Category Archives: Diabetes

In Diabetes and Me, RNZ's Megan Whelan shares her journey of learning to live with type 2 diabetes.

It's not a particularly productive question, but it's the one that plagues me: How much is this my own fault?

Photo: 123rf

If I hadn't eaten those cheeseburgers, would I be here? If the sport that spoke to me was marathon running and not yoga, might my pancreas have been in better shape?

I try to resist being that person who talks about my diet all the time because, my God, those people are boring, but I also can't help it. How to best eat for this condition, and the many hours of exercise I do, and how many grams of protein is in an egg (about six) occupies a pretty large part of my brain space.

And so I feel myself turning into a person I would have avoided a few months ago - and asking questions that I know I won't like the answers to.

To get some good answers, I spoke to Dr Jeremy Krebs, an endocrinologist. Endocrinology is the specialty of "glands and hormones" and diabetes is one of the areas endocrinologists study. He did a doctorate at the UK's prestigious Cambridge University investigating obesity, and he's now a consultant in Wellington, and researches nutrition, obesity and diabetes. So, a very good person to talk to, and - I promise, I wasn't trying to get some free medical advice.

Here's our conversation (edited for length and clarity, and to cut a massive discussion about exercise, which is a whole other column).

RNZ Head of Content Megan Whelan. Photo: RNZ / Rebekah Parsons-King

Megan: I think prior to my diagnosis, if someone had said "hormones" to me, I probably would have thought of progesterone and estrogen and maybe cortisol if I was having a good day. But there are so many, and they're so important, right?

Jeremy: The key one here is obviously insulin and that comes from the pancreas. But when you're thinking about type 2 diabetes, there are many, many different organs and hormones that are involved in the process, and there are many many different versions of it. And so not everybody with type 2 diabetes is the same, whereas type 1 diabetes, which is fundamentally about the failure of the beta cells in the pancreas because of an autoimmune process, is a much more homogeneous condition.

And that's partly what makes type 2 diabetes such a harder beast for people to get their head around. And I mean people in the broader sense, both people with diabetes, but also health professionals and people trying to, you know, find solutions and help and support because there's no one size fits all.

Megan: So, then, what is type 2 diabetes?

Jeremy: The simple version is that diabetes, by definition, is an increase in blood glucose, or blood sugar.

Blood sugar is controlled by two key hormones, the most important being insulin and the other being its counterpart or its counter-hormone, glucagon. The balance of glucose in the body is determined by how good your pancreas is at making insulin, and secondly, how good your tissues are (your liver and your muscle and other tissues in your body) - how good they are at responding to insulin and taking up and storing and using glucose.

So there's two main sides to the equation and type 2 diabetes is where you get a problem, usually on both sides of the equation, but one may dominate the other. So what I mean by that is, if your body becomes resistant to the action of insulin, which is something we generally see as people gain weight, then your pancreas can respond to that by simply pumping out more and more insulin. And it does. [It] does that incredibly well.

But there comes a point where the pancreas says 'bugger, this, I've had enough of that I'm going on strike,' and that's when it can't keep up with that demand. And that's when your blood sugar starts going up.

There's a researcher by the name of Defronzo, who coined a phrase called the ominous octet. It incorporates all of these sorts of ideas that we're talking about: the various hormones that are involved, but it also incorporates ideas of physical activity or inactivity, and then the other key thing which we haven't touched on yet, which is genetics and the role of family history and genes in terms of who might develop diabetes.

So we often think about some of these risk factors in terms of what is modifiable and what's not modifiable, and clearly your genes are not modifiable. There are modifiable things which can influence ... your chance of getting diabetes or your journey with diabetes.

Megan: In my journey I've kind of been swinging wildly between 'you're such a piece of shit, this is your own fault. You absolutely should have known that this was going to happen', it's in my family, I had allowed myself to become inactive, and I have a really stressful job and would come home every night and get takeaways because it's easier than cooking. I look back now and think 'how the hell did you let it get like this?'

And I guess one of the reasons I want to do this whole column is so someone like you can say "well, because you're a human being and that's what happens and it's not your own fault," but also it kind of is my own fault and maybe the ominous octet is a really nice way to do it. Maybe there's bits of it that were my own fault and bits of it that aren't my fault?

Endocrinologist, professor Jeremy Krebs. Photo: Otago University Wellington

Jeremy: There is no question that there are things we have conscious control over and that we can influence, but there's a heck of a lot we don't. Appetite is an incredibly subtle thing. How does anyone maintain a vaguely constant weight in the world that we live in? It's a miracle, frankly.

When we're bombarded with readily available - I used to say cheap, but that's changing - calorie dense, cleverly marketed food that appeals to the palate (because people understand what our tastebuds respond to) and a physical environment that has become less and less demanding for us to do things.

Megan: By doing this column, I'm gonna get some emails that are really, really nasty. What's the best response to those people who will say you should regret every cheeseburger you have eaten?

Jeremy: In a clinical environment that's very much where I start to talk about the genetic side of this and the subtleties of the influence of genes on our appetite regulation. Of course, those people will simply say, 'well, everyone says that, everyone hides behind that, but at end of the day, you know it's still [that] you're still sticking it in your mouth'.

And as you said there are bits of truth to some of that. I wish I hadn't had that 4th glass of red wine last night, but I did. And I had to spend an extra half hour on the treadmill this morning because of it.

But people who would hide behind those sorts of emails to you are lying to themselves, frankly, if they don't think they're not human, and aren't fallible to some of those choices.

Everyone makes choices they know retrospectively weren't the best choices. God, we're human.

Megan: I was doing my grocery order last night and a cauliflower was $7.50 and I thought to myself 'that's a happy meal, that's a combo at a fast food restaurant.' I'm incredibly lucky. I earn a decent amount of money. I don't have kids, so I have disposable income. I can spend $7.50 to buy a cauliflower, but lots of people can't, and that has to be really difficult.

Jeremy: There's no question about it. I was reviewing a paper last night from a group in Auckland and one of the key determinants of both developing diabetes, but also outcomes of diabetes, that overrode ethnicity was deprivation (and we know that ethnicities are a really important factor, which is largely driven by genetics).

You can know till the cows come home what you should be buying in the supermarket. But if the prices keep doing what they're doing at the moment, then you know we're all going to be buying white bread.

Megan: I am aware I am going to anger some people when I ask this, but I watched a talk of yours, and you had a graph of the overwhelming correlation between obesity and type 2 diabetes. And I wonder if there's a disconnect between what we want to believe about weight and what's actually true.

Jeremy: You're right, you will anger a lot of people by that. But there are some truths that you just have to accept. And unfortunately excess fat mass is not healthy. In a number of ways, not just metabolically, in terms of joints, in terms of the hormones of fertility, there's a whole range of stuff.

But turning that into self-blame and self-loathing is not going to achieve anything or help anybody. So if you have to frame it in a way that a person can still live with themselves and make some change which is taking them in a healthier direction, then I'm totally on board with that.

But where you have to be careful is where someone hides behind that and denies some of the harder effects.

Megan: If I had been honest with myself, I knew I wasn't healthy - that is no fault of the people who talk about this, and the really important activism that's happening in that space. But I think the people who think this is all my own fault might miss a point, which is that every experience I've ever had with a GP was negative because of my size. And so of course, I didn't look after myself [by getting help when I need it] because I would have to go to see my GP, who would weigh me and say something and that [made me] felt like shit.

Jeremy: Yep, it's not in any way supporting you.

Megan: So how do we bridge that gap between wanting to help people and not making them feel awful for needing help.

Jeremy: I think in the last 20-plus years of doing this there will be people that I have met that I've tried to help where I've got it right and it's helped them and there will be people where I've tried to help and for whatever reason for that person, I've got it badly wrong and they've gone away hating me because for whatever reasons we didn't quite manage to get that balance, that connection. It's tricky. It's very emotive.

***

Dr Krebs tells a story that many people will recognise. He was overweight, and a child poked him in the stomach, and said "you're fat". For him, that was the trigger to start running and losing weight.

It feels comforting to me that at least one doctor understands that feeling. I have countless stories like that. Like the time a woman walked past me in the supermarket carpark and said "see, that's why we don't buy chocolate biscuits. You don't want to end up like that." As I type this, I can feel the shame that pricked my cheeks, the tears I fought back that someone could be so casually cruel. But it certainly didn't make me want to don my leggings and hit the treadmill.

The question I want to ask isn't "is it my fault?" It isn't the "is being fat unhealthy" that I asked Dr Krebs, because I couldn't, in the moment, articulate what I meant. It's, did I get diabetes because I am fat, or because my fatness meant I couldn't access the care I needed that would have helped me avoid getting it?

That's a question that's much bigger than me, but it's one worth asking - and I am going to keep asking it in this column.

Diabetes and me will be a weekly column on Wednesday mornings.

Originally posted here:
Diabetes and me: Wrestling with the causes of diabetes - RNZ

Diabetes is on the rise in the U.S. and cases are at a record high. Chances are you know someone with the disease since over 37 million Americans, or 1 in 10 people have diabetes according to the Centers for Disease Control and Prevention and describes the diabetes as "a chronic (long-lasting) health condition that affects how your body turns food into energy. Most people's bodies naturally produce the hormone insulin, which helps convert sugars from the food we eat into energy that the body can use or store for later. When you have diabetes, your body either doesn't make insulin or doesn't use its insulin well, causing your blood sugar to rise. High blood sugar levels can cause serious health problems over time. With type 1 diabetes, the body can't make insulin. If you're diagnosed with type 1, you'll need to take insulin every day to survive. With type 2 diabetes, your body doesn't use insulin well. The good news is that type 2 diabetes can be prevented or delayed with healthy lifestyle changes." In spite of what many think, diabetes isn't a childhood condition or something older people get. Anyone at any age can get it and Eat This, Not That! Health spoke with Dr. Bayo Curry-Winchell, Urgent Care Medical Director and Physician, Carbon Health, and Saint Mary's Hospital, who explained what to know about diabetes and what the signs are that you might have the harmful health condition. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Curry-Winchell shares, "Diabetes can be caused by the immune system which is a network within your body that normally keeps you healthy. The immune system starts attacking the body targeting the pancreas, an (organ that produces a hormone) called insulin. Insulin is designed to help your body process or break down the sugar (glucose) you consume. When this happens, it is referred to as Type 1 diabetes and commonly associated with children, teens, and young adults.

A secondary cause of diabetes is referred to as Type 2 diabetes in which the hormone (insulin) is unable to regulate the amount of blood sugar in your body. The best way to think about it is to imagine a thermostat in your house that is normally set to a specific temperature based on the weather. The thermostat is no longer producing AC or heat.

The best way to prevent Type 2 diabetes is to eat a well-balanced meal and participate in daily exercise. Gestational diabetes is a form of diabetes that is new and not associated with Type 1 or Type 2 diabetes. It is caused by the body not being able to process elevated levels of blood sugar."

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Dr. Curry-Winchell says, "Type 1 diabetes is typically found in children, adolescents, and young adults however you can develop this type at any age. There is an association with patients developing. Type 1 diabetes that had a family history of someone (i.e., parent or sibling with the disease). Type 2 diabetes is typically diagnosed in those that are overweight and not actively participating in low to moderate forms of exercise."

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According to Dr. Curry-Winchell, "It's multifactorial and related to the options and choices people choose as snacks and daily meals. The pandemic has played a role in increasing risks of developing diabetes through stay-at-home orders, change in work distribution, and increased comfort/emotional eating."

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Dr. Curry-Winchell explains, "Most people with diabetes are living full lives. If your diabetes is not under control, it can affect your energy, ability to concentrate, mood, appetite and cause organ damage leading to complications that can require hospitalization. Diabetes increases your overall risks to ward off other illnesses and infections therefore it's important to have a health care provider keep a close eye on your health status."

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Dr. Curry-Winchell reveals, "Because you have increased blood sugar circulating throughout your body it places a strain on your kidneys affecting your ability to get rid of the increased sugar in your body."

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"The increased blood sugar in the body which normally would be converted for energy is stationary which leads to fatigue due to unused glucose within the body," says Dr. Curry-Winchell.

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Dr. Curry-Winchell states, "Extra blood sugar is harmful to your eyesight causing damage to part of your eyes needed for vision which can affect a person's ability to focus."

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Continue reading here:
Signs You Have Diabetes, Say Physicians Eat This Not That - Eat This, Not That

Welcome to my website! My name is David Mendosa, and I am a freelance medical writer, advocate, and consultant specializing in diabetes.

Diabetes is a disease that perhaps more than any other depends much more on the patient than on the doctor. Hence, the purpose of this website is to provide you with honest and accurate information to help you manage your diabetes.

If you wish to know why I started this website and began writing about diabetes in 1995, then please read this page.

How to get started?

You can start reading about diabetes by accesing the most popular articles and blog posts below.

Alternately, you can read articles Ive written over the years on various aspects of diabetes, by using the navigation bar on the top of this website.

Finally, you can visit my diabetes blog called Diabetes Developments, where I write about the most recent developments in diabetes research and on strategies to manage diabetes.

Read more:
David Mendosa: Helping Defeat Diabetes Since 1995

Despite its global impact, there is still no cure for diabetes. But there is hope! All over the world, new therapies that offer the promise to delay and improve the quality of life for patients with Type 1 Diabetes (T1D) are being investigated. Disease experts Prof Chantal Mathieu, Coordinator at T1D consortium INNODIA and Principal Investigator of the Imcyse IMPACT Phase 2 trial, and Patient Advisory Committee (PAC) members represented by Manon Perquy talk here about the needs of patients and how new approaches, such as immunotherapies, can change the landscape for T1D and what needs to be done to make this a reality.

Over 100 years ago, diabetes became treatable. And for most of the 9 million adolescents and adults worldwide (1), living with T1D, insulin turned the disease from a death sentence into a chronic condition. Still, it is not a cure.

In T1D, the insulin-producing beta cells in the pancreas are destroyed through an autoimmune attack, making patients dependent on daily glucose control and insulin injections for life. Even with modern technologies, controlling blood glucose levels to a level that will eliminate complications, such as organ damage caused by high blood sugar remains unachievable for most patients.

T1D is a very heterogeneous disease. Blood sugar levels are affected by much more than just what we eat and how much we exercise. There are a multitude of factors to consider everyone reacts differently. No two patients are alike, says Manon and the PAC members. This is what makes management of this disease so hard and why only a small fraction, around 30%, actually reach their treatment goals.

The fear of not managing T1D adequately stems from immediate risks, such as hyperglycaemia or hypoglycaemia and serious long-term consequences. Patients need to self-manage their disease round-the-clock which is a huge burden on them, their families, and caregivers. It is a 24/7 balancing act. Insulin helps people survive, but it is not enough, explains Manon and the PAC members.

Although important technological advances in the management of T1D have occurred in the past 40 years, most of the research has focused on developing better delivery and optimised insulin: long-, short- and ultra-rapid-acting insulins to better match the varying time-action needs, as well as insulin pumps and hybrid closed-loop systems for better control. This leaves an urgent need for new advances that can replace daily injections and give people a break from constant monitoring. Even though we have better tools today, the burden and impact on the quality of life of people living with T1D remains enormous. What we urgently need is innovation, which reduces the number of times a day, patients must think about their disease, says Manon and the PAC members.

The problem is that despite extensive research, the underlying causes and mechanisms of T1D are still far from being completely understood. This is why effective prevention strategies or causal therapies beyond insulin replacement are still lacking and treatment efforts to halt progression of the disease are to date unsuccessful, adds Prof Chantal Mathieu.

However, there is hope for potentially making insulin treatments obsolete. Researchers from all over the world have come a long way in recent years investigating alternative therapy options that offer the promise to delay T1D onset and improve life for patients.

There has always been an enormous enthusiasm among researchers to try and find better ways to predict and prevent T1D but also to arrest the progression of the disease because we as clinicians see what a terrible disease it is, says Prof Mathieu. One promising approach are immunotherapies that target the underlying cause of the disease by reprogramming the immune system so that it no longer attacks and destroys insulin-producing beta cells in the pancreas.

Among the four interventional trials currently being conducted under the INNODIA umbrella, the ImotopeTM approach, developed by Belgian company Imcyse, is one such immunotherapeutic being investigated in a Phase 2 study (IMCY-0098 Proof of ACtion in Type 1 Diabetes, IMPACT). ImotopesTM are based on modified peptides that induce cytolytic CD4 T cells to kill other immune cells involved in the destruction of a specific target, in this case, insulin-producing cells in the pancreas. This action works without affecting other functions of the immune system. Prof Mathieu explains the approach: The aim of this approach is to interfere early enough in the disease progression, so the aberrant immune response is halted. The immune system is recalibrated to stop the destruction of beta-cells and block the autoimmune response. Through this intervention, the pancreas maintains its natural ability to produce insulin and the rest of the immune system continues to function fighting infections. It is a very interesting, different approach and the safety profile we have seen so far is very impressive. A more detailed description of Imcyses technology is available in a previous article. (2)

To advance their immunotherapy as a safe and effective therapy for patients with early T1D, Imcyse has joined forces with INNODIA, gaining access to a broad supportive research network. To really make a difference, everyone needs to work together, says Prof Mathieu. Newly diagnosed patients need to get the opportunity to participate in these studies, clinicians need to inform their patients about ongoing intervention trials, companies need the patient perspective, there is this aspect of public funding and the industry side. This is why networks such as INNODIA are so important.

In the future, immunotherapies could help patients and those at risk of developing T1D, by stopping the disease in its tracks or preventing the condition entirely. For the latter, early intervention could prevent the immune attack from happening in the first place. In newly diagnosed patients, immunotherapy has the potential to stop the attack in its tracks and preserve surviving beta cells. In addition, researchers are currently working on manufacturing new beta cells in the lab to transplant into patients. To protect these new beta cells from the bodys immune system, immunotherapies will play an important part.

We may not be able to remove T1D from our lists of human ailments just yet, but what is most important is getting the news out to newly diagnosed patients and their families, that there are opportunities to join the research and ultimately help change the future of T1D, conclude Manon and the PAC members.

To learn more about T1D and for further information on clinical trials currently ongoing and how to get involved, please visit: INNODIA or T1D UK Consortium.

For more information about INNODIA please visit: https://www.innodia.eu/

References

*Please note: This is a commercial profile

2019. This work is licensed underCC-BY-NC-ND.

Editor's Recommended Articles

Read more:
Diabetes - Is life without insulin possible? - Open Access Government

GREAT FALLS, Mont. - In September of 2021, the Montana VA (MTVAHCS) took a look at how to improve its diabetes care, especially in Great Falls where over 600 VA patients have diabetes.

So, they developed a new and unique program...

It's a 12-week program and 15 veterans have crossed the finish at the Great Falls VA Clinic on March 23 after starting the program in January.

"For diabetes, education is the key," said Air Force veteran, James Hollinon.

The program is an innovative shared medical appointment program.

"We've found great benefits in bringing people together that have similar chronic illnesses and diseases and helping them. So, we applied that model, we took research and applied that model to what do here at the VA and our veterans absolutely love it," said Jason Gleason, certified nurse practitioner (NP-C) for the Great Falls VA.

"Besides the education, the interaction and the knowledge that we've gained has just been very helpful," said Hollinon.

Hollinon has been diabetic since 1995 and says in terms of education - this program has been the best.

A Montana Army National Guard veteran, Mark Hall, served overseas in Iraq, and for him, this program has helped change his outlook on life.

"I think about my family and my children and I think about all the interactions where I had to say no, I can't go and do that or I'm not feeling well. You know, and they're excited to tell me something but I have the grumpy look on my face and it just makes them feel bad. That's not today. Today when they tell me something exciting, I'm like I get to be involved in that and not be the grumpy face," said Hall.

MTVAHCS cares for 38,502 veterans and 4,935 of them have diabetes with 996 (20%) of them having uncontrolled diabetes (A1C >8%).

Which means the Great Falls VA Clinic pit crew got to work.

"For myself, I did the check-in and I kept everybody on task because we had 15 different people going to different stations," said Mike Nagel, assistant manager, RN northeast region.

"I do education, most veterans, most people who come in that were diagnosed with diabetes and say how did I get this, what is this, why do I have this, what do I do, can I ever just get rid of it," said RN Mary Toren.

It doesn't matter if you handled education, were a facilitator, a presenter, or the project lead - veterans tell Montana Right Now this program excites them.

"Today my future, I think, looks super bright and I'm excited for it," said Hall.

Gleason says they hope to continue this program in the future so more veterans can win the race against diabetes.

View original post here:
Winning the race against diabetes with the MTVAHCS | Great-falls | kulr8.com - KULR-TV

At a Glance

In type 1 diabetes, the immune system attacks and destroys the cells in the pancreas, called beta cells, that make insulin. Insulin helps glucose, a sugar from food, get into your cells to be used for energy. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age.

Pumps or regular injections can supply insulin to people with type 1 diabetes and prevent blood glucose from rising to dangerous levels. But insulin treatment comes with health risks and high costs. Currently, no oral drugs are approved to treat the disease.

In previous research, a team led by Dr. Anath Shalev from the University of Alabama at Birmingham found that a drug used to treat high blood pressure, called verapamil, protected beta cells and reversed diabetes in mouse models of type 1 diabetes. In a small clinical trial, they showed that the drug could improve the functioning of beta cells in people recently diagnosed with the disease.

But howand for how longverapamil could protect beta cells wasnt clear. To better understand how verapamil slowed the progression of diabetes, the team analyzed blood samples from 5 of the study participants who received verapamil and 5 who received an inactive placebo.

The study was funded in part by NIHs National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Results were published on March 3, 2022, in Nature Communications.

The researchers found that levels of 53 proteins changed in the blood after a year of verapamil treatment. One in particular, called chromogranin A (CHGA), stood out. It changed the most over time, dropping substantially in people who received the drug. CHGA is found in beta cells and suspected to play a role in the immune system attack that causes type 1 diabetes. CHGA blood levels were elevated in people with type 1 diabetes compared to healthy people.

After a year of treatment, people who received verapamil had levels of CHGA and markers of immune activity that were similar to people without diabetes. They also had better production of insulin by their beta cells. In contrast, CHGA levels remained high in people who received the placebo. This was true through the second year of the study as well.

Further experiments using isolated pancreas tissue revealed that verapamil treatment also changed patterns of gene activity in and around the beta cells. These changes signaled increased cell survival and a more normal immune response.

People who took verapamil needed less insulin. Those in the study who stopped treatment after a year needed more insulin to regulate blood sugar levels. The amount of insulin required by people who took the drug for a second year remained low and stable.

The fact that these beneficial verapamil effects seemed to persist for two years, whereas discontinuation of verapamil led to disease progression, provides some additional support for its potential usefulness for long-term treatment, Shalev says.

Data from larger, ongoing studies of verapamil will be needed to confirm these results. CHGA might also be useful as a simple blood test to help track beta cell destruction in type 1 diabetes and determine whether therapies to protect beta cells are working.

by Sharon Reynolds

Funding:NIHs National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); American Diabetes Association.

Read more from the original source:
Medication helps protect insulin production in type 1 diabetes - National Institutes of Health (.gov)

Virtual diabetes clinic 9am.health has partnered with Ascensia Diabetes Care to add the Contour Next One blood glucose meter to its patient diabetes toolkit.

As part of the collaboration, the clinics type 2 diabetes and prediabetes patients can now add Ascensias blood glucose meter and 100 to 300 test strips to their personalised treatment plan.

The addition of blood glucose meters will enable regular blood sugar check-ups at home.

This will complement lab tests, diabetes medications, telemedicine visits and all-in-one virtual diabetes care offerings.

The blood glucose meter will be offered for free on all patient care plans, while the test strip addition will be available to patients through a monthly or quarterly subscription added to their existing care plan.

9am.health noted that patients will also be able to further supplement their plan with a one-time order of a lancing device and lancets.

9am.health co-founder and co-CEO Frank Westermann said: The availability of blood glucose meters has been repeatedly requested by our customers from the very beginning, and we are proud to have partnered with Ascensia to provide their exceptional Contour Next One meter.

The company stated that regular blood glucose self-monitoring can help manage diabetes and prevent complications.

Ascensia Diabetes Care blood glucose meter marketing and strategy head Frank Held said: We are excited to team up with 9am.health to bring the benefits of our products to more people with diabetes.

Our remarkably accurate Contour Next One glucose meter is a great addition to their virtual diabetes clinic.

We look forward to working together to help make it as simple and affordable as possible for people to manage their diabetes.

Metal Micro-Stamping for the Medical Device Industry

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9am.health and Ascensia partner on diabetes toolkit blood glucose meter - Medical Device Network

A new study of older adults with diabetes is providing insight into the risk of hypoglycemia from glycemic overtreatment among nursing home residents in the US.

An analysis of data from more than 7000 patients in Veterans Affairs nursing homes, results provide insight into factors associated with increased risk of overtreatment and suggest nearly 1-in-5 patients met criteria for overtreatment and an additional 23% met criteria for potential overtreatment.

I hope this work lays the foundation for future projects that promote appropriate deintensification of glucose lowering medications in nursing home residents, said lead investigator Lauren Lederle, MD, of the San Francisco VA Medical Center, in a statement.

Together with colleagues from the University of San Francisco and the San Francisco Virginia Medical Center, Lederle and a team of investigators designed the current study with the intent of developing a more thorough understanding of incidence of overtreatment and deintensification practices in nursing home residents with diabetes. To do so, investigators created a cohort study using data from VA nursing homes admitted from 2013-2019 over 65 years of age with a diagnosis of type 2 diabetes, which was defined using HbA1c or ICD codes.

Including all adults aged 65 years or older with type 2 diabetes and a length of stay of 30 days or more, investigators identified 7422 individuals for inclusion in their analyses. This cohort had a mean age of 74.6 (SD, 7.9) years, 98.4% were male, and a mean HbA1c of 7.1 (SD, 1.4).

Overtreatment was defined as an HbA1c less than 6.5% with any insulin use and potential overtreatment was defined as an HbA1c less than 7.5% with any insulin use or HbA1c less than 6.5% on any glucose-lowering medication other than metformin alone.

Of the 7422 residents included, 17% met the criteria for overtreatment and an additional 23% met criteria for potential overtreatment. In analyses assessing treatment strategies among patients with overtreatment or potential overtreatment, deintensification of medication regimens was observed among 27% of those meeting criteria and 19% among those meeting criteria for potential overtreatment.

Further analysis suggested use of long-acting insulin (OR, 1.37 [95% CI, 1.14-1.65]) and hyperglycemia (OR, 1.35 [95% CI, 1.10-1.66]), defined as 300 mg/dL or greater, before index HbA1c were associated with increased likelihood of continued overtreatment. Additionally, results indicated severe functional impairment was associated with decreased odds of continued overtreatment (OR, 0.72 [95% CI, 0.56-0.95]), but hypoglycemia was not associated with decreased of overtreatment.

We found that overtreatment of T2DM is common in VA nursing homes residents and that a minority of NH residents have their medication regimens appropriately deintensified. Based on our study results, it will be important to develop deprescribing initiatives in nursing homes at time of admission that use behavior change principles to overcome prescribing inertia in overtreated residents, wrote investigators.

This study, Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes, was published in the Journal of the American Geriatrics Society.

Go here to see the original:
Overtreatment of Diabetes Leading to Hypoglycemia in Nursing Home Residents with Diabetes - Endocrinology Network

Photo supplied, University of Utah Health

Registered dietician Theresa Dvorak helps the public during a food demonstration at the SunnyVale Farmers Market in Salt Lake City in 2019.

OGDEN Free, confidential health services and educational programs are coming to the Marshall N. White Community Center this Friday by way of the Wellness Bus.

The mobile health clinic comes to Ogden on the second and fourth Fridays of every month from 10 a.m. to 2 p.m., offering screening services and nutrition education. Insurance and identification are not required. A basic information form with approximately 30 questions is available for those who choose to voluntarily fill it out.

If someone does not feel comfortable, we do not want that to be a barrier for people to get tested, said Nancy Ortiz, Mobile Health Program operations manager.

If language is a barrier, interpretation services are available for over 240 languages and dialects.

While anyone can take advantage of services offered by the Wellness Bus, they are mainly focused on adults, 18 years and older, because children are generally healthy with access to pediatric care.

Photo supplied, University of Utah Health

A patient is screened inside the Wellness Bus in 2019.

That said, children who are overweight, obese or have other high risk factors associated with diabetes may be screened. The Wellness Bus focuses on preventing chronic diseases such as diabetes, high blood pressure and high cholesterol.

Health screenings are administered by health care workers from the community and include testing blood glucose, blood pressure, cholesterol levels and body mass index. Registered dietitians provide nutrition counseling and lifestyle coaching.

Future health care workers from the University of Utah aid in wellness efforts in offering referrals to health and social service providers and programs.

Ortiz said there are many free or low-cost resources available with the help of local community organizations to address food and housing needs as well as dental care.

U of U Health launched the Wellness Bus in June 2018 in an effort to combat rising cases of diabetes and other chronic illnesses that are often preventable. As part of the Driving out Diabetes Initiative by Larry H. Miller Family Wellness, the Larry H. and Gail Miller Foundation donated $5 million to community outreach efforts by U of U Health.

The Centers for Disease Control and Prevention estimates that 1 out of 3 people will have diabetes by 2050.

According to the CDCs 2020 Behavioral Risk Factor Surveillance System, Utah adults have an age-adjusted rate of 8.6% being diagnosed with diabetes, compared to the U.S. age-adjusted rate of 10.0%.

Diabetes is said to be the leading cause of non-traumatic lower-extremity amputation and renal failure as well as blindness among adults younger than 75 years old and heart disease.

The Utah Department of Health estimates more than $1 billion is spent on direct and indirect medical costs in the state each year, placing an enormous burden on health care resources.

Communities that dont have enough access to medical services have a higher chance of developing diabetes because they are without regular access to screening, prevention and educational materials, Ortiz said.

While anyone can request the Wellness Bus at a community event, priority is given to events supporting the clinics mission in reducing the burden of diabetes and other chronic diseases in underserved areas by providing important preventative health services.

Ortiz said participants are encouraged to return as many times as they wish or feel necessary to do so.

(The Wellness Bus) hopes to empower our community members with the knowledge to make healthy lifestyle choices leading to improved health, she said.

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U of U Health's Wellness Bus helping drive out diabetes, other ailments in Ogden - Standard-Examiner

SINGAPORE: For many diabetic amputees, the fateful day may begin very much like any other - abump against the door, a small blister from walking a little too long or an ill-fitting pair of new shoes.

This unexpected occurrence soon leads to a fever, swelling and pain that wont go away or a wound that refuses to heal. And before the patient knows it, his doctor hasbad news: The limb must be amputated.

In Singapore, diabetes mellitus is on the rise. From 2019 to 2020, the crude prevalence of diabetes was 9.5 per cent, an increasefrom 8.8 per cent in 2017 (despite a five-year War on Diabetes).

According to the International Diabetes Federations 2021 report, Singapore continues to have a high prevalence of diabetes mellitus at 11.6 per cent, compared to the global average of 9.8 per cent, the Americanaverage of 10.7 per cent and Australian average of 6.4 per cent.

Commonly referred to as a lifestyle disease, diabetes can worsen if the patient doesnt change their diet, doesnt do regular exercise, has poor compliance with treatment or continues to smoke and drink.When the disease is not managed well, foot ulcers may develop and this can progress to lower limb amputations (defined as below knee or more proximal amputation).

Singapore has a fairly high rate of amputation according to data, up to four lower limb amputations were done in a day between 2015 and 2016.

At Tan Tock Seng Hospital (TTSH), 80 per cent of our patients who need amputationhave significant comorbidities like high blood pressure or heart disease. Add to that, a significant proportion lack awareness about how damaging untreated foot ulcers can be.

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Commentary: Losing a limb to diabetes is painful but not the end of the road - CNA