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Tag: type 2 diabetes

Published on Leave a comment on Gut Bacteria Imbalance and Diabetes

Another view of  type 2 diabetes - that the gut microbiome is involved, specifically two gut bacteria: Prevotella copri and Bacteroides vulgatus. View them as the bad guys. The researchers point out "... the majority of overweight and obese individuals are insulin resistant and it is well known that dietary shifts to less calorie-dense eating and increased daily intake of any kind of vegetables and less intake of food rich in animal fat tend to normalize imbalances of gut microbiota and simultaneously improve insulin sensitivity of the host." In other words, eat more vegetables and fewer calories (if you're overweight or obese) to improve the gut microbes. This is similar to yesterday's post of research that viewed type 2 diabetes as "a response to overnutrition" and potentially reversible. From Medical Express:

Gut bacteria imbalance increases diabetes risk

Currently, scientists think the major contributors to insulin resistance are excess weight and physical inactivity, yet ground-breaking new research by an EU funded European-Chinese team of investigators called MetaHit have discovered that specific imbalances in the gut bacteria can cause insulin resistance, which confers an increased risk of health disorders like type 2 diabetes.

We show that specific imbalances in the gut microbiota are essential contributors to insulin resistance, a forerunner state of widespread disorders like type 2 diabetes, hypertension and atherosclerotic cardiovascular diseases, which are in epidemic growth," says Professor Oluf Pedersen, Metabolism Center, University of Copenhagen, and senior lead author of the paper.

In the Danish study of 277 non-diabetic individuals and 75 type 2 diabetic patients, there was close collaboration between the University of Copenhagen and the Technical University of Denmark with extensive international participation from a team of investigators, who performed analyses of the action of the insulin hormone. They monitored the concentrations of more than 1200 metabolites in blood and did advanced DNA-based studies of hundreds of bacteria in the human intestinal tract to explore if certain imbalances in gut microbiota are involved in the causation of common metabolic and cardiovascular disorders.

The researchers observed that people who had a decreased capacity of insulin action, and therefore were insulin resistant, had elevated blood levels of a subgroup of amino acids called branched-chain amino acids (BCAAs). Importantly, the rise of BCAAs levels in blood was related to specific changes in the gut microbiota composition and function.

The main drivers behind the gut bacterial biosynthesis of BCAAs turned out to be the two bacteria Prevotella copri and Bacteroides vulgatus. To test mechanistically if gut bacteria were a true cause of insulin resistance, the researchers fed mice with the Prevotella copri bacteria for 3 weeks. Compared with sham fed mice the Prevotella copi fed mice developed increased blood levels of BCAAs, insulin resistance and intolerance to glucose.

"Most people with insulin resistance do not know that they have it. However, it is known that the majority of overweight and obese individuals are insulin resistant and it is well known that dietary shifts to less calorie-dense eating and increased daily intake of any kind of vegetables and less intake of food rich in animal fat tend to normalize imbalances of gut microbiota and simultaneously improve insulin sensitivity of the host," adds Pedersen. (Original study)

Published on Leave a comment on Type 2 Diabetes May Be Reversible

This study gives hope to those with type 2 diabetes that it may be reversible - even if they've had it for up to 10 years. Researchers demonstrated that in 40% of the 30 study participants on a very low calorie diet (VLCD) of 600 to 700 calories daily for 8 weeks achieved remission of their diabetes for as long as 6 months (the length of the study). They returned to nondiabetic blood glucose levels, had improvement in acute insulin secretion, normalization of liver fat content and insulin sensitivity, and were off all diabetes medicine. The average weight loss was 31 pounds and they maintained this weight loss over the length of the study, even though most remained obese or overweight. The researchers mention that there is already evidence that diabetes reversal lasts for at least 3 years, as long as weight is not regained.

What they did: A) 3 diet shakes per day and 240 grams (1 cup or 1/2 pound) of non-starchy vegetables taking in between 600 and 700 calories per day for 8 weeks, B) volunteers then gradually returned to eating normal food over the next two weeks with very careful instruction on how much to eat, C) volunteers were seen once a month and supported with an individualized weight maintenance program over the next 6 months, D) to keep weight steady after the weight loss, they were eating around one third less than before the study.

Overall, 12 patients who had had diabetes for less than 10 years reversed their condition, and 6 months later they remained diabetes free. In fact, after 6 months a thirteenth patient had reversed their diabetes. The 30 people with diabetes in the study had it between 0.5 and 23 years. The best results were in those who had it for a shorter time. Thus, while 40% of study participants overall reversed their diabetes, 60% of those with short-duration of diabetes (under 10 years) reversed their diabetes. These are fantastic results!

The researchers say that the study results "...supports our theory of a Personal Fat Threshold. If a person gains more weight than they personally can tolerate, then diabetes is triggered, but if they then lose that amount of weight then they go back to normal. Individuals vary in how much weight they can carry without it seeming to affect their metabolism -- don't forget that 70% of severely obese people do not have diabetes." The researchers say type 2 diabetes can now be understood to be a metabolic syndrome that is potentially reversible by substantial weight loss, and that this is an important paradigm shift. They also comment that studies and population data indicate that type 2 diabetes is solely a response to overnutrition.

Excerpts from Diabetes Care:  Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders.

Type 2 diabetes mellitus (T2DM) is generally regarded as an irreversible chronic condition. Because a very low-calorie diet (VLCD) can bring about acute return to normal glucose control in some people with T2DM, this study tested the potential durability of this normalization. The underlying mechanisms were defined.

People with a T2DM duration of 0.5-23 years (n = 30) followed a VLCD for 8 weeks. All oral agents or insulins were stopped at baseline.....Weight fell (98.0 ± 2.6 to 83.8 ± 2.4 kg) and remained stable over 6 months (84.7 ± 2.5 kg). Twelve of 30 participants achieved fasting plasma glucose <7 mmol/L after return to isocaloric diet (responders), and 13 of 30 after 6 months. Responders had a shorter duration of diabetes and a higher initial fasting plasma insulin level....A robust and sustainable weight loss program achieved continuing remission of diabetes for at least 6 months in the 40% who responded to a VLCD by achieving fasting plasma glucose of <7 mmol/L. T2DM is a potentially reversible condition.

However, restoration of normal glucose control is possible after weight loss in some individuals with T2DM . Although most commonly seen after bariatric surgery, reversal of diabetes can occur after any sharp decrease in calorie intake. In short-duration T2DM, fasting plasma glucose becomes normal within days on a very-low-calorie diet (VLCD) because of a rapid decrease in liver fat and return of normal hepatic insulin sensitivity, and normal b-cell function returns over 8 weeks.

This prospective, longitudinal, single center study comprised three phases: VLCD for 8 weeks; a stepped return to isocaloric intake of normal food over 2 weeks; and a structured, individualized weight maintenance program over 6 months. Assessments were carried out before the VLCD, after return to isocaloric eating, and at the end of the 6-month follow-up. The primary outcome measure was fasting blood glucose at 6 months in the group achieving nondiabetic levels after VLCD and return to normal eating, and the primary comparison was the change between post– weight loss and 6 months in responders.

We demonstrate that in 40% of study participants who responded to a VLCD by achieving fasting plasma glucose ,7 mmol/L, remission of T2DM lasts for at least 6 months. Return to nondiabetic blood glucose levels was characterized by improvement in acute insulin secretion, and this was sustained while off all hypoglycemic agents. Hepatic insulin sensitivity improved in both responders and nonresponders....Weight loss brought about normalization of liver fat content and insulin sensitivity in both responders and nonresponders. Of note, no redistribution of fat was seen to the liver from the subcutaneous or other deposits over 6 months of weight stability, even though the participants remained obese or overweight.

The present demonstration of ongoing reversal of T2DM (in 41% of the cohort overall or 60% of individuals with short-duration diabetes) is reflected in population data that indicate that T2DM is solely a response to overnutrition. Ready access to low-cost food is uniformly accompanied by high rates of T2DM, and when food supply becomes limited for any reason, the prevalence of T2DM falls.....The present data confirm reversal of T2DM for at least 6 months in those who achieve nondiabetic plasma glucose levels after VLCD. However, the critical question for health-care delivery is whether truly long-term reversal of T2DM can be achieved in primary care.

The likelihood of VLCD responders remaining free of diabetes indefinitely must be considered. After media coverage of our earlier study, many people with T2DM reversed their own diabetes (37). For such motivated individuals who avoid weight regain, maintenance of normoglycemia for up to 3 years has been reported.... Because progression of longterm complications of diabetes relates to ambient blood glucose control, durable reversal of diabetes would be expected to be associated with longterm health. T2DM can now be understood to be a metabolic syndrome potentially reversible by substantial weight loss, and this is an important paradigm shift. 

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Note that both eggs and high-fat dairy products were basically considered evil by the medical establishment for many years. Remember egg white omelettes?And now both are thought to have health benefits, especially reducing the risk of diabetes. From Science Daily:

Eating eggs reduces risk of type 2 diabetes, study indicates

Egg consumption may reduce the risk of type 2 diabetes, according to new research...Research has shown that lifestyle habits, such as exercise and nutrition, play a crucial role in the development of the disease. A new study has found that egg consumption was associated with a lower risk of type 2 diabetes as well as with lower blood glucose levels. Men who ate approximately four eggs per week had a 37 per cent lower risk of type 2 diabetes than men who only ate approximately one egg per week. This association persisted even after possible confounding factors such as physical activity, body mass index, smoking and consumption of fruits and vegetables were taken into consideration. The consumption of more than four eggs did not bring any significant additional benefits.

The dietary habits of 2,332 men aged between 42 and 60 years were assessed at the baseline of the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, at the University of Eastern Finland in 1984-1989. During a follow-up of 19.3 years, 432 men were diagnosed with type 2 diabetes.

Also note that high meat consumption is linked to higher risk of diabetes. From Science Daily:

High-fat dairy products linked to reduced type 2 diabetes risk

Consumption of high-fat yoghurt and cheese are linked to a reduction in the risk of type 2 diabetes by as much as a fifth, according to new research. High meat consumption, on the other hand, is linked to a higher risk.

However, the new study indicates that it is high-fat dairy products specifically that are associated with reduced risk."Those who ate the most high-fat dairy products had a 23 per cent lower risk of developing type 2 diabetes than those who ate the least. High meat consumption was linked to an increased risk of type 2 diabetes regardless of the fat content of the meat," said Ulrika Ericson, who conducted the study.

The researchers studied the eating habits of 27,000 individuals aged 45 to 74. The participants took part in the Malmö Diet and Cancer study in the early 1990s, in which they provided details of their eating habits. Twenty years on, over ten per cent -- 2 860 people -- had developed type 2 diabetes.

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The researchers think that repeated courses of antibiotics destroy the gut bacteria resulting in gut bacteria imbalance. From Red Orbit:

Antibiotic overuse could up diabetes risk, study says

Repeated use of some antibiotics could increase a person’s risk of developing type 2 diabetes, according to research published online Tuesday in the European Journal of Endocrinology. In the study, scientists from the University of Pennsylvania found that men and women who had ever been prescribed with at least two courses of specific types of antibiotics were more likely to eventually be diagnosed with type 2 diabetes than those who had taken no more than one.

The antibiotics used in the research came from one of four categories, according to LiveScience: penicillins, cephalosporins, quinolones and macrolides. The authors reviewed a database of UK patients, looking at the number of antibiotic prescriptions given to over 200,000 diabetic patients at least one year before those individuals were diagnosed with the condition...They found that the more courses of antibiotics that were prescribed to a person, the greater the risk that he or she would go on to develop the disease.

Patients who had been prescribed between two and five courses of penicillin increased their risk of diabetes by 8 percent, according to the Daily Mail, and the risk increased by 23 percent for those receiving more than five courses of the frequently used antibiotic versus the one- or no-course group.

Those who were given between two and five courses of quinolones, which are used to treat respiratory and urinary tract infections, had an increased diabetes risk of 15 percent, and those receiving more than five courses saw that risk shoot up by 37 percent. 

Those who were given just one course of antibiotics showed no such increase in diabetes risk, the researchers reported. Nor was there any link found between exposure to anti-virals and anti-fungals and diabetes risk. The reason for the association between frequent antibiotic use and the risk of diabetes is not clear, but may be related to a gut bacteria imbalance, they wrote.“Gut bacteria have been suggested to influence the mechanisms behind obesity, insulin resistance and diabetes in both animal and human models. Previous studies have shown that antibiotics can alter the digestive ecosystem,” added lead author Dr. Ben Boursi.

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Interesting, but it is currently unknown why this occurs. From Science Daily:

People with blood groups A, B and AB at higher risk of type 2 diabetes than group O

A study of more than 80,000 women has uncovered different risks of developing type 2 diabetes associated with different blood groups, with the biggest difference a 35 percent increased risk of type 2 diabetes found in those with group B, Rhesus factor positive blood compared with the universal donor group O, Rhesus factor negative.

While previous studies have investigated the links between blood group and stroke (finding an increased risk for group AB versus group O), those on blood groups and their link with diabetes have been small and thus underpowered and unable to provide definitive results. In this new research, Fagherazzi and colleagues took data from 82,104 women from the large prospective E3N cohort in France followed between 1990 and 2008. The objective of this study was to evaluate the relationship of ABO blood type (A, B, AB and O), Rhesus factor (positive or negative) and a combination of the two (ABO×Rhesus) with type 2 diabetes (T2D).

The results showed that, compared with women with group O blood, women with group A were 10% more likely to develop T2D, and those with group B 21% more likely (both statistically significant). The AB group was 17% more likely to develop T2D, but this result was not statistically significant. When looking solely at R+ versus R- women, neither group was at increased risk of developing T2D compared with the other.

The authors then combined ABO group and Rhesus group and compared each possible combination with O negative (O-), which is known as the universal donor group because since it contains none of the A. B, or Rhesus antigens, blood from people in this group can be successfully donated to any other group (without rejection).Compared with O- women, the highest increased risk of developing T2D was found in B+ (35% increased risk), followed by AB+ (26%), A- (22%), A+ (17%). The results for O-, B-, and AB- groups were not statistically significant.

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Bottom line: Try to avoid artificial sweeteners!

From Scientific American: Artificial Sweeteners May Have Despicable Impacts on Gut Microbes

I find it ironic that Thanksgiving coincides with American Diabetes Month. In honor of that irony, two recently published studies have suggested a possible link between what you eat, how it impacts the behavior of the microbes living in your gut, and type II diabetes.

Results from a study by researchers in Israel, published in the journal Nature in October, have suggested that consumption of artificial sweeteners—found in over 6,000 food products—can lead to changes in the gut microbiome, and have put forth an explanation for how this alteration might be associated with diseases such as type II diabetes.

Jotham Suez, a PhD candidate and lead author of the study explains, “We asked people who do not regularly consume artificial sweeteners to add them to their diet for one week, and saw that the majority of these subjects had poorer glycemic responses.” And like humans, mice that were given saccharin-spiked water also developed marked glucose intolerance compared to mice drinking sugar water, or water alone.

Their experiment revealed that mice did exhibit different microbiome profiles after consuming artificial sweeteners, just as with the human volunteers who had developed glucose intolerance. And importantly, the humans who did not show glucose intolerance after consuming artificial sweeteners also did not see changes in the community composition of their microbiome.

Consequently, this change in microbial community in mice also modified how the microbiota functioned as a group to regulate metabolism. Pathways that impact the transport of sugar in the body were found to have decreased function after saccharin treatment and, notably, there was an increased abundance of short-chain fatty acids (SCFAs), which are implicated in lipid biosynthesis.

An investigation done by an independent group of researchers in Canada found similar results in a study published in October in the journal PLoS ONE. Although conducted using rats instead of mice, and with a different artificial sweetener (aspartame instead of saccharin) this study also found an increased risk of glucose intolerance. In addition, both studies showed that propionate—a SCFA highly involved in sugar production—is increased in animals consuming artificial sweeteners (although, unfortunately, propionate concentrations in humans weren’t assessed in the Nature study).

But the take home point is this: findings from two independent studies suggest that messing with the microbiome may have despicable consequences. Artificial sweeteners were originally intended to stave off the increasing obesity and metabolic disease epidemic, but instead they may have directly contributed to it.

In other words, consuming artificial sweeteners appears to throw metabolism out of whack by upsetting the critical balance of the biota in the gut—just as how chaos would surely ensue if you were to throw Gru’s minions out of whack.

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Are probiotic bacteria the reason?

From Medical Xpress: Does a yogurt a day keep diabetes away?

A high intake of yogurt has been found to be associated with a lower risk of developing type 2 diabetes, according to research published in open access journal BMC Medicine. This highlights the importance of having yogurt as part of a healthy diet.

Type 2 diabetes is a chronic condition that occurs when the body doesn't produce enough insulin, or the body's cells develop resistance to insulin. There is an increased risk of developing it if a relative has the condition or if an individual has an unhealthy lifestyle. 

Researchers from Harvard School of Public Health pooled the results of three prospective cohort studies that followed the medical history and lifestyle habits of health professionals. These studies were the Health Professionals' Follow-up Study (HFPS), which included 51,529 US male dentists, pharmacists, vets, osteopathic physicians and podiatrists, aged from 40 to 75 years; Nurses' Health Study (NHS), which began in 1976, and followed 121,700 female US nurses aged from 30 to 55 years; and Nurses' Health Study II (NHS II), which followed 116,671 female US nurses aged from 25 to 42 years beginning in the year 1989.

Within the three cohorts 15,156 cases of type 2 diabetes were identified during the follow-up period. The researchers found that the total dairy consumption had no association with the risk of developing type 2 diabetes. They then looked at consumption of individual dairy products, such as skimmed milk, cheese, whole milk and yogurt. When adjusting for chronic disease risk factors such as age and BMI as well as dietary factors, it was found that high consumption of yogurt was associated with a lower risk of developing type 2 diabetes.

The authors then conducted a meta-analysis, incorporating their results and other published studies, up to March 2013, that investigated the association between dairy products and type 2 diabetes. This found that consumption of one 28g serving of yogurt per day was associated with an 18 per cent lower risk of type 2 diabetes.

Previous research has suggested calcium, magnesium, or specific fatty acids present in dairy products may lower the risk of type 2 diabetes. It has been shown that probiotic bacteria found in yogurt improves fat profiles and antioxidant status in people with type 2 diabetes and the researchers suggest this could have a risk-lowering effect in developing the condition. 

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These results go against the medical advice we've been hearing for years (why am I not surprised?). The new advice: High-fat dairy  yes, low-fat dairy no. I also think processed meat (with nitrates) should not be lumped together with unprocessed meat. From Science Daily:

Consumption of high-fat dairy products associated with lower risk of developing diabetes

People with the highest consumption of high-fat dairy products -- eight or more portions per day -- have a 23 percent lower risk of developing type 2 diabetes (T2D) than those with the lowest consumption -- one or less per day, a new study shows.

The study included 26 930 individuals (60% women), aged 45-74 years, from the population-based Malmö Diet and Cancer cohort. Dietary data was collected with a modified diet history method. During 14 years of follow up, 2860 incident T2D cases were identified. 

The researchers found that high intake of high-fat dairy products was associated with a 23% lower incidence of T2D for the highest consuming 20% of participants (or quintile) (median=8 portions/day) compared with the lowest consuming 20% (median=1 portion/day).

In contrast to these findings, there was no association found between intakes of low-fat dairy products and risk of developing type 2 diabetes.

High intakes of meat and meat products were, regardless of fat content, associated with increased risk, but the increased risk was higher for lower fat meats (increased risk of type 2 diabetes for high fat meats 9%, for low fat 24%), both referring to the risk in the highest-consuming versus lowest-consuming 20%). The highest consuming group for the high-fat meat had 90g or more per day, and for the low-fat meat 80g per day.

Same research, some extra details in write-up. From Medscape:

Big Intake of High-Fat Dairy May Be Protective for Diabetes

Previous research led by Nita Forouhi, MD, program leader and public-health physician at the MRC Epidemiology Unit, University of Cambridge, United Kingdom, published in August this year, suggested that molecules with odd numbers of carbon atoms (15 and 17), which are found in dairy products such as yogurt, cheese, and milk, appeared to have a protective effect.

This contrasts with evidence suggesting that even-chain saturated fatty acids, as found in alcohol or margarine, are associated with a greater risk for type 2 diabetes.

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Research reports and articles on the benefits of exercise have been piling up. Here are some worth looking at. From Science Daily:

Sitting too much, not just lack of exercise, is detrimental to cardiovascular health

Cardiologists have found that sedentary behaviors may lower cardiorespiratory fitness levels. New evidence suggests that two hours of sedentary behavior can be just as harmful as 20 minutes of exercise is beneficial.

From Science Daily:

Out of shape? Your memory may suffer

Here's another reason to drop that doughnut and hit the treadmill: A new study suggests aerobic fitness affects long-term memory. "The findings show that lower-fit individuals lose more memory across time," said a co-author. The study is one of the first to investigate young, supposedly healthy adults. 

From Science Daily:

Less exercise, not more calories, responsible for expanding waistlines

Sedentary lifestyle and not caloric intake may be to blame for increased obesity in the US, according to a new analysis. A study reveals that in the past 20 years there has been a sharp decrease in physical exercise and an increase in average body mass index (BMI), while caloric intake has remained steady. 

From Science Daily:

Older adults: Build muscle and you'll live longer

The more muscle mass older Americans have, the less likely they are to die prematurely, new research shows. The findings add to the growing evidence that overall body composition -- and not the widely used body mass index, or BMI -- is a better predictor of all-cause mortality. "In other words, the greater your muscle mass, the lower your risk of death," said the study's co-author. "Thus, rather than worrying about weight or body mass index, we should be trying to maximize and maintain muscle mass."

From Medical Xpress:

Keeping active pays off in your 70s and 80s

Older people who undertake at least 25 minutes of moderate or vigorous exercise everyday need fewer prescriptions and are less likely to be admitted to hospital in an emergency, new research has revealed.

Researchers from the Universities of Bath, Bristol and UWE-Bristol looked at data from 213 people whose average age was 78. Of people studied, those who carried out more than 25 minutes of moderate to vigorous physical activity per day – such as walking quickly, cycling or swimming - received 50 per cent fewer prescriptions than those who were more active over a four to five year period.

Such physical activity leads to a higher metabolism and better circulation, reducing the risk of conditions and diseases common in older age such as high blood presure, type 2 diabetes, coronary heart disease, and strokes.

From Everyday Health:

The Best Anti-Aging Medicine? Exercise

Everyone knows that exercise is good for you — it helps manage weight, improves muscle and bone strength, and even lifts your spirits. It can also add years to your life.“People have been looking for the secret to a long and healthy life for millennia,” said Neil Resnick, MD, chief of the division of geriatrics and director of the University of Pittsburgh Institute on Aging. “It turns out the most powerful intervention is exercise.”

A recent study conducted at Harvard found that exercise can be at least as effective as prescription drugs when it comes to preventing common conditions such as heart disease, stroke, and diabetes.

Exercise at any age is beneficial. From Science Daily:

Seniors who exercise regularly experience less physical decline as they age

Older adults in retirement communities who reported more exercise experienced less physical decline than their peers who reported less exercise, although many adults -- even those who exercised -- did not complete muscle-strengthening exercises, which are another defense against physical decline.

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Excellent reason to enjoy coffee every day. From Science Daily:

Increasing consumption of coffee associated with reduced risk of type 2 diabetes, study finds

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) shows that increasing coffee consumption by on average one and half cups per day (approx 360ml) over a four-year period reduces the risk of type 2 diabetes by 11%. 

The authors examined the associations between 4-year changes in coffee and tea consumption and risk of type 2 diabetes in the subsequent 4 years.

The authors used observational data from three large prospective, US-based studies in their analysis: the Nurses' Health Study (NHS) (female nurses aged 30-55 years, 1986-2006), the NHS II (younger female nurses aged 25-42 years 1991-2007), and the Health Professionals Follow-up Study (HPFS) (male professionals 40-75 years, 1986-2006). The final analysis included 48,464 women in NHS, 47,510 women in the NHS II, and 27,759 men in HPFS.

The authors documented 7,269 incident type 2 diabetes cases, and found that participants who increased their coffee consumption by more than 1 cup/day (median change=1.69 cups/day) over a 4-year period had a 11% lower risk of type 2 diabetes in the subsequent 4-years compared to those who made no changes in consumption. Participants who decreased their coffee intake by 1 cup a day or more (median change=-2 cups/day) had a 17% higher risk for type 2 diabetes. Changes in tea consumption were not associated with type 2 diabetes risk.

Those with highest coffee consumption and who maintained that consumption -- referred to as "high-stable consumers" since they consumed 3 cups or more per day -- had the lowest risk of type 2 diabetes, 37% lower than the "low-stable consumers" who consumed 1 cup or less per day.

While baseline decaffeinated coffee consumption was associated with a lower type 2 diabetes risk, the changes in decaffeinated coffee consumption did not change this risk.