We could be doing more to prevent vision loss for people with diabetes

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Clare Villalba, Queensland University of Technology; Anjali Jaiprakash, Queensland University of Technology, and Anthony Russell, The University of Queensland

Diabetes-related vision loss is the leading cause of blindness for working-aged Australians. Yet it’s almost entirely preventable.

A recent Australian study found only half of people with diabetes get the recommended annual eye checks.

We could be doing things better.

One of many complications

Around 1.7 million Australians have diabetes. Aboriginal and Torres Strait Islander people are three times more likely to develop diabetes than non-Indigenous Australians.

Diabetes occurs when glucose (sugar) in your blood is not converted into energy, so its level becomes too high. Blood glucose is our main source of energy and mostly comes from the food we eat.

Diabetes can be managed, for example through lifestyle modifications, medication, or insulin. Diabetes management will be a different experience for each person, and depend on the type of diabetes they have.

But the central aim is keeping blood sugar levels within a healthy range. When they’re not, people with diabetes are at higher risk of complications, which can affect all parts of the body.

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The most common complication of diabetes — globally and for Australians — is eye disease.

Diabetes-related eye disease affects more than one in three people with diabetes. When left undiagnosed and untreated, it can cause vision loss and blindness.

What causes it?

Diabetes-related eye disease can occur when there is damage to the blood vessels on the retina, a thin layer at the back of the eye. This damage limits oxygen and other nutrients reaching the eye.

We need a healthy retina to be able to see.

Diabetes-related eye disease can occur when the blood vessels at the back of the eye become damaged.
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The chance of developing diabetes-related eye disease is higher for some people, including those who have high blood pressure, high cholesterol, or who have had diabetes for many years.

Worryingly, the study we mentioned above found people who had been living with diabetes for ten or more years were even less likely to get regular eye checks. Almost 80% of people in this group didn’t have the recommended annual eye check.

Prevention and treatment

When diabetes-related eye disease becomes more advanced, it can cause blurred or distorted vision and blindness. But we can prevent most diabetes-related vision loss before it reaches this stage.

Special cameras allow us to look at the retina and see if irregular spots or blood vessels are developing.

At this early stage the disease has no impact on a person’s vision. Once we detect it, we can provide timely treatment with laser therapy or injections.

But without regular eye checks, we might not know until it’s too late.

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How Australians Die: cause #5 – diabetes

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We have made progress

Strong social impact work from the government, not-for-profits and local health services is already preventing diabetes-related eye disease from developing into vision loss and blindness in many people.

2020 Australian of the Year, ophthalmologist James Muecke, cofounded the not-for-profit Sight For All and has brought attention to the issue of preventable vision loss for people with diabetes.

The federal government is investing in a national diabetes eye screening program, as well as primary health-care technology and training to embed retinal care in 105 existing health services across Australia. But national programs can put a blanket solution over the population.

When one Aboriginal and Torres Strait Islander health-care service introduced cameras in 2008, they screened 93% of regular clients with diabetes for eye disease — a significant improvement on 16% the previous year. But we found these rates subsequently declined and by 2016, only 22% had an eye check.

We can see just having the technology in primary care is not enough. Ongoing quality improvement is integral to a successful service in the long term.

About 1.7 million Australians have diabetes.
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What else can we do?

In the case of diabetes-related eye disease, the science supporting early detection is advancing every day. But it’s not reaching those who need it the most, including Aboriginal and Torres Strait Islander people.

Having the technology, policy or medicine alone is not sufficient. We need to unlock the potential of communities, empowering everyone to have joint responsibility.

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A model of person-centred eye care would involve:

• making screening and treatment easy to access for people with diabetes. This means addressing physical barriers, such as distance and cost, but also cultural, emotional and social barriers that might stop people from getting their eyes checked

• thinking about the screening experience, including:

  • before: how will we motivate people to get their eyes checked, especially if they’re not experiencing any problems with their vision?
  • during: how can eye checks be streamlined with regular diabetes care, and how can we make the process as seamless as possible for patients?
  • after: how do we ensure they come back every year?

• considering the experience of the diverse teams providing this care, including keeping staff well equipped, trained and motivated

• investing in researching, developing and testing the non-medical components of eye care services. For example, the reminder system, the workflow of each eye check, and how the results are delivered to patients.

We must pursue ongoing improvement of eye care that involves and empowers people with diabetes, their health teams and communities to develop services, systems, new technology and policies that meet their needs.

There is potential for us to prevent blindness in more people with diabetes.

Clare Villalba, Service Designer and Researcher (PhD), Queensland University of Technology; Anjali Jaiprakash, Senior Research Fellow and Deputy Director, Centre for Biomedical Technologies, Queensland University of Technology, and Anthony Russell, Associate Professor, Faculty of Medicine, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Weekly injection could treat type 2 diabetes, new enzyme discovery suggests

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Magdalene Montgomery, University of Melbourne and Matthew Watt, University of Melbourne

A newly discovered protein produced by the liver, and which helps to control blood sugar levels, could potentially revolutionise treatment for type 2 diabetes.

Our research, published today in Science Translational Medicine, found that injecting this protein, called SMOC1, into diabetic mice helped them control their blood glucose much more easily.

We have also engineered a long-lasting form of SMOC1 which, if it works the same way in humans as in mice, would only need to be injected once a week, rather than given daily as is the case for many current diabetes medications.

Our results in mice suggest SMOC1 is more effective than metformin, the current frontline drug for type 2 diabetes, in improving blood glucose control and insulin sensitivity. It’s also without the risk of dangerously low blood sugar associated with current drugs.

Most of us have friends, family members or colleagues with type 2 diabetes. This is not surprising, given the disease affects more than 400 million people worldwide, and almost one million in Australia alone.

Type 2 diabetes is also closely linked to obesity, and with the reported incidence of obesity growing (more than two billion people worldwide are overweight or obese), it is forecast 578 million adults will have diabetes by 2030, and 700 million by 2045.

People with diabetes have many complications that can impair their quality of life and reduce their life expectancy. A major problem for people with type 2 diabetes is high blood glucose, which if left unchecked and untreated, can cause the development of many serious health problems:

• people with diabetes are up to four times more likely to suffer heart attacks and strokes

• they’re three times more likely to suffer kidney failure

• amputations are 15 times more common in people with diabetes

• diabetes is the leading cause of preventable blindness in Australia.

Almost every second person with diabetes experiences a mental illness, such depression or anxiety.

Reducing blood glucose levels before any sign of diabetes damage is evident can help thwart this silent and underestimated killer.

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Current diabetes medications aren’t good enough

A healthy diet and exercise are the first lines of treatment for diabetes. But this has limited effectiveness in reducing blood glucose, particularly as the disease progresses. So it ultimately becomes necessary to use drugs to control blood glucose.

There are a range of drugs available to maintain blood glucose levels. The most common first-choice drug is metformin, which is prescribed to more than 120 million people worldwide. While metformin is generally safe and effective, it frequently causes gastrointestinal symptoms such as diarrhoea and flatulence.

Metformin has long been doctors’ go-to drug for type 2 diabetes.
Ash/Wikimedia Commons

All diabetes medications, without exception, have either limited effectiveness or unpleasant side effects. Many can also potentially cause very low blood sugar (hypoglycemia), which can cause shakiness, anxiety, sweating, chills, lightheadedness, confusion and, in severe cases, coma or even death.

Insulin is used to treat type 2 diabetes typically later in disease progression, after other anti-hyperglycemic medications become less effective at managing blood glucose levels.

So, we can see there is an urgent need to develop new approaches to treat patients with this disease.

The next generation of diabetes therapies

Our discovery of SMOC1, which is naturally produced by the liver and is released into the blood when glucose levels are high, could offer a new way to control blood glucose.

We initially discovered SMOC1 as a protein that was released from mouse liver cells (hepatocytes). Its release increased when liver cells accumulated excess fat.

We further found SMOC1 levels in the blood to be reduced in people that are insulin resistant (pre-diabetic). Based on our animal studies and studies using human liver cells, we anticipate SMOC1 could be effective in people with type 2 diabetes, whether advanced or newly diagnosed. SMOC1 could make daily medications a thing of the past, boosting a patient’s quality of life.

Given the prevalence of type 2 diabetes, this would help reduce the public health burden of the disease, with patients potentially needing fewer hospital visits and shorter hospital stays.

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What happens next? We will need to test SMOC1 in humans, and enlist the help of the pharmaceutical industry to help develop this potential new therapy.

With the right support, SMOC1 could move to human trials within six to eight years, helping us get closer to reducing the global public health toll of type 2 diabetes and obesity in general.

Magdalene Montgomery, NHMRC CDF Fellow, Senior Research Fellow, Head Metabolic Crosstalk Laboratory, University of Melbourne and Matthew Watt, Head, Department of Physiology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Type 2 diabetes: eating a diet rich in fruit and vegetables daily lowers risk, study shows

The more fruit and vegetables consumed, the lower the risk.
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Nita Forouhi, University of Cambridge; Ju-Sheng Zheng, Westlake University, and Nick Wareham, University of Cambridge

Eating about five servings of fruit and vegetables a day is widely promoted as a key part of a healthy diet. This is because consuming fruit and vegetables is linked to lowering the risk of health problems such as coronary heart disease, stroke and some types of cancer.

But there’s still confusion about the role that fruit and vegetables have in preventing type 2 diabetes. Evidence from research has been inconsistent, partly because most studies have relied on participants remembering what they ate – which can be inaccurate. But our latest research found that people who regularly ate more fruit and vegetables in their diet had half the risk of developing type 2 diabetes compared to those who ate less.

Since research shows that type 2 diabetes can be prevented through a healthy diet, we wanted to know just how important eating fruit and vegetables is as part of that. We conducted the world’s largest study that measured blood levels of vitamins linked to fruit and vegetable consumption in a population. This method of using objective nutritional biomarkers – indicators of dietary intake, metabolism or nutritional status that are present in our blood – cuts out the errors and inaccuracies that affected previous studies. We also asked people to report what specific foods they ate to compare with the biomarker data.

We followed a group of 340,234 people from eight European countries. We specifically studied biomarkers in 10,000 people who developed type 2 diabetes during follow-up and compared them with 13,500 people who didn’t.

The biomarkers we measured were levels of vitamin C and six different carotenoids or plant pigments in the blood. These biomarkers tell us about the fruit and vegetables a person gets in their diet. We then calculated the total sum of these seven nutrient biomarkers as a composite score, then split scores into five categories ranging from lowest consumption to highest.

We found that the higher the biomarker score level, the lower the risk of future type 2 diabetes. People whose biomarker score was in the top 20% of the population had a 50% lower risk of developing type 2 diabetes compared to those with lower scores. We also found that eating around 66 grams of fruit and vegetables daily could potentially cut risk of type 2 diabetes by a quarter.

One to two portions daily cut risk by a quarter.
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Our findings build upon the results of a smaller study of 21,831 people living in England, 735 of whom developed type 2 diabetes. This study showed a strong link between higher blood vitamin C level and lower risk of diabetes. But the link was weaker when examining fruit and vegetable intake as reported by the participants. By repeating this work on a larger scale and in several countries, our results further strengthen evidence that these results are likely to be repeated in other populations, too.

Five a day

Since UK dietary guidelines consider each portion of fruit or vegetable to be 80 grams, our study shows eating even one portion per day could have health benefits. For instance, seven cherry tomatoes, two broccoli spears, or one banana would all roughly equal one portion.

Although “five a day” has been around for decades, fruit and vegetable consumption remains low. Only one in seven people over 15 eat at least five portions everyday – and one in three people don’t eat any daily. Encouragingly, our results show there are large potential benefits from making small changes to our diets.

Our research highlights that reduced risk isn’t just because of certain nutrients or vitamins. Rather, the benefits we observed are because of the combination of multiple beneficial components found in fruits and vegetables. Alongside vitamin C and carotenoids, other components including fibre, potassium and polyphenols, which have beneficial effects on weight, body inflammation, blood sugar levels, and keep gut bacteria healthy. And a diverse variety of fruit and vegetables has the greatest health benefits, as you consume more of these beneficial components.

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We also took into account how several factors – including age, gender, body mass index, education level, occupation, smoking, alcohol intake, physical activity and use of vitamin supplements – all affected the risk of type 2 diabetes. We found that the biomarker results linked to fruit and vegetables were independent of these other factors – so regardless of whether a person smoked or was physically active, eating a diet rich in more fruit and vegetables is relevant for lowering the risk of developing type 2 diabetes.

Our research doesn’t establish cause and effect, because we did not intervene with dietary change – rather we observed what happened over time to participants with different blood biomarker levels. But, by using these objective measures and a large sample size in different countries with varying diets, our confidence in these findings is increased. We still don’t yet know whether our findings would be different among different ethnic groups, which should be a focus of future research.

It’s well known that fruit and vegetables are an important part of maintaining good health throughout life, but we also know that in reality the majority of people do not eat enough of them. Our study shows that even just a small increase in the amount of fruits or vegetables you get in your diet can significantly reduce your risk of developing type 2 diabetes.

Nita Forouhi, Programme Leader, MRC Epidemiology Unit, University of Cambridge; Ju-Sheng Zheng, Principal Investigator, Human Nutrition and Epidemiology, Westlake University, and Nick Wareham, Director of the MRC Epidemiology Unit, University of Cambridge

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A disease that breeds disease: why is type 2 diabetes linked to increased risk of cancer and dementia?

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Rachel Climie, Baker Heart and Diabetes Institute and Jonathan Shaw, Baker Heart and Diabetes Institute

In Australia, more than 1.1 million people currently have type 2 diabetes.

A host of potential complications associated with the disease mean a 45-year-old diagnosed with type 2 diabetes will live on average six years less than someone without type 2 diabetes.

This week we published a report bringing together the latest evidence on the health consequences of type 2 diabetes.

Aside from demonstrating the complications we know well – like the link between diabetes and heart disease risk – our report highlights some newer evidence that suggests type 2 diabetes is associated with an increased risk of cancer and dementia.

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How Australians Die: cause #5 – diabetes

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Common complications of type 2 diabetes

Type 2 diabetes, which typically develops after the age of 40, is usually due to a combination of the pancreas failing to produce enough of the hormone insulin, and the cells in the body failing to adequately respond to insulin.

Since insulin is the key regulator of blood glucose (sugar), this causes a rise in the blood sugar levels.

Risk factors for developing type 2 diabetes include being overweight, being physically inactive, having a poor diet, high blood pressure and family history of type 2 diabetes.

Being overweight is a risk factor for type 2 diabetes – but not all people with type 2 diabetes are overweight.
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People with type 2 diabetes are about twice as likely to develop heart disease than people without type 2 diabetes.

While heart attacks, due to blockages in the coronary arteries, are perhaps the better recognised form of heart disease, heart failure, where the heart muscle is unable to pump enough blood around the body, is becoming more common, especially in people with type 2 diabetes.

This is due to a number of factors, including better treatment and prevention of heart attacks, which has allowed more people to survive long enough to develop heart failure.

People with type 2 diabetes are up to eight times more likely to develop heart failure compared to those without diabetes.

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Meanwhile, diabetes is the most common cause of kidney failure and vision loss in working age adults, and accounts for more than 50% of foot and leg amputations.

But beyond these common and familiar complications of diabetes, there’s mounting evidence to suggest type 2 diabetes increases the risk of other diseases.

Emerging complications of type 2 diabetes

People with type 2 diabetes are approximately two times more likely to develop pancreatic, endometrial and liver cancer, have a 30% higher chance of getting bowel cancer and a 20% increased risk of breast cancer.

Increased cancer risk is of particular concern for the growing number of people under 40 living with type 2 diabetes. In Australia, this group saw a significant increase in deaths from cancer between 2000 and 2011.

Dementia, too, is a recently recognised complication of type 2 diabetes. A meta-analysis involving data from two million people showed people with type 2 diabetes have a 60% greater risk of developing dementia compared to those without diabetes.

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Why the increased risk?

It’s important to acknowledge the studies we looked at are observational and can’t tell us diabetes necessarily caused these conditions. But they do suggest having diabetes is associated with an increased risk.

The two leading theories for why cancer risk is increased in people with type 2 diabetes relate to glucose and insulin.

Many types of cancer cells use glucose as a key fuel, so the more glucose in the blood, potentially, the more rapidly cancer will grow.

Alternatively, insulin can promote the growth of cells. And since in the early stages of type 2 diabetes insulin levels are elevated, this might also promote the development of cancer.

It’s especially important people with diabetes take up cancer screening programs.
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There are several possible explanations for the link between diabetes and dementia. First, strokes are more common in people with type 2 diabetes, and both major and repeated mini-strokes can lead to dementia.

Second, diabetes affects the structure and function of the smallest blood vessels throughout the body (the capillaries), including in the brain. This may impair the delivery of nutrients to a person’s brain cells.

Third, high glucose levels and other metabolic disturbances associated with diabetes may, over time, directly affect the way certain types of brain cells function.

Room for improvement

Despite well-established recommendations for the management of type 2 diabetes, such as guidelines for medication use, healthy diet and regular physical activity, there remains a significant gap between the evidence and what happens in practice.

A study from the US showed only one in four patients with type 2 diabetes met all the recommended targets for healthy levels of glucose, cholesterol and blood pressure.

Australian data has shown having diabetes is associated with 14% increased likelihood of discontinuing cholesterol medication after one year.

In our report, we showed increasing the use of a range of effective medications would prevent many hundreds of people with diabetes developing heart disease, strokes and kidney failure each year.

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With the burden of diabetes complications in our community casting such a large shadow in terms of death rates, disability and impact on the health system, we need greater education and support for people with living diabetes, as well as health professionals treating the condition.

For people with type 2 diabetes, close monitoring for other diseases such as cancer through screening programs is particularly important.

And alongside managing their blood sugar levels, it’s essential Australians with type 2 diabetes are supported to keep risk factors for complications, such as blood pressure and cholesterol, at healthy levels.

A healthy diet and regular physical activity is a good place to start.

Rachel Climie, Exercise Physiologist and Research Fellow, Baker Heart and Diabetes Institute and Jonathan Shaw, Deputy Director, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Had gestational diabetes? Here are 5 things to help lower your future risk of type 2 diabetes

For women who have had gestational diabetes, maintaining a healthy diet can help lower the risk of developing type 2 diabetes later on.
From shutterstock.com

Clare Collins, University of Newcastle; Hannah Brown, University of Newcastle, and Megan Rollo, University of Newcastle

Gestational diabetes is a specific type of diabetes that occurs in pregnancy.

Once you’ve had gestational diabetes, your risk of having it again in your next pregnancy is higher. So too is your lifetime chance of developing type 2 diabetes and heart disease.

The good news is taking steps such as adopting a healthier diet and being more active will lower those risks, while improving health and well-being for you and your family.

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What is gestational diabetes?

Gestational diabetes affects about one in seven to eight pregnant women in Australia.
Women are screened for gestational diabetes at around 24 to 28 weeks gestation using a glucose tolerance test. Gestational diabetes is diagnosed when blood glucose levels, also called blood sugar levels, are higher than the normal range.

Screening is designed to ensure women with gestational diabetes receive treatment as early as possible to minimise health risks for both the mother and the baby. Risks include having a baby born weighing more than four kilograms, and the need to have a caesarean section. Management of gestational diabetes includes close monitoring of blood glucose levels, a healthy diet, and being physically active.

The risk of developing type 2 diabetes increases markedly in the first five years following gestational diabetes, with risk plateauing after ten years. Women who have had gestational diabetes have more than seven times the risk of developing type 2 diabetes in the future than women who haven’t had the condition.

Type 2 diabetes

If type 2 diabetes goes undiagnosed, the impact on your health can be high – especially if it’s not detected until complications arise.

Early signs and symptoms of type 2 diabetes include extreme thirst, frequent urination, blurred vision, frequent infections and feeling tired and lethargic.

Doing regular exercise can lessen the risk of developing type 2 diabetes.
From shutterstock.com

Long-term complications include an increased risk of heart disease and stroke, damage to nerves (especially those in the fingers and toes), damage to the small blood vessels in the kidneys, leading to kidney disease, and damage to blood vessels in the eyes, leading to diabetes-related eye disease (called diabetic retinopathy).

If you’ve ever been diagnosed with gestational diabetes, here are five things you can do to lower your risk of developing type 2 diabetes.

1. Monitor your diabetes risk

Although gestational diabetes is a well-known risk factor for type 2 diabetes, some women have not been informed of the increased risk. This means they may not be aware of the recommendations to help prevent type 2 diabetes.

All women diagnosed with gestational diabetes should have a 75g oral glucose tolerance test at 6–12 weeks after giving birth. This is to check how their body responds to a spike in blood sugar after they’ve had the baby, and to develop a better picture of their likelihood of developing type 2 diabetes.

From that point, women who have had gestational diabetes should continue to have regular testing to see whether type 2 diabetes has developed.

Talk to your GP about how to best monitor diabetes risk factors. Diabetes Australia recommends a blood glucose test every one to three years.

2. Aim to eat healthily

Dietary patterns that include vegetables and fruit, whole grains, fish and foods rich in fibre and monounsaturated fats are associated with a lower risk of developing type 2 diabetes.

In more than 4,400 women with prior gestational diabetes, those who had healthier eating patterns, assessed using diet quality scoring tools, had a 40-57% lower risk of developing type 2 diabetes compared with women with the lowest diet quality scores.

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Are you at risk of being diagnosed with gestational diabetes? It depends on where you live

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Glycaemic index (GI) ranks carbohydrate-containing foods according to their effect on blood glucose levels. The lower the GI, the slower the rise in blood sugar levels after eating. Research suggests that a higher GI diet, and consuming lots of high GI foods (glycaemic load), is associated with a higher risk of developing type 2 diabetes, while a lower GI diet may lower the risk of type 2 diabetes.

Take our Healthy Eating Quiz to check how healthy your diet is and receive personal feedback and suggestions on how to boost your score.

3. Be as active as possible

Increasing your physical activity level can help lower your risk of developing type 2 diabetes.

Engaging in 150 minutes of moderate-intensity exercise per week, such as walking for 30 minutes on five days a week; or accumulating 75 minutes of vigorous-intensity physical activity a week by swimming, running, tennis, cycling, or aerobics, is associated with a 45% lower risk of developing type 2 diabetes after having had gestational diabetes. Importantly, both walking and jogging produced a similar lower risk of type 2 diabetes.

In contrast, prolonged time spent watching TV was associated with a higher risk of type 2 diabetes in women with a history of gestational diabetes.

Strength training is also important. A large study of 35,754 healthy women found those who engaged in any type strength training, such as pilates, resistance exercise or weights, had a 30% lower rate of developing type 2 diabetes compared to women who did not do any type of strength training.

Women who did both strength training and aerobic activity had an even lower risk of developing either type 2 diabetes or heart disease.

Breastfeeding has been shown to reduce the risk of type 2 diabetes, even in mums who haven’t had gestational diabetes.
From shutterstock.com

4. Breastfeed for as long as you can

Research shows breastfeeding for longer than three months reduces the risk of developing type 2 diabetes by about 46% in women who have had gestational diabetes. It is thought that breastfeeding leads to improved glucose and fat metabolism.

The Nurses Health Study followed more than 150,000 women over 16 years. It found that for every additional year of breastfeeding, the risk of developing type 2 diabetes was reduced by 14-15% – even in mothers who had not been diagnosed with gestational diabetes.

Organisations such as the Australian Breastfeeding Association and lactation consultants offer support to help all women, including those who have had gestational diabetes, to breastfeed their infants for as long as they choose.

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5. Keep an eye on your weight

Weight gain is a known risk factor for developing type 2 diabetes. In a study of 666 Hispanic women with previous gestational diabetes, a weight gain of 4.5kg during 2.2 years follow-up increased their risk of developing type 2 diabetes by 1.54 times.

Another study saw 1,695 women with previous gestational diabetes followed up between eight to 18 years after their diagnosis. This research found that for each 5kg of weight gained, the risk of developing type 2 diabetes increased by 27%.

Aiming to modify your eating habits and being as active as you can will help with weight management and lower the risk of developing type 2 diabetes. Within interventions that support people to adopt a healthy lifestyle, one review found every extra kilogram lost by participants was associated with 43% lower odds of developing type 2 diabetes.

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Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle; Hannah Brown, PhD Candidate Nutrition and Dietetics, University of Newcastle, and Megan Rollo, Postdoctoral Research Fellow, Nutrition & Dietetics, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Plinky Prompt: What Non Profit Organizations Do You Support? Would You Ever Start Your Own?

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I don’t have any non profit organizations that I support on a regular basis. I do support various non profit organizations from time to time, but it tends to be a bit all over the shop.

I have supported such environmental organizations as Bush Heritage Australia and WWF, among others. I have also supported Compassion and other similar organizations from time to time, such as when the appeal went out for assistance during the tsunami crisis on Boxing Day a few years ago.

I do have an interest, should I have access to any money, to start a foundation-type organization for diabetes research and support. The reason for this interest is that a dear friend died a few years ago who suffered badly from diabetes.

Plinky Prompt: What I'd Do With a Million Dollars

‘Diabetes causes amputations’, warns poster

I do have something of a plan for when (or rather if) I have a million dollars. I would like to start a diabetes foundation in memory of a friend who died. My friend had diabetes and this would be a great way to remember her I think.

Obviously, there would be other things I would do with some of the money, but the establishment of a foundation would be very important to me.

Plinky Prompt: If You Had Unlimited Resources What Would You Create?

I would create a Diabetes Research Foundation. Why would I do this? Because I would like to do something in memory of my friend Rebecca who had diabetes.

ERITREA: THIRD CHRISTIAN THIS YEAR DIES IN MILITARY PRISON

LOS ANGELES, July 27 (Compass Direct News) – Another Christian imprisoned for his faith in Eritrea has died from authorities denying him medical treatment, according to a Christian support organization.

Sources told Netherlands-based Open Doors that Yemane Kahasay Andom, 43, died Thursday (July 23) at Mitire Military Confinement Center.

A member of the Kale-Hiwot church in Mendefera, Andom was said to be secretly buried in the camp.

Weakened by continuous torture, Andom was suffering from a severe case of malaria, Open Doors reported in a statement today.

“He was allegedly further weakened by continuous physical torture and solitary confinement in an underground cell the two weeks prior to his death for his refusal to sign a recantation form,” the organization said. “It is not clear what the contents of the recantation form were, but most Christians interpret the signing of such a form as the denouncement of their faith in Christ.”

Andom is the third known Christian to die this year at the Mitire camp, located in northeastern Eritrea. Mogos Hagos Kiflom, 37, was said to have died from torture at the same center in early January. On Jan. 16, Mehari Gebreneguse Asgedom, 42, died in solitary confinement at the Mitire camp from torture and complications from diabetes, according to Open Doors.

It was not immediately known whether Andom was married or how many family members survive him. He had spent the past 18 months at the Mitire camp.

Last October Open Doors learned of the death of another Christian, Teklesenbet Gebreab Kiflom, 36, who died while imprisoned for his faith at the Wi’a Military Confinement Center. He was reported to have died after prison commanders refused to give him medical attention for malaria.

In June 2008, 37-year-old Azib Simon died from untreated malaria as well. Weakened by torture, sources told Compass, Simon contracted malaria only a week before she died.

With the death of Andom last week, the number of Christians who have died while imprisoned for their faith in Eritrea now total nine. Along with the two Christians who died in January and Kiflom and Azib last year, Nigisti Haile, 33, tied from torture on Sept. 5, 2007; Magos Solomon Semere, 30, died from torture and pneumonia at Adi-Nefase Confinement Center, outside Assab, in February 2007; Immanuel Andegergesh, 23, died in Adi-Quala Confinement Center in October 2006 from torture and dehydration; and also at the Adi-Qaula center, Kibrom Firemichel, 30, died from torture and dehydration also in October 2006.

More than 2,800 Christians remain imprisoned for their faith in Eritrea, according to Open Doors.

The Eritrean government in May 2002 outlawed all religious groups except Islam and the Orthodox, Catholic and Lutheran churches. The government of President Isaias Afwerki has stepped up its campaign against churches it has outlawed, once again earning it a spot on the U.S. Department of State’s latest list of worst violators of religious freedom.

Incarcerated Christians from throughout Eritrea have been transferred to the Mitire prison. In April Open Doors learned that 27 Christian prisoners held at police stations in the Eritrean capital of Asmara had been transferred to the Mitire military camp for further punishment.

They included a pastor identified only as Oqbamichel of the Kale-Hiwot Church, pastor Habtom Twelde of the Full Gospel Church, a pastor identified only as Jorjo of the Full Gospel Church, two members of the Church of the Living God identified only as Tesfagaber and Hanibal, Berhane Araia of the Full Gospel Church and Michel Aymote of the Philadelphia Church.

On April 17, according to the organization, 70 Christians were released from the Mitire military facility, including 11 women imprisoned for six months for allegedly failing to complete their required 18 months of military service. The Christians said that authorities simply told them to go home and that they had no idea why they had been released. They had been originally arrested in Asmara, Dekemhare, Keren, Massawa and Mendefera and transported to Mitire for punishment.

Eritrean officials have routinely denied that religious oppression exists in the country, saying the government is only enforcing laws against unregistered churches.

The government has denied all efforts by independent Protestant churches to register, and people caught worshipping outside the four recognized religious institutions, even in private homes, suffer arrest, torture and severe pressure to deny their faith. The Eritrean Orthodox Church and its flourishing renewal movement have also been subject to government raids.

Reliable statistics are not available, but the U.S. Department of State estimates that 50 percent of Eritrea’s population is Sunni Muslim, 30 percent is Orthodox Christian, and 13 percent is Roman Catholic. Protestants and Seventh-day Adventists, along with Jehovah’s Witnesses, Buddhists, Hindus, and Baha’is make up less than 5 percent of the population.

Report from Compass Direct News 

PAKISTAN: MINORITY RIGHTS DEFENDER SAID TO BE VICTIM OF ISLAMISTS

Muslim who converted, married Christian woman opposed Joseph Francis’ efforts.

LOS ANGELES, July 23 (Compass Direct News) – Pakistani minority rights defender Joseph Francis has been unjustly jailed by Islamists and others who oppose his work on behalf of Christians, according to the legal aid organization Francis directs.

An Islamist in Punjab Province who said he had converted to Christianity subsequently converted a young woman to Islam and married her, setting into motion a series of spurious charges when her parents brought her to Francis for counsel, according to the Lahore-based Centre for Legal Aid Assistance and Settlement (CLAAS). Angered when her family brought her to Francis hoping he would counsel her away from Islam, Mehboob Basharat then arranged for baseless charges to be filed against Francis, director of CLAAS, for allegedly detaining her and setting her on fire, CLAAS officials said in a statement.

Francis was jailed on July 12 after Basharat filed specious charges against him for forging documents and concealing his travel out of the country while on bail. Those charges arose out of the previous case, in which Basharat arranged for the woman he converted to Islam to charge the CLAAS director and others with forcibly detaining and assaulting her in 2006 – even though she previously had told police she suffered no ill treatment at the CLAAS offices.

“His only crime was to help suffering parents of a young Christian girl who was taken away from her family,” according to the CLAAS statement.

Francis’ predicament began when Basharat went to Bishop Samuel Azariah of Raiwind diocese in 2006 and told him that he, his wife and two children had converted from Islam to Christianity. Since his conversion, he told Bishop Azariah, his Muslim family and friends had ostracized him, and he pleaded with the clergyman to employ him. Bishop Azariah gave him a job in the diocese and provided a living space for him on the church premises, according to CLAAS.

Though he never attended church services, Basharat started socializing with Christian families of the congregation and showed excessive interest in their daughters, according to CLAAS. Pastor Emmanuel Khokhar took note and gave Basharat a warning, according to CLAAS.

Basharat became close with Roma Masih, one of six daughters in a family at the congregation, and on Sept. 26, 2006 he took her to a Muslim education center called Jamia Naeemia Lahore, where she embraced Islam and took on the name Aisha; he later eloped with her, and on Nov. 26, 2006 they married under Islamic rites, according to CLAAS.

When her family found out, they went to Bishop Azariah, who referred them to CLAAS for help. Roma/Aisha’s parents, Khursheed Masih and Shamim Masih, asked Francis to talk with their daughter. Basharat, meantime, returned to Raiwind (25 kilometers from Lahore) to collect his first wife and children, at one point threatening Bishop Azariah when the clergyman tried to talk to him. On Dec. 23, 2006 Basharat allowed Roma/Aisha to go to her parents’ house. They immediately brought her to CLAAS offices, insisting that Francis keep her in the organization’s second-floor shelter for abused women.

“They said that if she stayed away from Basharat, maybe she will change her mind and come back to her family,” according to the CLAAS statement.

Roma/Aisha, some of her sisters and their mother stayed overnight at the shelter, and the convert told Francis that she was now a Muslim and did not wish to associate with “infidels.” Francis told Roma/Aisha’s parents that she now considered herself a Muslim and urged them not to insist on their daughter remaining with them, according to CLAAS.

Upon learning that the Masihs had taken their daughter to CLAAS offices, Basharat on Dec. 23, 2006 complained to police in Lahore that the Christian parents of his wife were detaining her. The next day, police summoned Francis. When he and Roma/Aisha arrived at the station that evening, Basharat and a crowd of 40-45 mullahs (Muslim clergy) were waiting for them.

Nevertheless, Roma/Aisha signed a statement at the police station saying that she had not been held hostage or detained against her will, that she went to CLAAS offices of her own free will and that no one misbehaved or ill-treated her there, according to CLAAS. She left with Basharat.

On Feb. 18, 2007, Basharat, Roma/Aisha and attorney Raja Nathaniel, a church-going attorney at odds with the local Christian community, held a press conference in which Basharat accused Bishop Azariah and Francis of abducting his new wife and forcing her to reconvert back to Christianity. Nathaniel, according to CLAAS, at times “has converted to Islam to marry young girls” and has several cases pending against him for illegally confiscating church property in Raiwind; CLAAS notes that in most of those cases it provides legal assistance to the church.

Three months after the press conference, under the guidance of Basharat and with the financial support of Nathaniel, Roma/Aisha filed charges at the Icchara, Lahore police station against her father, mother, three sisters, Bishop Azariah, Pastor Khokhar and Francis; she accused all of them of forcibly detaining her, mistreating her and attempting to burn her.

Incarceration

All of the accused obtained pre-arrest bail. In July 2007, Francis went to England at the invitation of the late former Prime Minister Benazir Bhutto, along with prominent political leaders, to attend a three-day conference in London. Summoned to a bail hearing on July 14, 2007, he came back on July 15, 2007 and appeared in court the next day, according to CLAAS.

On Dec. 24, 2008 Francis learned that Basharat had filed a new case against him, accusing him of concealing his travel abroad while on bail and forging a medical certificate. Also charged were CLAAS employee Ashar Sarfaraz and Sarfaraz’s brother-in-law, Zulfiqar Wilson.

The forgery charges arose after CLAAS submitted a medical certificate indicating that Francis, who suffers from diabetes, was too ill to return quickly for the court hearing on July 14, 2007. CLAAS Program Officer Katherine Sapna said that former CLAAS staff members Aneeqa Maria Akthar and Justin Gill submitted the medical certificate, but Akthar told Compass neither she nor Gill submitted any documents related to the certificate and never went to the court. She added that CLAAS had not even assigned her to the case.

“When someone submits any document before the court,” she told Compass, “the court takes the submission by getting signatures of a person who submits the document, and certainly there are no signatures of mine.”

She acknowledged that she discussed the matter with CLAAS lawyers at the time – Akbar Munawar Durrani, Tahir Gull and Aric John – and that she suggested that if Francis were to try to return in time for the July 14 court summons, it would cause an undue hardship on him as a diabetic to appear in court after arriving in Pakistan from England early in the morning.

“It was just a suggestion, and it did not lead to [me committing] forgery,” she said. “Instead, Ashar Sarfaraz heard this and he went to the doctor himself who was treating Mr. Francis, without asking or telling any of us, and got the certificate. He also submitted the certificate himself in the court, and not the lawyers.”

On these charges Francis obtained pre-arrest bail on Dec. 29, 2008, and when CLAAS filed a petition in Lahore High Court for the dismissal of this case, the court set a hearing for June 8, according to CLAAS.

At that hearing, Basharat’s lawyer accused Francis not only of being in contempt of court by having traveled abroad while on bail but of using his influence to harass Roma/Aisha into forsaking Islam – the young woman’s remaining a Muslim notwithstanding.

Francis’ counsel tried to explain to the court that Basharat and his wife were “misleading the court by purposely making it a religious issue for their own vested interest.” They informed the court that his travel was not concealed but public knowledge, having been published in major newspapers, and that therefore Francis had no reason to prepare or submit any documents explaining his actions.

“But the court overlooked every argument and dismissed the petition for dismissal,” according to CLAAS’ statement. “On July 9, the same judge who dismissed the petition rejected Mr. Joseph Francis’ bail in this case and ordered the police to arrest Mr. Francis.”

This is not the first time that Pakistani courts have put their bias against Christians on display, according to CLAAS.

“Over the years, CLAAS has perused several such cases in which law was overlooked and justice was denied to victims on the basis of their religion, gender, political affiliation and social status,” organization officials said in the statement.

CLAAS urged proponents of human rights to write the Pakistani president, prime minister, foreign and interior ministers, chief justice, federal minister of Law Justice and Human Rights, and Pakistani Embassies around the world.

Report from Compass Direct News