Category Archives: Diabetes

Katherine R. Tuttle, MD, FASN, FACP, FNKF, a nephrologist from the University of Washington and Providence Health Care, discussed new consensus guidelines that call for the early use of sodium glucose cotransporter 2 (SGLT2) inhibitors, GLP-1 receptor agonists, and finerenone in the care of patients with both chronic kidney disease (CKD) and diabetes.

Rising rates of type 2 diabetes (T2D) worldwide are driving up incidence of chronic kidney disease (CKD), but these patients can reduce their risk of early death if physicians make better use of available therapies, starting with sodium glucose cotransporter 2 (SGLT2) inhibitors.

Katherine R. Tuttle, MD, FASN, FACP, FNKF, clinical professor of medicine, Division of Nephrology at the University of Washington, and executive director for research, Providence Health Care, called for a more holistic approach to addressing glucose control while also protecting the heart and the kidney late last month, as she addressed the American Society for Preventive Cardiology, meeting in Louisville, Kentucky.

Despite all that is known about prevention, Tuttle said, Today, 4 out of 10 people with type 1 (diabetes) and 3 out of 10 with type 2 will still develop kidney disease. This is half of all chronic kidney disease worldwide, she said. With 537 million people having diabetes in 2021, that translates into 200 million developing CKD; and the numbers with diabetes are forecast to reach 783 million by 2040.

So, for the foreseeable future, all of us will be seeing more and more people with chronic kidney disease, she said.

Tuttle offered additional data highlighting the interconnected nature of diabetes, heart failure, and CKD, noting the majority of patients with end-stage renal disease have diabetes. Cardiologists treat many of these patients, and they may be the first clinicians in a position to prescribe newer therapies that can halt renal progression. These are the highest risk patients who have the most to gain from what you have to offer, she said.

Not that its been easy to sort through conflicting advice. Guidelines from groups such as the American Diabetes Association (ADA) and nephrology professional society may not have been well harmonized, Tuttle explained, leading to confusion for treating physicians. To that end, she was part a joint effort by the American Diabetes Association and KDIGO (Kidney Disease: Improving Global Outcomes) that presented a consensus statement in June. The statement called for renin-angiotensin system inhibitors and statins to be used as first-line treatment for all CKD patients, including those with type 1 diabetes (T1D). But significantly, multiple other new therapies were included in first-line treatment, even ahead of metformin.

Over the past decade, she said, trials involving SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, have demonstrated significant benefits to the heart, kidney, and all-cause mortality in patients with diabetes.

Although SGLT2 inhibitors were developed to treat T2D, many other benefits have been discovered because of cardiovascular outcomes trials, which were required by the FDA to rule out any safety issues. When the drug class was shown to have benefits in heart failure and prevention of renal decline, manufacturers launched dedicated trials in these areas; some are still awaiting results.

Tuttle highlighted both a meta-analysis and 2 dedicated kidney studies that had been published this far (EMPA-KIDNEY for empagliflozin is due to report results). Importantly, both the heart and kidney benefits are present, even in this very high risk group of patients with established kidney disease, she said.

Kidney outcomesmeasures of estimated glomerular filtration rate (eGFR) that track kidney decline, showing the need for dialysis or transplanthave shown 40% risk reduction, while composites for heart failure, hospitalization for heart failure, and cardiovascular outcomes have declined 25%. Both are enormous, Tuttle said. Remember, especially people with kidney disease, these are the two major risks in this population. This is really a breakthrough moment for us.

She made special note of the historic significance of the DAPA-CKD study, which led to dapagliflozin receiving fast track breakthrough therapy designations in 2020firsts in nephrology. Results showed a 39% risk reduction for a composite measure of worsening renal function or risk of cardiovascular or renal death among CKD patients already receiving standard of care. Reductions in all-cause death or hospitalization for cardiovascular disease or heart failure were also impressive.

More recently, Tuttle said, trials involving the nonsteroidal mineralocorticoid antagonist (MRA) finerenone, have shown that the potent anti-inflammatory effects have produced positive renal outcomes. (Last year, results presented at the European Society of Cardiology showed finerenone cut hospitalization 29% in the highest-risk patients.)

So, were beginning to build the concept of combination therapy, because these drugs work very differently, she said.

Its extremely important, Tuttle said, for cardiologists to not rely solely on eGFR but also to screen for albuminuria, because that can help catch CKD in its earliest stages, when its treatable. She highlighted trial results that showed how finerenones results are not adversely affected by SGLT2 use, and then presented a case study about their concurrent use. So, the beautiful thing about this is, is not only may these drugs be providing complementary efficacy, but it may be that using and SGLT2 inhibitor mitigates hyperkalemia and allows us to deliver finerenone safely.

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SGLT2 Inhibitors, Combination Therapy Needed to Stem the Tide of CKD in Diabetes - AJMC.com Managed Markets Network

One of the most nuanced areas of diabetes management has become a focal point for diabetes care and education specialists: use of new technologies to improve care. With many in patient-facing roles, optimal uptake and dissemination of information, and the technologies themselves, have led to diabetes technology becoming a main topic of discussion at the Association of Diabetes Care and Education Specialists (ADCES) annual meeting and for good reason. In just the first half of 2022, major regulatory decisions have been made related to Omnipod 5, Eversense E3, and the FreeStylen Libre 3 devices.

With an interest in learning more about the real-world need for diabetes care and education specialists in advancing use of continuous glucose monitoring and other diabetes-centric technology, EndocrinologyNetwork sat down Gary Scheiner, MS, CDE, owner and clinical director of Integrated Diabetes Services, at the ADCES 2022 annual meeting for his perspective on the ever-changing landscape. That conversation is the subject of the video found below:

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The Role of Diabetes Care and Education Specialists on Leveraging Technology in Diabetes, with Gary Scheiner, MS, CDE - Endocrinology Network

Camp Kudzu is having their Kudzu One Day to educate families and kids with diabetes and spreading awareness in Central Georgia.

WARNER ROBINS, Ga. Camp Kudzu is hosting their 1st Kudzu One Day event on Saturday from 10 a.m. - 4 p.m. at Green Acres Baptist Church in Warner Robins.

Families with kids that have type 1 diabetes and are insulin-dependent can register today on the Camp Kudzu website.

There will be educational classes with health experts, camp activities, and snacks and drinks provided.

Check-in time starts at 9:45 AM.

The day will start with Dr. Stephen Ponder who will speak to parents about diabetes education.

Then, Jessica Hutchins, a pediatric endocrinologist with Atrium Health Navicent Medical Center in Macon, will discuss diabetes and mental health.

While the parents are attending classes, the campers and their siblings will create arts and crafts, play camp games, and learn about diabetes.

Families and kids will participate in color wars and a snow cone social.

Camp Kudzu asks that families bring their own lunch food for the picnic.

If you have questions or want more information, you can contact Community Coordinator Caroline Tallman by email at caroline.tallman@campkudzu.org.

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Camp Kudzu hosts event for families and kids with diabetes - 13WMAZ.com

Teachers and school staff of children with type 1 diabetes are being urged by the HSE and Diabetes Ireland to follow new guidelines about their care.

According to Diabetes Ireland, for children living with diabetes, a return to or starting school for the first time also means adapting to their diabetes management, sometimes changing insulin regimes, and thinking about blood glucose monitoring and safety in school.

Diabetes is a disease that occurs when a persons blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy.

It is caused by the bodys own immune system destroying the insulin-making cells (beta-cells) of the pancreas.

Ireland has a high incidence rate of type 1 diabetes in children and adolescents with on average 285 new cases of type 1 diabetes in those under 15 years diagnosed annually. Our country is in the top 25 per centfor diabetes incidence worldwide, according to Diabetes Ireland.

Up to five children and teenagers are diagnosed each week with Type 1 diabetes in Ireland.

There can be an added concern for parents, as well as for the teacher if a child with diabetes is starting school for the first time or changing to a new class or school with a teacher who may not be yet familiar with diabetes.

The younger the child, the greater the involvement in the diabetes management and care of school staff it is, often including special needs assistants.

To help make the transition as easy as possible for everyone, new guidelines have been published by the HSE in an effort to provide useful information and a number of tools and easy-to-follow actions to help school staff to understand type 1 diabetes and the needs of such pupils.

The document sets out clear guidelines that will help structure the conversation and preparations between the family, diabetes team, and school staff. It explains diabetes and diabetes management to teachers and school staff and sets out clear lines of responsibility for all partners.

The document also includes a Personal Pupil Plan to agree on current diabetes management and the needs of a child. This includes information such as personal hypoglycemia symptoms, what to eat during hypoglycemia, and when to check glucose levels and deliver insulin.

The school can have a personalised information pack for all their pupils with type 1 diabetes.

Dr Kate Gajewska, Diabetes Ireland Research and Advocacy Manager explained that for parents, the challenge of leaving a child on their own or under the care of others can be very stressful so good preparations and effective communication with school staff is vital and will help to reduce the feeling of uncertainty.

Dr Gajewska added: We hope this online resource will be helpful and we strongly recommend involving the childs diabetes team early in the planning and communication process and the guidelines will be of great help to everyone involved.

The online resource has separate sections for parents and carers, and the teachers and school staff. The first section includes tips on how to start planning for back to school early, explains how to prepare the school and what to expect, provides information on special needs assistance and requires non-teaching support, gives tips on healthy lunchtime snacks, and how to support the child from the mental health and well-being side.

In the section for teachers, SNAs and other staff educational materials about type 1 diabetes, hypo and hyperglycemia and diabetes management are provided, as well as information on how important it is for their mental health and well-being to be included in school life.

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Teachers and school staff of children with type 1 diabetes urged to follow new guidelines - BreakingNews.ie

This transcript has been edited for clarity.

I'm Dr Neil Skolnik. Today we're going to talk about Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association, which was put together with designated representation from the American College of Cardiology.

The big news here is that early detection of presymptomatic heart failure utilizing annual screening with N-terminal pro B-type natriuretic peptide (NT-proBNP) or troponin is now recommended. It turns out that although we don't think about diabetes and heart failure the same way that we think about diabetes and vascular disease or microvascular complications of diabetes, heart failure is a very common complication of diabetes. Approximately 22% of all patients with diabetes eventually develop heart failure. In fact, it's two to four times more common in people with either type 1 or type 2 diabetes than in those without diabetes.

Risk factors for heart failure in both for type 1 and type 2 diabetes include duration of diabetes, poor glycemic control, uncontrolled hypertension, hyperlipidemia, higher body mass index (BMI), microalbuminuria, renal dysfunction, ischemic heart disease and peripheral vascular disease.

Heart failure classification includes stage A, which is people who are at risk for developing heart failure. That's essentially everyone with diabetes. Stage B, which is our focus today, can be thought of as presymptomatic heart failure or preheart failure. These are people who have an echocardiogram with evidence of structural heart disease, abnormal cardiac function, or elevated natriuretic peptide or cardiac troponin levels. Classification of heart failure includes symptomatic heart failure (stages C and D), which are the subjects of a different discussion.

The reason for these new guidelines is recent good randomized trial evidence showing that appropriate treatment of people at risk for heart failure who have elevated NT-proBNP levels (eg, people who have preheart failure or stage B heart failure) can reduce the risk for left ventricular dysfunction, newly diagnosed heart failure, and heart failure hospitalization.

That leads to the main recommendation of this consensus statement: annual testing of brain natriuretic peptide (BNP), NT-proBNP, or high-sensitivity cardiac troponin to identify the presence of stage B heart failure. The cutoff value for BNP is 50 pg/mL, and for NT-proBNP, it is 125 pg/mL.

Patients who are identified in this manner should receive an echocardiogram and then, based on the results of the echo, be treated with appropriate medications that include renin-angiotensin system blockade (either an angiotensin-converting enzyme [ACE] inhibitor or an angiotensin receptor blocker [ARB]), a sodium-glucose co-transporter 2 (SGLT-2) inhibitor, and other medications per the AHA/ACC heart failure guidelines, summarized here.

These are big, important new recommendations that are easy to implement and have the potential to make a big difference for our patients with diabetes. I'm Dr Neil Skolnik, and this is Medscape.

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Don't Wait for Symptoms! Annual Heart Failure Testing in Diabetes: New Recommendation - Medscape

Table 1 shows the demographic characteristics of 41 participants. There were 24 females and 17 males, with 16 participants in their 30s, 14 in their 40s, and 11 in their 50s. Ethnic distribution followed 61%, 15%, and 20% for Chinese, Malay, and Indian, respectively.

Table 2 presents a hierarchal thematic scheme of the novel findings. We identified 5 main themes, each with 3 sub-themes: (i) perceptions of diabetes, (ii) sources of perceptions, (iii) relational identity between food and T2D, (iv) perceived losses from healthy eating in T2D, and (v) perceived gains from physical activity in T2D. Even though the findings are categorized by the domains of inquiry, all the sub-themes are interrelated and create the narrative of the given context.

All the participants were aware of diabetes with a good understanding of its risk factors, like obesity, family history, dietary habits, and sedentary lifestyle. Commonly cited symptoms included increased thirst, frequent urination, changes in weight, and sweet pee which attracted ants. A few responded there would be no visual symptoms until a blood test has been taken. Participants also had a good understanding of the disease progression. Apart from the cost of treatment, the initial stages of the disease management were perceived as inconvenient due to the daily medications and diet considerations.

If I had it, I had to take medications regularly and properly. I had to bring medications with me. Its inconvenient. If I were to be in a social setting, Id be like, Oh, Im sorry, I cant eat this or drink that or like I need to take my medication. Then, people would look at me weirdly. Id be like, Should I explain or not? (30s, F, Chinese)

Later stages of T2D were perceived as disastrous to quality life due to the complications arising from T2D. Many participants were concerned that they may become a burden and be unable to care for others. Complications of T2D were associated with disabilities that could cause (loss of) ability to work, (and) ability to live independently.

There is a risk of complications like having kidney problems, amputations, or maybe even blindness, or losing your sensitivity, your extremities. These are the complications that someone with diabetes will have to anticipate. But if I develop complications that result in me developing blindness or limb amputation, that one will be quite disastrous to the quality of my life. (30s, M, Chinese)

However, most participants expressed that the development of these complications would be far away, and the progression from the initial stage to complications would be slow. They believed such a slower progression of diabetes compared to other diseases meant that it was not as life-threatening and that diabetic patients have an opportunity to control and manage diabetes with medication and lifestyle adjustment.

You may have diabetes, but it may not happen like a one-shot. For diabetes, first, you have medication to manage it. You have time for treatment. You still can control in a way. You can try to minimise potential injuries. It will not get fatal as compared to heart disease where it strikes up, the recovery time and saving the person is very acute (30s, M, Chinese)

Participants said they actively seek expert knowledge only after specific triggers like health screening results or hearing about T2D diagnosis from their social circles. Some participants found the amount of information and use of jargon overwhelming, and the information on actionable steps sometimes contradicting.

I usually inquire into a condition when somebody I know is diagnosed with the condition. It usually takes a few searches to understand because there are many sources, which tend to be overly clinical in their jargon, which is not very helpful and only targeted to medical professionals. Usually, the contradictions are not in the diagnosis but understanding if it is major or minor, or if any meaningful action should be taken. (50s, M, Chinese)

Hence, many lay perceptions were influenced by the media portrayal of diabetic patients. Participants recollected that the characters with diabetes in the media were often in the later stages with limb amputations, which were somewhat disturbing. However, diabetes was rarely reported as a cause of death, even if it was an underlying health condition.

To me, diabetes is a bit far away. We hear about stroke and heart attacks when the media reports that somebody collapsed while jogging. Whereas, when somebody dies from diabetes, we dont usually read it in the papers. You might die of heart attack with a pre-existing condition of diabetes. But people just report your heart attack. Diabetes tends to be at the back of everybodys mind. It exists, but the media doesnt put it in the spotlight that often. (30s, M, Chinese)

For participants who had family, relatives, or friends with T2D, their perceptions of the disease cause, risk, and consequence of diabetes were influenced by what they observed and heard from the patients. In particular, participants who had parents and relatives with late stage-associated conditions, their descriptions about the impact of T2D on life were specific and vivid.

She suddenly started to bleed very badly after just gently scratching a black spot, but she didnt feel any pain. She passed out at home because of the excess bleeding. We had to call the ambulance, and she had to go for another operation for her leg. When you have diabetes, it will take longer for the wounds to be healed, so it took her a long time to heal. This is a real problem. (40s, F, Indian)

Common factors influencing perceived risk among participants were poor health screening results, obesity, positive family history, and unhealthy practices, especially around dietary choices. Many participants perceived that having too much sugar was the main cause of diabetes, which translated to reduced perceived susceptibility of T2D among those who did not have many sugary foods.

I think my risk is very low. I am someone who is not into sugar - I dont drink bubble tea, I don't have a lot of sweets, biscuits or cakes or chocolates. I dont have that kind of craving. (40s, F, Chinese)

Several participants said when friends and families speak about diabetes, it is usually candidly referring to having too many sweet food items. However, the colloquial reference to sweet foods and sugar as the cause of diabetes did not reduce the consumption of these foods.

When you have a gathering, you look at the amount of food and sugar. Then, you casually say like this is going to get me diabetes. But its a form of a joke than anything serious. (40s, M, Malay)

Participants were asked to share how they thought their lives could be impacted if they were to be diagnosed with T2D. A common perceived loss was related to the restriction of diet to manage T2D.

If I had diabetes, I would have to have a more restrictive lifestyle. I would not be able to eat as much of the food that I enjoy snacking, eating ice cream and things like this. I myself have sweet tooth. For me having to be a bit more restrictive would be quite a downer (30s, M, Chinese)

Many participants shared that the diet restriction was particularly impactful in Singapore as the local food culture is important in shaping the Singaporean identity. With the variety of food, there were expectations of having a certain level of culinary experience during social gatherings.

Given that we are Singaporeans, we love to eat. It is difficult to maintain a healthy lifestyle or a healthy diet. Our culture is about eating we have a fusion of food and all kinds of foods from all around the world. Even if healthier, people do not want to meet friends over a fruit platter. They will meet for a Korean barbeque. So, from a cultural perspective, its very hard to disconnect from food. (30, M, Chinese)

Participants defined good food as tasty and cheap and shared that people are willing to travel significant distances in search of good food. Singaporeans take pride in finding food that has the best value for money, and this pursuit is often a topic of conversation among friends and family.

I think it is difficult for people to control their diet. Singaporeans like to travel around to find food to eat. They might be living in [a neighbourhood in the east], but they do not mind travelling to [a neighbourhood in the west]. They want the best food that they can get for the three dollars fifty cents. They will talk to each other about where to go and what to eat. They enjoy eating so much and want total value for money in getting the best bang for their buck. (40s, M, Indian)

Participants pointed out the convenience, ease of access, and budget-friendly options; hawker centres located within every public housing estate providing diverse local cuisines quickly and cheaply. Furthermore, in recent years options of delivery service and the availability of all types of cuisine, one can access cheaper and more delicious food any time, from the comfort of home.

When you are craving something, or you want to eat something, usually I must travel all the way there. But now everything is a lot easier to eat something, and it will come to your doorstep. Even if I am tired or it is late at night, and I feel like having ice cream, there is [food delivery platform]. So, there are a lot more opportunities to indulge in these kinds of things. (30s, F, Chinese)

Conversely, many participants pointed out that healthy food options are more expensive and can take a long time to prepare.

In Singapore, the faster and cheaper options are unhealthy. So, if you want to prepare healthy food, and you have working hours, you need to make a lot of sacrifices like wake up early or prepare it the night before. And the ingredients for healthy meals are not cheap. (40s, F, Malay)

When speaking of restrictive diet and healthy eating, participants alluded to a loss in their lifestyle due to reduced enjoyment and impaired social interactions associated with food. Social relationships and celebrations are centred on food, and declining food or refusing to eat could be interpreted as an insult to the host. This was mentioned by participants across all the ethnic groups.

Youre stopping me from eating my favourite food, you know? I rather die. What makes it really hard is that any form of Chinese celebration has got to do with food. The bigger the celebration, the more food we have. Its like, if you dont eat, youre extremely rude its insulting not to eat something that is placed before you. (50s, M, Chinese)

Many participants also shared that eating provided a source of enjoyment and that some participants turned to food when they were upset or stressed. While some participants shared that they exercise to de-stress, some participants shared that they eat to de-stress. A participant mentioned the endorphins released when exercising, while another said the same but when indulging in delicious food. While there was awareness for the need to mitigate the effects of unhealthy eating, it came in the form of compromising other meals instead of giving up the pleasure derived from unhealthy foods.

The only thing that Im doing now to control my eating is trying not to have breakfast in the morning. I will just try to have lunch and dinner, but it is usually not controlled. I should stop eating less fried food. But I dont think I can give up fried chicken that easily. Its just really too good to give up. (30, M, Chinese)

Similarly, some participants expressed that they justify their eating habits by having earned their calories after exercising and consider their indulgence as a reward. The influence of social media culture was also reported, where people post pictures of the aesthetics of the setting and the food. Participants shared that social identity is associated with food and enjoying life, and rarely with healthy eating in the context.

People eat to survive. But for me, I live to eat because I love to eat. So, if Im not happy, I need to eat to be happy. I love food. To continue eating unhealthy food, I compensate for it by doing more exercise. So, I had the calories burned to eat. If I dont exercise and eat, Ill get fat or something like that. But if I exercise and eat, it can balance out, right? Nowadays, people post their food on social media. Wow, theyre so yummy! But, if you burn a fish at home, you wouldnt post on social media. You will only post nice and presentable ones. (40s, F, Chinese)

Demanding work environments and familial responsibilities created multiple competing priorities even though exercise is desirable. These responsibilities often lead to sacrificing sleep, poor eating habits, and exercise time to meet these expectations. Participants shared that Singapores competitive work environment creates high-stress situations. There is an expectation to constantly improve skills and qualifications to ensure job security.

Stress is one contributing factor. People tend to eat more and badly when they have stress. People want to have job security. Now there is digital disruption, so you can become invalid, which is quite scary. So, we need to upgrade ourselves. I have attended many courses, and I will attend more, so there is no time to exercise sometimes even though I want to. (40s, M, Others)

Participants, especially mothers, shared that time for themselves when they could exercise is seen as a luxury or culturally challenging. A Muslim woman shared how she felt different and watched when running with a hijab, a head covering worn by many Muslim women. Internalised expectations of clothing worn during exercise contrasted with wearing a hijab, creating potential psychological barriers.

Im making a conscious effort, but it is really tough for me to find a time with kids, work, and everything. Most of the days, as a working mom, I seldom get time for myself to do what I want. You feel good about yourself with those endorphins. It is very good to mentally detox by getting away from home and kids. But, when I ran in the park, I used to feel a bit shy and embarrassed because I was wearing hijab, and then I felt like everyone was looking at me (30s, F, Indian)

Despite these challenges, there is interest to engage as several participants shared their rewarding experiences from physical activity. When talking about physical activity, participants alluded to a gain, citing how they feel lighter and good after exercising. Participants shared that initial adoption of physical activity was often in response to an external cue, including a worrying health screening result or a recent loss of life. Accountability through exercise programmes or friends or incentives were cited as facilitators of engaging in physical activity. However, the reasons to sustain behaviour were to ensure they could maintain their physical appearance, retain independence and physical mobility to continue doing the things they enjoy, or continue experiencing the immediate benefits and enjoyment of certain exercises.

I dont want to be obese or unhealthy. I dont want to inject myself all the time or spend my hard-earned money on doctors or medications. So, I exercise. Then, Ill feel lighter. Ill feel good, fit. Ill be happy, and I can do a lot of things. Through all these exercises, my muscle wont be so stiff. I can do a lot of things together with my children. I can cook for them and continue to work. Then I can go travel if money permits. (50s. F. Chinese)

Many participants also reported that observing self-improvement by tracking progress acted as positive feedback for their self-efficacy, and in return, motivated them to exercise further or longer. Participants who exercise regularly also pointed out that exercise is a more individual activity, and therefore it is not affected like healthy eating by its social context.

One day you cycle down a road, you see some things and buildings. Then the next time, you motivate yourself to cycle further. Its with running also in my mind, I will motivate myself to jog slowly. And then now I can run to this place, to that place, and then further. Then slowly, I can run back. It motivates me. So every time, you look for a new goal to achieve. I can go somewhere further, you know? (40s, F, Chinese)

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Lay perceptions of diabetes mellitus and prevention costs and benefits among adults undiagnosed with the condition in Singapore: a qualitative study -...

Acupuncture has been used as an alternative medical practice for about 3,000 years. First started in China, acupuncture has become a more widespread practice in Western countries since the 1950s. A survey of Americans in 2012 reported about 3.5 million Americans used acupuncture as a complementary health approach.

Past research shows acupuncture to be effective in providing relief from a variety of different medical issues, including low back pain, headaches, nausea, and menopausal symptoms.

Adding to this list, a team of researchers from Edith Cowan University in Australia reports findings showing acupuncture therapy may be useful in helping prediabetic patients ward off type 2 diabetes.

The new study was recently published in the journal Holistic Nursing Practice.

Acupuncture is an ancient practice from traditional Chinese medicine. An acupuncturist inserts very thin needles into various areas of the body. The needles help stimulate these specific areas known as acupuncture points to help remove any blockages in the bodys natural energy flow, called qi (pronounced /chi/).

Researchers have examined acupuncture as a possible treatment for diabetes for some time now. About 415 million people globally live with diabetes, with projections to hit half a billion in 2040.

Past research examined acupuncture as a treatment for insulin resistance, and as a complementary therapy for controlling type 2 diabetes

According to Min Zhang, a Ph.D. candidate at the School of Nursing and Midwifery at Edith Cowan University in Perth, Australia, associate professor at the College of Nursing and Rehabilitation at North China University of Science and Technology, China, and the lead author of this study, the aim of this research was to identify the effects of acupuncture-related therapies on prediabetes management in community settings; and to find the best treatment protocol.

Acupuncture works by improving insulin sensitivity, which determines how sensitive our bodys cells are in response to insulin a hormone to help our body turn food into energy, she explained to MNT.

That means acupuncture can help to control blood sugar levels among people with prediabetes by enhancing insulin production and the efficacy of insulin utilization, Dr. Zhang said.

For this study, Zhang and her team analyzed data regarding acupuncture-related therapy interventions for glycemic control of prediabetes from 14 databases and five clinical registry platforms. The studies ranged over 100 years, from April 1921 to December 2020, and included more than 3,600 individuals with prediabetes.

From their research, the team discovered acupuncture therapy helped significantly improve key markers, including fasting plasma glucose, two-hour plasma glucose, and glycated hemoglobin. They also found acupuncture helped lower the incidence of prediabetes.

The study also showed no reports of adverse reactions from acupuncture therapy among patients.

Additionally, Zhang and her team believe acupuncture provides a holistic option to help alleviate other health issues known to worsen diabetes. These include stress, sleep issues, and high blood pressure.

More than 70% of prediabetic people will develop diabetes within their lifetime. If you ignore it, your risks for heart disease and stroke will also go up, Zhang explained.

She also touched on its advantages over some medications for some people.

[T]he medication used for people with diabetes, such as metformin, is not recommended or approved for prediabetes by TGA (Therapeutic Goods Administration in Australia) due to side effects. Since prediabetes is reversible, holistic and non-pharmacological treatment is an investment rather than an expenditure, she pointed out.

Additionally, Zhang said past research has demonstrated that acupuncture also has benefits for patients with type 2 diabetes.

Acupuncture could improve glycemic control in adults with type 2 diabetes without significant adverse events, she said. This effect is facilitated through improved glucose tolerance and insulin sensitivity that reduces the blood glucose level.

MNT also spoke with Dr. Mahmud Kara, founder of KaraMD & Alternative Health Solutions, about the study. Dr. Kara said there are a few areas that warrant further research.

The first is that the study does not exclude those who received acupuncture treatment while also making lifestyle changes, specifically dietary changes, which makes it difficult to conclude that acupuncture alone has a significant impact on diabetes risk, he said.

Another area to look at is the benefits of acupuncture on other health areas indirectly related to diabetes. For example, chronic stress is often associated with glycemic levels and fluctuations in blood sugar levels. Based on this, it would be important to look at whether acupuncture directly impacts blood sugar levels or whether it has an impact on stress reduction and through this, it indirectly benefits ones health, Dr. Kara explained.

Finally, relying on acupuncture alone may not produce the results one is looking for, he continued.

While acupuncture may offer some health benefits, other time-proven methods such as lifestyle changes (e.g. diet, exercise, stress reduction) should not be overlooked when it comes to prediabetes and reducing disease risk. Dr. Mahmud Kara

Dr. Rohit Moghe, an ambulatory care and population health clinical pharmacist at Trinity Health Mid-Atlantic, agreed that further research in this area was merited.

My overall approach to practice after reading this study is that it informs it, but doesnt change it, at least not right now, he explained to MNT.

I will continue to push hard and coach my patients through lifestyle as medicine through the ADCS7, with significant emphasis on dietary modification, enjoyable physical activity, addressing stress through coping skills, and restful sleep. If someone with prediabetes has musculoskeletal pain and/or looking for non-pharmacological treatment of pain, I would recommend acupuncture along with other complementary approaches to treat it, he said.

Dr. Moghe also stressed the need for more research funding in non-pharmacological methods for treating and preventing common chronic conditions.

Due to heavy research on medications, devices, and procedures accepted within Western view of medicine, we are able to prove they work and how they get approved, he detailed, adding: However, we need to also devote equal and equitable resources to studying medicine and procedures from other traditions to bring these therapies into options for those who want to use them.

Medical traditions that are older than Western medicine, like acupuncture, traditional Chinese medicine (TCM), Ayurveda, yoga therapy, and other shamanistic medical practices also need due respect and equitable research funding. Since we are now a global community, it is only prudent to do so. Dr. Rohit Moghe

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Preventing type 2 diabetes: Could acupuncture help? - Medical News Today

Diabetes is a condition in which the body cannot properly process sugar. Sugar is an important source of energy for the body, and the pancreas produces a hormone called insulin to help convert sugar into energy. However, in people with diabetes, either the pancreas does not produce enough insulin or the body cannot effectively use the insulin that is produced. As a result, sugar builds up in the blood instead of being used for energy (via Healthline).

Over time, high blood sugar can lead to serious health problems such as heart disease, stroke, kidney damage, nerve damage, and vision loss. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is usually diagnosed in children or young adults, while type 2 diabetes is most common in adults over the age of 40. However, type 2 diabetes is on the rise in children and teens due to obesity.

The symptoms of diabetes can vary depending on how high the blood sugar level is. Some people with diabetes may not have any symptoms at all. In general, the early symptoms of untreated diabetes include frequent urination, unusual thirst, feeling tired all the time, and slow healing of cuts and bruises. If blood sugar levels continue to rise, other symptoms may include weight loss, constant hunger, confusion, blurred vision, and numbness or tingling in the hands and feet.

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Is There A Link Between Diabetes And Anemia? - Health Digest

Drew Carey famously dropped 80 pounds with exercise and a low-carb diet, putting his type 2 diabetes into remission. "It sucks being fat, you know," Carey said. "I was diabetic with type 2 diabetes. I'm not diabetic anymore. No medication needed." Worried about your blood sugar? Here are five signs you might have diabetes. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Constant thirst is one of the most common signs of diabetes. "No matter how much you drink, it feels like you're still dehydrated," say Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES, and Lisa M. Leontis RN, ANP-C. "Your tissues (such as your muscles) are, in fact, dehydrated when there's too much glucose (sugar) in your blood. Your body pulls fluid from the tissues to try to dilute the blood and counteract the high glucose, so your tissues will be dehydrated and send the message that you need to drink more. This is also associated with increased urination."

Chronic insomnia raises the risk of developing type 2 diabetes, doctors say. "This isn't a surprise," says Elena Christofides, MD, FACE. "Stress is a known contributor to the development and progression of obesity and diabetes because it causes the body to not be ever able to go into repair and relaxation mode. It is always in reaction mode."

Too much abdominal fat is strongly linked to an increased risk of getting type 2 diabetes. "A person who has a highly inflammatory diet and carries excess adiposity around their central organs is more likely to get type 2 diabetes," says Dr. Christofides.

"The effects of type 2 diabetes make it harder for your body to fight off an infection, so you may experience frequent infections," say Hess-Fischl and Leontis. "Women may have frequent vaginal (yeast) and/or bladder infections. That's because bacteria can flourish when there are high levels of glucose in the blood."

There is a hereditary risk to developing type 2 diabetes, experts warn. "Type 2 diabetes tends to be fairly hereditary in contrast to type 1 diabetes," says James Norman, MD, FACS, FACE. "Approximately 38% of siblings and one-third of children of people with type 2 diabetes will develop diabetes or abnormal glucose metabolism at some point. The degree of obesity also seems to be a factor, with a larger percentage of diabetes developing in those who are more obese. Studies with identical twins showed that 90-100% of the time when diabetes developed in one it would also develop in the other compared with 50% in type 1 diabetes."6254a4d1642c605c54bf1cab17d50f1e

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Sure Signs You Have Diabetes Like Drew Carey Eat This Not That - Eat This, Not That

The study covered in this summary was published in Preprints for Research Square as a preprint and has not yet been peer reviewed.

South Asians dying with atherosclerosis in the United States were twice as likely to have concurrent diabetes compared with other Americans (8.3% vs 4.1%), in a new study.

The findings come from mortality data of American adults aged 45 and older who died in 2012-2019, were South Asian (with ancestry from India, Pakistan, Bangladesh, Nepal, Bhutan, or Sri Lanka) or other Americans, and the cause of death included type 2 diabetes (diabetes) and/or atherosclerotic disease (ischemic heart disease, ischemic stroke, or atherosclerosis), based on ICD-10 codes.

The increased likelihood of having diabetes plus atherosclerotic disease as the cause of death in South Asians versus other Americans was greatest in women younger than 60.

South Asians in their native countries ordiaspora populations have a higher risk of developing diabetes and diabetic complications than others, and their leading cause of death is atherosclerotic disease. This study now shows that atherosclerotic disease and diabetes have "vicious synergistic consequences" on risk of earlier death.

Public health strategies targeted at South Asians should focus on prevention and treatment of both atherosclerotic disease and diabetes, especially in young and middle-aged adults, and especially younger women.

There is a need to "step-up" detection and management of atherosclerotic disease and diabetes in South Asians as well asincrease efforts to prevent diabetes in patients with atherosclerotic diseaseand prevent atherosclerotic disease in patients with diabetes.

Renewed efforts are needed to improve access to healthcare for immigrant communities in the United States.

The researchers obtained mortality data compiled in the Mortality Multiple Cause files from the National Center for Health Statistics, based on death certificates, from 2012 through 2019, for people who died at age 45 and older, were US residents, and had data for race/ethnicity/nationality.

The patients were classified as having South Asian ancestry or other ancestry (non-Hispanic White, non-Hispanic Black, American Indian, Hispanic, Japanese, Chinese, Filipino, Korean, Vietnamese, or other Asian and Pacific Islanders).

During the study period, 20,145,499 people died, including 55,461 (0.28%) who were South Asian.

Among South Asian Americans, the contributing causeof death was:

Among other Americans,the contributing causeof death was:

Diabetes and atherosclerotic disease were more likely to be co-occurring causes of death in South Asians than in other Americans (P < .0001)

The likelihood of having diabetes and atherosclerotic disease as co-contributors to death in South Asians versus otherAmericanswas highest for South Asian women younger than 60.

This is a summary of a preprint research study, "Are US Asian Indians Dying With Atherosclerosis More Likely to Have Concurrent Diabetes Mellitus: Analysis of National Multiple Cause of Mortality Data (2012-2019)," written by researchers from Armed Forces Medical Collegein Pune, India, and Johns Hopkins University School of Medicinein Baltimore, Maryland. Preprints from Research Square are provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on Research Square.

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Cite this: Marlene Busko.Atherosclerosis and Diabetes Synergistic, Deadlier in South Asians-Medscape-Aug11,2022.

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Atherosclerosis and Diabetes Synergistic, Deadlier in South Asians - Medscape