Night Shift Work May Increase Risk of Diabetes

Working rotating shifts can affect the body's ability to properly use insulin to break down sugars in the blood and promotes the likelihood for developing type 2 diabetes.

Working rotating shifts may promote the likelihood for developing type 2 diabetes. Scientists at Harvard School of Public Health have found that women who work during the hours that most people are sleeping can affect the body's ability to properly use insulin to break down sugars in the blood. The details of the study appear in the journal PloS Medicine.

For the 26 percent of Americans who perform shift work during the overnight hours, the grim news adds to concerning findings of previous research that night work interferes with the body’s circadian rhythm, which increases the risk of such medical issues as heart disease, obesity, and ulcers, as well as raises the risk for suffering from depression.

The focus of the analysis, which involved nearly 177,000 women ages 25 to 67, was on those who work rotating shifts, defined for purposes of the study as working three or more nights a month, plus days and evenings. All of the study participants were enrolled in one of two Nurses’ Health Studies.

Findings of the analysis revealed that women who worked rotating night shifts for one to two years faced an increased risk of 5 percent in developing diabetes, over a 20-year follow-up period, in comparison to women who did not work nights shifts.

Among women who works nights for 10 to 19 years, the increase in risk jumped to 40 percent, while working rotating night shifts for more than two decades was found to be associated with a 58 percent increase in risk for develping the condition.

Part of the problem may be due to night workers putting on extra pounds from snacking during hours when the body would normally be sleeping. The body’s metabolism naturally slows down at night, which likely prevents the extra calorie intake from being burned off, and causes it to be stored as fat, and being overweight is a known risk factor for diabetes.

In addition, sleeping at odd hours, or not getting enough sleep, can disrupt the metabolism and cause a boost to the appetite-stimulating hormone ghrelin, and a drop in the level of the appetite-curbing hormone leptin.

The body’s circadian clock is also indirectly responsible for regulating body weight, by controlling body temperature and blood glucose levels. According to senior study author Dr. Frank Hu, a professor of nutrition and epidemiology at Harvard School of Public Health, it remains unclear as to whether or not people who routinely work at night have the ability to adjust their internal body clocks to avoid an increase in the risk of diabetes.

Hu says, “The bottom line is there are probably multiple mechanisms through which disrupted sleep patterns or long term rotating night shift work can influence the risk of Type 2 diabetes.” Regarding the cumulative effect of working night shifts, he noted, “It’s something people should keep in mind. If they minimize or reduce the time they work on night shifts, they may be able to attenuate their risk.”

Diabetes is diagnosed in about one in 12 American adults, while about 346 million people worldwide live with the condition. The majority suffer from type 2 diabetes, which is typically caused by excess body weight and physical inactivity. As the disease progresses, damage to vital organs, such as kidneys, nerves and the heart may occur.

If you perform rotating shift work, you can minimize your risk for developing diabetes by getting adequate sleep to diminish the effects of sleep deprivation suffered while working during overnight hours. In addition, commit to a daily exercise routine to improve your quality of sleep, and minimize caffeine intake during night work hours to prevent sleep interference after your shift.

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Some Depressed People Do Worse on Medications

According to a new look at past antidepressant trials, up to a fifth of patients on Cymbalta and similar medications may actually do worse than those given drug-free placebo pills.

NEW YORK (Reuters Health) - According to a new look at past antidepressant trials, up to a fifth of patients on Cymbalta and similar medications may actually do worse than those given drug-free placebo pills.

Researchers found that patients' symptoms over the first couple months of antidepressant use separated them into "responders," who got progressively better, and "non-responders," who didn't improve with treatment but may still have suffered side effects.

However, "It's difficult to say a priori who will be in which group," Ralitza Gueorguieva, the study's lead author from the Yale University School of Medicine in New Haven, told Reuters Health.

The findings highlight the importance of identifying as soon as possible which patients will and won't respond to certain drugs, her team said.

The researchers combined data from seven studies that randomly assigned patients to receive Eli Lilly's drug Cymbalta (known generically as duloxetine), other antidepressants, or a placebo pill for two months. Those trials involved a total of about 2,500 people with major depression.

People getting the placebo tended to report small, gradual improvements in depression symptoms. On the other hand, those on Cymbalta or another antidepressant fell into one of two categories: most had steeper, steady improvements in depression symptoms, but a sizeable chunk didn't seem to get any better.

About four in five patients on all antidepressants were responders. For Cymbalta in particular, about 84 percent of patients improved and 16 percent did not.

Medication responders saw significantly bigger improvements in their depression symptoms than patients assigned to the placebo. Non-responders, however, did worse.

Differences between antidepressant responders and non-responders were seen as early as a week or two into treatment, and the researchers wrote in their Archives of General Psychiatry report that initial improvements seem to predict who will have a better outcome on Cymbalta, along with the other drugs.

"You know within the first couple weeks of starting a treatment who's the most likely to benefit because they're already starting to show improvement," said Dr. Michael Thase, a psychiatrist from the University of Pennsylvania Perelman School of Medicine who wasn't involved in the new study.

"The first few weeks are revealing, and obviously if the patient's getting worse instead of better, I would use that as a strong indicator that this particular treatment isn't likely to work," he told Reuters Health.

"I think this finding holds true for the antidepressants that are most commonly used today," he said of the gap between responders and non-responders.

Thase pointed out that side effects of antidepressants, such as stomach problems and poor sleep, could make some patients score lower on measures of depression -- perhaps explaining the worse symptoms seen in non-responders compared to placebo patients.

He added that if patients don't benefit from a first antidepressant, they could still respond to a different type of drug, although the chances fall with each successive treatment attempt.

Another scientist said the latest research has been trying to pick out certain patient characteristics -- genetics or specific depression and anxiety symptoms, for instance -- that could help determine who will end up in the responder category, and who won't see any benefit from individual drugs.

"If you can identify people who would be potential responders to a particular medication...it would be a great, huge advantage for the field," said C. Hendricks Brown, who has studied depression treatments at the University of Miami Miller School of Medicine, but wasn't linked to the new research.

Gueorguieva agreed. "Identifying variables that are associated with response is a very important question that we haven't quite tackled," she said.

One of the study's authors is an employee of Eli Lilly and another is on the company's scientific advisory board.

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Posted in: HEALTH