Category Archives: Diabetes

Whether you have elevated blood sugar numbers and have been told youre borderline diabetic, or you have a family history of type 2 diabetes, chances are youve heard the phrase: prediabetes. While receiving a diagnosis of prediabetes isnt necessarily a sign that you will eventually develop type 2 diabetes, its a good indicator that something is going on internally. And for some people, recognizing prediabetes symptoms can lead to making major changes (like dietary and overall lifestyle) to help them avoid moving from the pre-diabetic stage to type 2 diabetes.

While high blood sugar (hyperglycemia) definitely has some telltale signs, not everyone will be able to recognize the signs of prediabetes. We spoke with two endocrinologists to find out prediabetes symptoms and preventative measures you could be taking to help mitigate your chances of developing type 2 diabetes.

Prediabetes refers to blood sugar (plasma glucose) levels that are higher than normal but do not meet the criteria for types of diabetes, explains Aleem Kanji, M.D., Endocrinologist, Ethos Endocrinology, PLLC. The American Diabetes Association (ADA) considers people who meet one of three specific criteria to be prediabetic:

Those diagnosed with prediabetes may have an increased risk of developing type 2 diabetes and cardiovascular disease, such as heart disease, explains Dr. Kanji. Prediabetes can remain unrecognized for years, he says. Prompt diagnosis and treatment [are] necessary to prevent the progression to diabetes and reduce the risk of cardiovascular disease. If you think youre suffering from prediabetes, you should reach out to your primary care physician to talk about your symptoms and testing options immediately.

Unfortunately, there is no checklist when it comes to determining if youre experiencing some of the early signs of diabetes because prediabetes does not have any overt (or clinically obvious) symptoms, according to Benjamin U. Nwosu, M.D., Chief of Endocrinology, Cohen Childrens Medical Center in New York, and Researcher at the Feinstein Institutes for Medical Research.

That can make it hard for the average person to know if their blood sugar has reached those concerning markers without the aid of a blood test. Considering how significantly a diabetes diagnosis can change a persons day-to-day lifestyle, that can be worrisome.

That being said, Dr. Kanji says that if your blood sugar is rising enough (and/or frequently enough), you may notice some common hyperglycemia-related symptoms that could raise a red flag in patients.

While not a sign of prediabetes, another type of insulin resistance called acanthosis nigricans, which Dr. Kanji says presents as a darkening of the skin in certain body areas, can be related to prediabetes and is worth mentioning to your healthcare provider.

Prediabetes can serve as a precursor to type 2 diabetes, according to Dr. Nwosu. In patients with prediabetes leading up to type 2 diabetes, he says. The risk factors are obesity, which increases insulin resistance, and a family history of type 2 diabetes.

Dr. Kanji says that in addition to the risk factors mentioned by Dr. Nwosu, environmental causes, age (more specifically those over the age of 45), history of gestational diabetes, and polycystic ovary syndrome, can all play a role in a persons risk of developing prediabetes.

Prediabetes prevention

Knowing that prediabetes can lead to type 2 diabetes makes prevention important. We have proof from The Diabetes Prevention Program that prediabetes can be reversed in a population of people through intensive lifestyle changes or Metformin [a drug often used to help treat type 2 diabetes], says Dr. Kanji. Of those who didnt reverse prediabetes, a significant number lowered their chance of developing type 2 diabetes. Adjusting your diet, increasing your level of exercise, and losing weight if applicable can all help.

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Prediabetes Symptoms, Causes, and Prevention - Prevention Magazine

With just three months remaining until the International Genetically Engineering Machine (iGEM) Jamboree in Paris, France, the 2022 UC Santa Cruz iGEM team is making steady progress on their project: an alternative treatment for Type 2 diabetes, a chronic condition that affects the bodys ability to regulate blood sugar and the 7th leading cause of death globally. Their project addresses the high costs and limited availability of diabetes medication with a yeast-based treatment, which would allow underserved populations around the world to grow and access the medicine locally.

Each year, a new team of UCSC undergraduates participating in iGEM chooses a synthetic biology project that aims to solve a pressing global health issue and joins hundreds of other teams from universities around the world in a global competition. The UCSC team is advised by David Bernick, associate teaching professor of biomolecular engineering (BME), and receiving additional support and mentorship from UCSC Ph.D. student and TA Eric Malekos and Hartnell College intern Gabino Guzman.

After forming in December 2021, the teams first priority was to identify a project that was both viable and addressed a pressing global health challenge.

We asked team members which project, out of four total, they thought would be the most feasible and would be able to make a substantial impact, said Elizabeth Beer, BME student and one of this years captains. At the end, we had consensus on moving forward with the diabetes treatment idea.

When both diabetic and non-diabetic individuals eat, glucagon-like-peptide-1s (GLP1s) are naturally secreted in response to the rise in blood glucose levels. The secretion of GLP1s causes a cascade effect, which ultimately leads to the release of insulin to regulate blood sugar.

People living with Type 2 diabetes either lack insulin sensitivity or resist insulin. A class of medication currently used to treat Type 2 diabetes is called GLP1 RA, glucagon-like-peptide-1 receptor agonists. GLP1 RA medications mimic the binding that occurs between GLP1 and its receptor in the body and have longer half lives. This allows for GLP1 RAs to be an attractive and effective treatment for Type 2 diabetes.

GLP1 RAs are really effective for people with Type 2 diabetes because their issue is insulin sensitivity, not necessarily insulin production, said Kiana Imani, a BME student and team co-captain. GLP1 RAs are at the forefront of Type 2 diabetes treatment, but are wildly expensive and not easily accessible in many parts of the world, with underserved populations most affected. Our teams focus is to develop an inexpensive and naturally derived treatment to address the high cost and limited accessibility of diabetes medication.

GLP1 RAs are naturally-derived peptides and can be produced naturally within a plant host, an organism that houses a smaller organism, such as soybeans, yeast, or microalgaeall organisms that the team has considered employing for their project because of their ability to grow fast and be manipulated at the genetic level.

Were trying to find a host or multiple hosts that allows us to prove our concept within the relatively short timeline of our project, said Gia Balius, human biology student and UCSC iGEM team member.

This summer, team UCSC is working in the lab daily. Wet lab work will begin soon as they bring their project to the test phase. The team is divided into four focuses: host development, plasmid design, human impact, and wiki (documentation).

The host-finding group is researching organisms, like yeast or microalgae, to create a bio-encapsulated version of the medication. The plasmid design group will work on inserting the bioengineered gene into the host organism. Plasmids are small DNA structures in the cells of bacteria that have the ability to self-replicate.

The human impact group is connecting with diabetes patients, doctors, and other health professionals to learn more about how their approach can help those that are most impacted by the limited availability and high cost of diabetes medication. The wiki group is building the teams website, where they will share weekly updates, lab notes, resources, and any other information about their project.

Our team structure is completely horizontal; were all equal in the lab and have the freedom to experiment, Imani explained. Were also given a lot of creative freedom from Profesor Bernick, which allows us to get a ton of hands-on experience and learn new concepts by doing.

The past two UCSC iGEM teams won gold at the annual iGEM Jamboree. Team Progenie, which designed a system to target and eliminate a toxic gene found in Shiga toxin-producing E. colia family of bacteria responsible for some of the most severe forms of food poisoningwon in 2021. And the 2020 team earned gold for developing a cellulose-based biodegradable plastic for strawberry growers called Komaplastics that breaks down into glucose monomers that the microbes in soil can use as nutrients and allows farmers to till the plastic into the soil at the end of the growing season, keeping it out of landfills.

The 2022 iGEM competition will be held October 2628 in Paris, France. This will be the first time in three years that team UCSC will be traveling to the competition. Stay tuned for updates on the teams progress this summer and fall at engineering.ucsc.edu/news.

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UCSC iGEM developing yeast-based type 2 diabetes medication for 2022 international competition - University of California, Santa Cruz

Individuals with diabetes who utilize yearly annual wellness visits are 36% less likely to need a major lower-extremity amputation.

According to the researchers prior work, the use of annual wellness visits was linked to increased use of preventive care for diabetes patients. In this study, they sought to find an association between annual wellness visits and a reduced risk of lower extremity amputations for patients in the Diabetes Belt of the United States.

The researchers used a sample size of data from 2006 to 2015 with an approximate total of 900,000 Medicare beneficiaries. The Centers for Disease Control and Prevention categorized the Diabetes Belt as a region of 644 counties in portions of Appalachian and the south of the US with a high prevalence of diabetes.

Among patients in the Diabetes Belt that had an annual wellness visit in the past year, the rate of major lower-extremity amputations was significantly lower when compared with people that did not have an annual wellness visit. Additionally, the researchers noted that patients in that same region had approximately 27% higher odds of receiving a major lower-extremity amputation compared with people living in surrounding areas.

Patients who used [annual wellness visits] may have had their diabetic foot examined sooner to prevent a major adverse outcome than those who did not, the researchers added. Policy makers should prioritize incentives for having patients participate in [annual wellness visits] to help reduce [major lower-extremity amputations].

Jessica Ganga

Reference:

Lobo JM, Kim S, Kang H, Soh MW. Association between annual wellness visits and major amputations among medicare beneficiaries in the Diabetes Belt. Diabetes. Published online June 01, 2022. doi:10.237/db22-122-OR

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Diabetes-Related Amputations Are Reduced by Annual Wellness Visits - Consultant360

Type 2 diabetes is a product of poor insulin production. Insulin is a hormone that's responsible for regulating blood sugar - the main type of sugar in blood. If you have type 2 diabetes, insulin secretion is hampered, and the result is uncontrolled blood sugar levels. This is where diet steps in. You can mimic the effect of insulin by overhauling your diet.

Certain items have been touted for their ability to regulate blood sugar spikes.

Blood sugar levels spike in response to eating specific foods so the key is to consume items that counter this rise and moderate the impact of blood sugar.

Ginger tea has proven to be particularly adept at this process, both in the short and long-term.

Ginger is most often used as an ingredient in South East Asian and Indian cooking, but the spicy root has traditionally been used for centuries. You can take ginger fresh, dried or powdered as a tea, in food, or as a supplement.

READ MORE:Diabetes: Have diabetes? Do not 'overindulge' in a particular type of fruit warns doctor

It's worth noting that other studies did not not turn up this association so further research is required before conclusions can be drawn.

For example, researchers in an analysis of eight randomised trials published in the journal Medicine found "no significant" difference in fasting blood glucose following ginger consumption.

However, they did find dietary ginger "significantly improved" HbA1c, suggesting that this "natural medicine might have an impact on glucose control over a longer period of time" in patients with type 2 diabetes.

It's thought that this effect is attributed to gingerols - the active compound found in ginger.

Research suggests that gingerols have antioxidant, antimicrobial, anti-inflammatory and anti-allergenic properties.

Many people have type 2 diabetes without realising. This is because symptoms do not necessarily make you feel unwell.

Symptoms include:

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Diabetes: The yellow drink that 'significantly' improves blood sugar levels within hours - Express

Patients with diabetes on Medicare Advantage were also less likely to be prescribed newer, more expensive medicine than patients on Medicare Fee-For-Service plans, indicating potential disparities in care.

Patients with diabetes on Medicare Advantage were more likely to have high blood pressure and worse blood glucose control compared with patients on Medicare Fee-For-Service plans, according to a study recently published in Diabetes Care.

Patients with diabetes on Medicare Advantage were also less likely to be prescribed newer, more expensive medications, though they were more likely to receive preventive treatment. The study foreshadows a potential trend toward poorer health outcomes and disparities in care for the growing number of patients on Medicare Advantage compared with those on Medicare Fee-For-Service plans.

Researchers used data from more than 5000 clinicians who participate in The Diabetes Collaborative Registry. The study included nearly 350,000 patients with type 2 diabetes 65 years of age or older on Medicare Advantage or Medicare Fee-For-Service plans.

The researchers compared quality metrics, preventive care, and prescription patterns between the 2 groups.

The study found that older, generic medicines, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), were appropriately prescribed to Medicare Advantage beneficiaries. However, patients on Medicare Advantage plans were less likely to receive newer, evidence-based medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i).

We saw a clear drop in Medicare Advantage enrollees getting those medications, despite unequivocal evidence that they benefit patients with diabetes by reducing kidney diseases, cardiovascular disease, and death, said lead author Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the VA Pittsburgh Healthcare System, in a press release.

Medicare Advantage limits access to newer and more expensive medications as a strategy to mitigate the costs of care. Additionally, the results showed that patients with Medicare Advantage were more likely to receive preventive treatments, including tobacco cessation, foot care, and other screenings.

However, despite this increased access to preventive care, Medicare Advantage patients were found to have poorer health outcomes.

Given the rising risk factors for diabetes among Americans, were going to see increasing numbers of Medicare Advantage enrollees needing high-quality diabetes care, Essien said. Im a general internistmy primary focus is on preventionbut our data suggest that is not enough.

Specifically, the study found that patients on Medicare Advantage plans were more likely to have higher blood pressure and poorer diabetes blood glucose control compared with patients on Medicare Fee-For-Service plans.

Preventive treatments are not enough to keep patients from utilizing the health care system down the road, Eissen said in a statement. We need to make sure the right patients are getting the right treatment, likely a combination of preventive and therapeutic interventions.

The researchers hope their findings can help guide improvements in the Medicare Advantage program, allowing the growing number of patients to access necessary care and treatments while keeping health care costs and utilization low.

With Medicare Advantage plans continuing to rapidly expand and now covering nearly half of all Medicare beneficiaries, these data call for ongoing surveillance of long-term health outcomes under various Medicare plans, senior author Muthiah Vaduganathan, MD, MPH, co-director of the Center for Implementation Science and staff cardiologist at Brigham and Womens Hospital and Harvard Medical School, concluded in the press release.

Reference

Diabetes patients on Medicare Advantage plans more likely to have worse health, study finds [press release]. Pittsburgh, PA: EurekAlert. July 7, 2022. https://www.eurekalert.org/news-releases/958085. Accessed July 7, 2022.

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Patients with Diabetes on Medicare Advantage More Likely to Have Worse Health Outcomes Despite Preventive Care Access - Pharmacy Times

The University of Nebraska Medical Center has a new program, "On Track: Transforming Rural Diabetes Care and Education."The Diabetes Care Foundation of Nebraska pledged $7 million to fund it. Dr. Stephen Mohring is one of the physicians leading the 'On Track' program. He said diabetes affects 1 in 10 Nebraskans. Health experts say it's a disease that's already hard to prevent and treat. It can be even more difficult for rural areas.Nineteen-year-old Mollie Kubicka was diagnosed with Type 1 diabetes at just 2 years old."I'm actually going into nursing and my goal is to become a diabetes care and education specialist just because of everything that I've learned throughout my time as a diabetic, all the amazing people I've met," she said. "I've been on an insulin pump for almost 16 years now. I'm on a continuous glucose monitor."The native of Juniata near Hastings, Nebraska, said accessing diabetes care isn't always easy. "A lot of my diabetes care-- the clinics I go to, the hospitals I go to, have been moved to the Eastern part of the state. Bigger cities like Lincoln and Omaha," Kubicka said.And while Kubicka does end up getting the treatment she needs, UNMC says that's not the case for many other Nebraskans in rural areas. "One of the challenges in treating diabetes in rural communities is lack of resources," Mohring said. "I think that improving diabetes and pre-diabetes care is an extremely large challenge. It might be the largest health crisis that we're facing in the state of Nebraska."Mohring said pre-diabetes is when your body shows signs your pancreas isn't producing as much insulin as it's supposed to, or when your body rejects the insulin your pancreas produces. "By placing additional resources within the clinics and partnering with local communities, we can improve access to those vital resources that are so critical in treating Diabetes," Mohring said.He said medication alone can't treat and prevent the disease.He points to a "Lack of access to behavioral health or social work services or even food insecurity."UNMC will partner with clinics in rural areas to hire more staff that can help address those issues and educate people on helpful lifestyle changes."It's really (about) improving lifestyle and access to things like walking trails, or fitness classes or nutrition classes even," Mohring said.For three years, UNMC will focus on the cities of Hastings and Wayne. Then, physicians hope to expand their efforts across the state."We're studying data and aggregating the data across those two communities through all of their health clinics and health systems as well as the health department," Mohring said.As for Kubicka, she hopes others can also learn how to live alongside Diabetes without letting it take over their lives. She said this program is a step in that direction."I think that it will definitely make a huge difference for people in these rural communities," Kubicka said.

The University of Nebraska Medical Center has a new program, "On Track: Transforming Rural Diabetes Care and Education."

The Diabetes Care Foundation of Nebraska pledged $7 million to fund it.

Dr. Stephen Mohring is one of the physicians leading the 'On Track' program. He said diabetes affects 1 in 10 Nebraskans. Health experts say it's a disease that's already hard to prevent and treat. It can be even more difficult for rural areas.

Nineteen-year-old Mollie Kubicka was diagnosed with Type 1 diabetes at just 2 years old.

"I'm actually going into nursing and my goal is to become a diabetes care and education specialist just because of everything that I've learned throughout my time as a diabetic, all the amazing people I've met," she said. "I've been on an insulin pump for almost 16 years now. I'm on a continuous glucose monitor."

The native of Juniata near Hastings, Nebraska, said accessing diabetes care isn't always easy.

"A lot of my diabetes care-- the clinics I go to, the hospitals I go to, have been moved to the Eastern part of the state. Bigger cities like Lincoln and Omaha," Kubicka said.

And while Kubicka does end up getting the treatment she needs, UNMC says that's not the case for many other Nebraskans in rural areas.

"One of the challenges in treating diabetes in rural communities is lack of resources," Mohring said. "I think that improving diabetes and pre-diabetes care is an extremely large challenge. It might be the largest health crisis that we're facing in the state of Nebraska."

Mohring said pre-diabetes is when your body shows signs your pancreas isn't producing as much insulin as it's supposed to, or when your body rejects the insulin your pancreas produces.

"By placing additional resources within the clinics and partnering with local communities, we can improve access to those vital resources that are so critical in treating Diabetes," Mohring said.

He said medication alone can't treat and prevent the disease.

He points to a "Lack of access to behavioral health or social work services or even food insecurity."

UNMC will partner with clinics in rural areas to hire more staff that can help address those issues and educate people on helpful lifestyle changes.

"It's really (about) improving lifestyle and access to things like walking trails, or fitness classes or nutrition classes even," Mohring said.

For three years, UNMC will focus on the cities of Hastings and Wayne. Then, physicians hope to expand their efforts across the state.

"We're studying data and aggregating the data across those two communities through all of their health clinics and health systems as well as the health department," Mohring said.

As for Kubicka, she hopes others can also learn how to live alongside Diabetes without letting it take over their lives. She said this program is a step in that direction.

"I think that it will definitely make a huge difference for people in these rural communities," Kubicka said.

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'It might be the largest health crisis that we're facing in the state of Nebraska': New UNMC program aims to tackle diabetes in rural areas - KETV...

Researchers have found that several traditional medicines commonly used in South Asia are effective in maintaining blood sugar levels in patients with type 2 diabetes.

Several traditional medicines commonly used in South Asia, are effective in maintaining blood sugar levels in patients with type 2 diabetes, according to a new study led by experts at the University of Nottingham.

Many South Asian countries, including India and Nepal, have been using the Ayurvedic natural medical system for thousands of years. Some of the herbs included in this traditional medical system are also used in other parts of the world including Iran, China, and Mexico to name a few.

It features a multi-pronged and individualized approach to managing health conditions that can include lifestyle modification (including diet), Ayurvedic detoxifying and purifying therapies (e.g. Panchakarma), and Ayurvedic medicines (containing plant, animal, or mineral-origin ingredients single or in combination).

In this new study, published recently in the journal Frontiers in Pharmacology, experts conducted an in-depth review to show that these medicines are effective in blood sugar control in people with type 2 diabetes. Other beneficial effects were also demonstrated in the research, including improvements in body weight, blood pressure, cholesterol, and other diabetes-related parameters.

According to the scientists, it is the first comprehensive systematic review of any traditional medicine (including Ayurveda), which included a wide range of Ayurvedic medicines. The research was led by Dr. Kaushik Chattopadhyay, Associate Professor in Evidence Based Healthcare in the School of Medicine and the Nottingham Center for Evidence Based Healthcare (A JBI Center of Excellence) at the University. The team members have expertise in Ayurveda, diabetes, and this type of research, and are based in top institutes in the UK, India, and Nepal.

As a complex disorder, type 2 diabetes has major health, social, and economic consequences. It is also one of the main diseases for which patients consult Ayurvedic practitioners and use Ayurvedic medicines, often continuously from the point of diagnosis.

Patients often choose ayurvedic medicine because it aligns with their cultural and health views. Its acceptability, satisfaction, and perceived relief are usually high, especially among rural, poor, older, and indigenous/minority populations. Many patients with type 2 diabetes prefer not to use Western medicines due to the associated side effects, cost, and mode of administration (e.g., injections).

Previous systematic reviews have shown the potential for managing type 2 diabetes with these medicines, however many need updating and none have provided a comprehensive summary of all the medicines evaluated for managing the condition.

As part of this review, the team searched a range of sources, including 18 electronic databases. Two hundred and nineteen articles were included in the review, which represented 199 randomized controlled trials (21,191 participants) and 98 Ayurvedic medicines.

Many Ayurvedic practitioners may view the inclusion of herb extracts and proprietary Ayurvedic medicines in this review as a deviation from the classical style of management. However, in reality, many Ayurvedic practitioners prescribe, and many people consume these types of medicines.

Dr. Chattopadhyay said: This is the first time a thorough review has taken place looking at all these medicines on a much larger scale. The current evidence suggests the benefits of a range of Ayurvedic medicines in improving glycemic control in type 2 diabetes patients. Given the limitations of the available evidence and to strengthen the evidence base, high-quality randomized controlled trials should be conducted and reported.

As part of the funded project, we have developed a clinical guidelinefor managing type 2 diabetes by Ayurvedic practitioners based on this evidence and will be evaluating it.

Reference: Effectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis by Kaushik Chattopadhyay, Haiquan Wang, Jaspreet Kaur, Gamze Nalbant, Abdullah Almaqhawi, Burak Kundakci, Jeemon Panniyammakal, Michael Heinrich, Sarah Anne Lewis, Sheila Margaret Greenfield, Nikhil Tandon, Tuhin Kanti Biswas, Sanjay Kinra and Jo Leonardi-Bee, 8 June 2022, Frontiers in Pharmacology.DOI: 10.3389/fphar.2022.821810

The research is funded by the UKs FCDO, MRC, NIHR, and Wellcome Trust under the prestigious Joint Global Health Trials scheme.

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Study Finds Traditional Native Indian Medicine Effective Treatment for Type 2 Diabetes - SciTechDaily

A Halifax doctor's new approach to treatment-resistant bipolar disorder involves treating an underlying metabolic disorder to improve the psychiatric condition.

Dr. Cindy Calkin said herresearch represents a paradigm shift in psychiatry and was recently published in theJournal of Clinical Psychiatry. She spent thousands of her own dollars to make it publicly available.

Calkin worked as a family doctor for a decade before training as a psychiatrist. "I was told my medicine wouldn't be of any use to me, but it was a huge advantage because I could not stop treating the whole patient," she said.

Bipolar disorder is a conditionthat causesdramaticmood swings, from depressed lows to manicepisodes, along with changes in appetite and energy levels.

It's typically treated with lithium, and anti-epilepsy, anti-psychotic and anti-depressant drugs. But many people find the drugs lose effectiveness after a few years, throwing them back into bipolar disorder.

"What I was finding is it wasn't just patients with diabetes who had worse outcomes, it was other patients as well. I felt like there was something right in front of me that I was missing. And that ended up being insulin resistance," she told CBC News.

She launched a clinical trial in which people with treatment-resistant bipolar disorder were given metformin, a drug that's been used to treat diabetes in Canada for decades, to reverseinsulin resistance.

"Patients had been ill on average for 25 years," she said. "Most of these people had lost any hope of ever being better again."

Her research found 54 per cent of people who have bipolar also have insulin resistance, and half of those patients will be treatment resistant.

The results were stunning.

"By week six in the study, patients started to become well. And by week 14, which was study-end point, they remained well. Andeven 26 weeks out, they remained well."

MRI scans she did withDr. Alon Friedman show a dramatic difference in one of her first patients.

"So this one is an MRI of a patient who has extensive blood-brain barrier leakage. This is multiple [images]through his brain. And this is before treatment with metformin. He was insulin resistant and severely depressed. And this is three months on metformin. Blood-brain barrier has healed, he's no longer insulin resistant, and his depression has been in remission the last six years."

That barrier is supposed to keep viruses and bacteria out of the brain. "So I believe that patients with insulin resistance may have had inflammatory molecules crossing into the brain, making their brain disorder worse."

She compares it to how people once thought peptic ulcers were caused by stress, until two Australian researchers won a Nobel Prize in medicine for discoveringa bacteria in the gut caused them.

"This is a paradigm shift in our field. This is a completely new way of approaching psychiatry. It's been coined metabolic psychiatry."

An estimated 33,000 Maritimers suffer from treatment-resistant bipolar disorder. Worldwide, the number runs into the millions. Kellie Williams used to count herself among them.

People had described her as "moody" for most of her life, and she was diagnosed with bipolar disorder in her late twenties.

"My depression felt like if someone had passed away. That complete sadness, that complete despair. I would have this constant, all day long, and with no one passing away.I knew there was something very seriously wrong then," she said.

The symptoms impacted her life with family, friends and at work. She struggled to keep plans, and she never knew when she would be incapacitated by a mood disorder.

"There were some times, several times, where I contemplated suicide. To try and get rid of that despair or pain I felt, I actually started cutting as well, just to try and redirect that pain you feel inside in your head."

She saw Calkin's name on a bulletin board at a mental health clinic recruiting people with bipolar whose medication had stopped working. She was surprised when they tested her and told her she was insulin resistant. Calkin treated that condition, and the devastating disorder went away.Calkin thinks it lets the traditional drugs work again.

"I couldn't believe it was actually gone. I'd never felt such a sense of wellness in my life," Williams said. "This is truly a miracle. I have my life I want to say back, but I have my life better."

She's discovered she's an avid planner and loves filling her schedule up months in advance.

She says her bipolar is in remission, and she's hopeful it will stay that way. She said others should feel hope, too.

"Don't be afraid to go out and do some research. Go online, ask people," she said. "You do have that right to be healthy and happy."

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50-year-old diabetes drug helps patients with bipolar disorder, study finds - CBC.ca

Alexandra drops TD1 kits off to a Yonkers school (Photo by Jason Malkin)

An Ardsley teen is working to make life with type 1 diabetes easier on local kids. Alexandra Malkin, a rising senior at Ardsley High School, started T1D Kits for Kids to provide free essential health supplies (along with a few small treats) to elementary-aged children. And people are taking notice she was recently named Hero of the Day by Good Day New York for her work.

Malkin saw firsthand what kind of hardships kids face with juvenile diabetes after her childhood friend was diagnosed with the condition at age 9. As I watched her life change extremely quickly, I began to understand the true impact that diabetes can have on someones life especially at a very young age, she told River Journal.

The experience stayed with her. Malkin decided to focus on diabetes once she was accepted into her schools science research program, a 3-year elective that allows students to dive into specific research areas. After reading various articles on past diabetic studies during the year, I was sure I wanted it to be what I would study for the remainder of my time in the program influencing the two summer research projects I have been a part of involving diabetes.

While immersing herself in the science, Malkin also discovered that the high costs associated with type 1 diabetes can be especially detrimental to children. More recently, I found out from a friend that their cousin who works at an elementary school in Michigan has seen a lot of diabetic students who arent able to afford the basic diabetic technology, she said. As I looked into this issue more, I noticed extremely high prices of diabetic kits sold by large diabetes companies more than any underprivileged family could afford.

This sparked the idea to provide children with the devices and medical supplies needed for free. Her kits include glucose monitors, lancets, Band-Aids, batteries, and glucose tabs, basic and necessary tools to stay healthy throughout the day. While those items will make many parents happy, Malkin doesnt forget her main focus: kids with juvenile diabetes. She tucks a few treats inside each basket to make them smile. I also wanted to address the desire for comfort from young type-1 diabetics by including teddy bears, sugar-free candy, and bracelets, pins, that help them embrace their T1D identity.

Since kicking off in January, Malkin has donated batches of kits to three different elementary schools, where she works with nurses to identify those who would benefit from them most. The greatest amount of newly-diagnosed type 1 diabetics usually are found within that age group (kindergarten 4th grade), she noted. The kits have been specialized to appeal to this

age group as well. Shes working to keep relationships with the schools, and has been sent photos of the recipients holding the kits and smiling ear-to-ear.

Malkin hopes to expand the program outside Westchester in the future and has applied for grants to continue funding and upgrading her kits. And she wants to help connect children with juvenile diabetes through their stories. I also have an idea to create a diabetes advice book that would include advice from experienced type 1 diabetics to help the younger diabetics make a smoother transition and feel like they arent alone.

To help keep the program going, Malkin said sharing her work with others and making a donation would go a long way. The only way to truly make my organization grow is to promote necessary funding and recognition for the work of T1D Kits for Kids and the concept behind it, she said. With these contributions, I can achieve the goals I have for the non-profit and expand my impact to the larger diabetic community.

Visit t1dkitsforkids.org to learn more or to make a donation.

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Local Teen Brings Smiles and Health Kits to Kids with Diabetes - River Journal Staff

News Release

Thursday, July 14, 2022

NIH-funded clinical trial finds that starting with a cheaper drug and switching to a more expensive drug as needed leads to good vision outcomes in diabetic macular edema.

Clinical trial results from the DRCR Retina Network suggest that a specific step strategy, in which patients with diabetic macular edema start with a less expensive medicine and switch to a more expensive medicine if vision does not improve sufficiently, gives results similar to starting off with the higher-priced drug. The main complication of diabetic macular edema, fluid build-up in the retina that causes vision loss, is commonly treated with anti-vascular endothelial growth factor (VEGF) drugs.

The trial was funded by the National Eye Institute (NEI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), both part of National Institutes of Health. Results of the trial, which examined a stepped regimen of anti-VEFG drugs Avastin (bevacizumab) and Eylea (aflibercept), were published today in the New England Journal of Medicine.

Our study showed that switching treatments when needed is a reasonable strategy, said Chirag Jhaveri, M.D., Austin Research Center for Retina, Texas, the lead study author. Insurance companies often require clinicians to start with the less expensive treatment, so we really wanted to see how a specific treatment strategy using this approach would affect patient care.

Diabetic macular edema is caused by diabetes-related alterations to retinal blood vessels. Symptoms include blurred vision. If untreated, vision loss can become permanent and progress to blindness. Retinal injections of anti-VEGF drugs can restore vision. The DRCR Retina Network previously showed that Avastin and Eylea improve visual acuity in people with diabetic macular edema. However, while Eylea is approved by the U.S. Food and Drug Administration to treat diabetic macular edema and results in better visual outcomes on average, off-label Avastin is much less expensive and is sometimes required by insurers as a first-line treatment.

The study enrolled 270 participants with diabetic macular edema, some of whom received treatments in both eyes. At enrollment, all had best-corrected visual acuity between 20/50 and 20/320. Half the study eyes were assigned to Eylea from the start, and half were assigned to start with Avastin. For participants who needed treatment in both eyes, each eye started treatment with a different drug. Participants received either Avastin or Eylea injections every four weeks for 24 weeks. If eyes assigned Avastin failed to reach the pre-set improvement benchmarks starting at 12 weeks, the eye was switched to Eylea.

After 24 weeks, physicians could taper down the frequency of injections as appropriate to maintain visual acuity. The study collected information about participants retinal structure and visual acuity for two years.

After two years, eyes in both groups had similar visual acuity outcomes, improving on average approximately three lines on an eye chart, compared to the trials start. In the Avastin group, 70% of eyes switched to Eylea during the study.

While most participants on Avastin eventually switched to Eylea, they still had improvement during those initial weeks, even if they didnt hit our pre-set benchmarks, said Adam Glassman of the Jaeb Center for Health Research and director of the DRCR Retina Network coordinating center. There are large cost disparities between these drugs, so differences in treatment strategies may have substantial cost implications.

Weve demonstrated here one method to managing a step treatment, where the outcomes are similar to the best existing treatment protocol with Eylea, said Jennifer Sun, M.D., M.P.H., of Joslin Diabetes Center and Harvard Medical School, Boston, and chair of diabetes initiatives for the DRCR Retina Network. Any time we can add to a clinicians toolbox, whether its a new medication or a new approach to using existing medications, as in this study, its a benefit for patients.

The study was supported by NEI (EY014231) and NIDDK through the Special Diabetes Program for Type 1 Diabetes Research. Clinical trial number NCT03321513.

NEI leads the federal governments research on the visual system and eye diseases. NEI supports basic and clinical science programs to develop sight-saving treatments and address special needs of people with vision loss. For more information, visit https://www.nei.nih.gov.

About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIHTurning Discovery Into Health

Jhaveri CD, Glassman AR, Ferris FL, Liu D, Maguire MG, Allen JB, Baker CW, Browning D, Cunningham MA, Friedman SM, Jampol LM, Marcus DM, Martin DF, Preston CM, Stockdale CR, Sun JK, DRCR Retina Network. Aflibercept monotherapy versus bevacizumab first followed by aflibercept if needed for treatment of center-involved diabetic macular edema. NEJM. July 14, 2022.

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A type of 'step therapy' is an effective strategy for diabetic eye disease - National Institutes of Health (.gov)