The results are published in the scientific journal Cell.

Type 2-diabetes is a chronic disease resulting from a reduction in insulin-production from the pancreas or an inability of other tissues in the body to respond adequately to the produced insulin, so called insulin resistance. This leads to increased blood sugar, which in turn leads to a worsening of the insulin resistance, increasing the risk of developing many serious diabetes-associated complications.

An international research team, led by Professor Juleen R. Zierath at Karolinska Institutet in Stockholm have identified previously unknown molecular mechanisms by which elevated blood sugar leads to impaired insulin sensitivity in people with diabetes. The research team identified a fat-burning' gene, the products of which are required to maintain the cells insulin sensitivity. They also discovered that this gene is reduced in muscle tissue from people with high blood sugar and type 2-diabetes. In the absence of the enzyme that is made by this gene, muscles have reduced insulin sensitivity, impaired fat burning ability, which leads to an increased risk of developing obesity.

The expression of this gene is reduced when blood sugar rises, but activity can be restored if blood sugar is controlled by pharmacological treatment or exercise, says Professor Juleen Zierath. Our results underscore the importance of tight regulation of blood sugar for people with diabetes.

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There are a number of likely scenarios in which flu prevention through vaccinations could prove inadequate, the authors say. For example, viruses might change after the development of a vaccine for a given year, making it less effective. Alternatively, during a pandemic, vaccine supplies might be inadequate.

Antiviral agents therefore form an important part of a rational approach to influenza management, concludes the review.

Fortunately, most circulating flu viruses remain susceptible to two newer antiviral drugs: oseltamivir (Tamiflu) and zanamivir (Relenza). But U.S. reserves contain only a small fraction of the doses needed to treat the nation's children and adolescents during a pandemic, according to the American Academy of Pediatrics (AAP). Furthermore, neither of the newer drugs is licensed for children younger than 1 year.

It is possible that susceptibility to the older drugs will return some year, although many virologists doubt that, says John Bradley, M.D., a member of AAP's Committee on Infectious Disease. Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among those most at risk.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.

Alves Galv o MG, Rocha Crispino Santos MA, Alves da Cunha AJL. Amantadine and rimantadine for influenza A in children and the elderly (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.

Interviews: Antonio Alves da Cunha at +55 21 2562 6148 or antonioledoyahoo.br

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