail accounts of Chinese human rights activists.

Following Microsoft's revelation that Explorer had been used in the attacks, the French and German governments advised their citizens to switch to a different browser until the hole had been closed.

The UK government downplayed the threat and said there was "no evidence that moving from the latest fully patched versions of Internet Explorer to other browsers will make users more secure".

However, Microsoft has taken the unusual step of patching the hole nearly three weeks ahead of its regular security update.

The new patch is available via the Microsoft Update site and will also be fed out to those who have their machines set to update automatically. All versions of Internet Explorer will receive the update.

Malicious code exploiting the weakness is known to be circulating on the web, said security experts.

If a web user were to visit a compromised site using a vulnerable browser, they could become infected with a "trojan horse", allowing a hacker to take control of the computer and potentially steal sensitive information.

Microsoft said on 18 January that the firm had only seen malicious code that targeted the older version of its browser, IE6 and that there were "very few" infected sites on the web.

But security firms had said they had seen "copycat" sites trying to exploit the vulnerability.

The bad publicity has allowed rivals such as Firefox to gain market share.

According to web analytics company StatCounter Firefox is now a close second to Internet Explorer (IE) in Europe, with 40% of the market compared to Microsoft's 45% share.

In some markets, including Germany and Austria, Firefox has overtaken IE, the firm said.

Mozilla, the foundation behind Firefox has just released the latest version (3.6) of the open-source browser.