Category Archives: Diabetes

Type 2 diabetes affects 400 million people globally. It carries the risk of heart disease, stroke, blindness, and amputations. Several measures previously described to control diabetes involved intensive lifestyle modifications and an extreme reduction in dietary calories. Nevertheless, researchers from Cambridge University have shown that early weight control is strongly associated with normalizing blood glucose levels in diabetic patients. The results of their study were published in the journal Diabetic Medicine.

For the study, 867 people with newly diagnosed type 2 diabetes, aged between 40-69 years, were selected from different parts of England. The patients were followed up for five years, assessing changes in weight, physical activity, and dietary calories. Their blood glucose and HbA1c were regularly measured. Remission was defined as an HbA1c level <6.5% without using any diabetes medication or weight-loss surgery.

They found that 257 participants (30%) achieved remission after five years. This result was significant in people who lost 10% of their body weight in the first year of diagnosis. It was achieved without any extensive behavioral changes or unattainable dietary restrictions.

Dr. Hajira Daambha-Miller from the Department of Public Health and Primary Care says Weve known for some time now that its possible to send diabetes into remission using fairly drastic measures such as intensive weight loss programs and extreme calorie restriction. These interventions can be very challenging for individuals and difficult to achieve. But, our results suggest that it may be possible to get rid of diabetes, for at least five years, with a more modest weight loss of 10%. This will be more motivating and hence more achievable for many people.

The study included a significant number of diabetic patients from several areas of England and was conducted for a long duration of five years, allowing some generalizability to the general population. Achieving diabetes control with such simple, less intensive measures is an encouraging result. To dig deeper into the effects of weight management in diabetes control, the researchers are currently conducting another study called GLoW (Glucose Lowering through Weight management).

Written by Dr.Radhika Baitari, MS

References:

DambhaMiller, H., Day, A., Strelitz, J., Irving, G. and Griffin, S. (2019). Behaviour change, weight loss and remission of Type 2 diabetes: a communitybased prospective cohort study. Diabetic Medicine.

EurekAlert!. (2019). Type 2 diabetes remission possible with achievable weight loss, say researchers. [online] Available at: https://www.eurekalert.org/pub_releases/2019-09/uoc-t2d092719.php [Accessed 8 Oct. 2019].

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Can type 2 diabetes be reversed by weight loss? - Medical News Bulletin

Type 2 diabetes is a condition in which the body cant control the amount of glucose in the blood. The body doesnt respond to insulin properly, and may not produce enough, causing a persons blood glucose level to become too high. If blood sugar stays too high and the condition is left untreated, a number of complications can occur, including kidney failure, nerve damage, heart disease, foot ulcers and stroke. So what can you do to control blood glucose levels?

Regularly eating a poor diet can increase a persons risk of developing type 2 diabetes.

Bupa explains: This might be a diet that doesnt contain much fibre, for example.

A high glycemic index (GI) diet may also make you put on weight, which in turn, increases your risk of type 2 diabetes.

So eating a healthy diet is one way to help manage blood sugar levels.

The NHS advises: Theres nothing you cannot eat if you have type 2 diabetes, but youll have to limit certain foods.

You should eat a wide range of foods - including fruit, vegetables and some starchy foods like pasta and keep sugar, fat an salt to a minimum.

The health body adds the importance of eating breakfast, lunch and dinner every day, and not to skip meals.

When it comes to the first meal of the day, breakfast, what foods are considered best?

Rising in popularity over the last few years and dubbed a superfood, turmeric - a bright yellow spice commonly used in Asian food - has been proven to have a positive impact on blood sugar levels, and may be the perfect addition to your morning meal.

Scientists believe turmeric may have properties that help reduce inflammation and oxidative stress - factors that appear to play a role in diabetes.

For this reason, its believed turmeric may be useful for people with diabetes.

Turmerics blood sugar-lowering properties have been attributed to its curcumin content - most research to date has focused on curcumin rather than whole turmeric.

Authors of a review published in the journal Evidence-based Complementary and Alternative medicine compiled more than 200 research papers on the connected between diabetes and curcumin.

The results found curcumin can help people with diabetes in different ways, including improving insulin resistance and cholesterol levels.

A study in Diabetes Care also found people with pre diabetes who took cur cumin for nine months were less likely to develop type 2 diabetes than those taking a placebo.

Turmeric can be added to eggs and oats - both of which have also been shown to have a positive impact on blood sugar levels.

When it comes to the last meal of the day, enjoying a certain drink before bed may help lower blood sugar.

Other ways to control blood sugar levels include regular exercise and losing weight if youre overweight.

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Type 2 diabetes: Adding this 'superfood' to your breakfast could lower your blood sugar - Express

Power couple Priyanka Chopra and Nick Jonas walk the red carpet for Chopard party, along with Amber Heard, Elle Fanning, Julianne Moore and Richard Madden (May 18). AP, AP

Priyanka Chopra is opening up about what life is like with husband Nick Jonas, who is a type 1 diabetic.

The 37-year old actress described how much she admires Jonas' dedication to his healthon "The View"Tuesday.

Initially, when we first got married, I couldnt wrap my brain around the fact that he knew when his sugar dropped, even whilehe was sleeping, shesaid. He feels it.

Though she trusts Jonas' "crazy discipline" about monitoring his blood sugar, Chopra confessed she "used to wake up in the middle of the night" to make sure her husband was OK.

She also praised Jonas, 27, for not letting his disorder affect the way he lives.

"He lives the biggest life possible," she said."He's not restricted himself from anything. He plays sports. He's touring. He lives an incredible life, and it's so inspiring to see."

This passion for living life to the fullest, Chopra said, is what inspired Jonas to found Beyond Type 1, a nonprofit organization dedicated to diabetes education, advocacy and the path to a cure.

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"That's what he wanted to show people," Chopra said. "That even if you have type 1 diabetes doesn't mean that your life has to be different. You can live it to its fullest, and it's so inspiring to me."

According to Mayo Clinic, type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin. Though there is no cure, treatment "focuses onmanaging blood sugar levels with insulin, diet and lifestyle to prevent complications."

More: Awww! Nick Jonas writes fairy-tale 'one year' love letter to wife Priyanka Chopra

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This transcript has been edited for clarity.

I first became passionate about diabetes and humanitarian crises when I spent a month practicing general internal medicine at a small district hospital near the Congo-Rwanda border. We had many refugees come through from the Congo at that time, including a number of young men who were clearly in diabetic ketoacidosis.

Because we did not have insulin or glucose strips with which to monitor them, they all died within hours of presenting to the hospital. None of them survived. Those with type 2 diabetes kept being readmitted to the hospital because we were unable to manage their hyperglycemia, although we were able to manage their infections or trauma.

This experience led me to dedicate my career to this issue. Today, about half a billion people worldwide are affected by diabetes, 80% of whom are living in low- and middle-income countries. This is projected to increase over the next 20 years as a result of urbanization, climate change, global warming, etc., so the crisis will get even worse.

At the same time, low- and middle-income countries are predominantly and disproportionately affected by humanitarian crises. Most people who are displaced due to conflict spend decades as refugees or internally displaced people. The average duration of this conflict-induced displacement is 27 years, and these people have diabetes. As a result, humanitarian actors are now having to take on broader roles.

Yet, at present, data on this issue are not being collected. There are no evidence-based guidelines on how to manage diabetes best in these circumstances, and there is no education. Medicines, including insulin, are not routinely supplied in these contexts, which is a death sentence for anyone with type 1 diabetes.

For this reason, we organized a symposium in early April at Harvard University, where we convened more than 100 leaders in global and humanitarian health, including various academic institutions, the Centers for Disease Control and Prevention, the World Health Organization, and pharmaceutical and diagnostics companies. The objectives were to discuss this issue, build partnerships, figure out how to collaborate, prioritize the most immediate needs as a community, and design projects going forward.

Out of that meeting, we published the Boston Declaration in TheLancet Diabetes & Endocrinology, which outlines this incredible and urgent need for insulin, especially for those with type 1 diabetes, and the need for chronic care for people with type 2 diabetes.[1] This care includes cardiovascular risk management and all comorbidities, which would hopefully pave the way for improved care for other chronic diseases.

The group, comprising 64 signatories from about 43 different organizations, outlined four major targets to work toward. The first is improved advocacy and global awareness, which is a major need. The second is improved access to insulin, essential medicines, and diagnostics for diabetes and hypertension. The third major target is to develop improved clinical and operational guidelines that are coherent among organizations, and the last target is improved data collection, surveillance, and monitoring across organizations. These are the four main targets that we're setting out to tackle over the next 3 years.

Many new projects are beginning, and we would love everyone's involvement. If you would like to get involved, you can contact me via the Global Endocrinology website, or contact any humanitarian organization, including Doctors Without Borders, the International Committee of the Red Cross, and Save the Children. They're all doing phenomenal work, they definitely need this money, and they will put it to good use.

Thank you.

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'None of Them Survived': Diabetes in the Time of Humanitarian Crises - Medscape

Elevated levels of fibroblastgrowth factor 23 (FGF23) are associated with increased risks for a majoradverse cardiovascular event (MACE) and death in patients with type 2 diabetesand normal to mildly impaired kidney function, according to new study findings publishedin Diabetes Care.

Martin H. de Borst, MD, PhD,of the University of Groningen in the Netherlands, and colleagues analyzedplasma c-terminal FGF23 levels in 310 patient with type 2 diabetes (mean age 62years; 58% men) with an estimated glomerular filtration rate (eGFR) of 60mL/min/1.73 m2 or higher from the Diabetes and Lifestyle CohortTwente (DIALECT). During 5.8 years of follow-up, 47 patients experienced a MACEand 28 patients died. Each doubling of FGF23 was significantly associated with a1.7- and 2.8-fold increased risk for MACE and all-cause mortality, respectively,in adjusted analyses.

In a subset of patients witheGFR of 90 mL/min/1.73 m2 or higher, each doubling of FGF23 was significantlyassociated with a 3.3-fold higher risk for all-cause mortality in adjustedanalyses. Theassociation with MACE was attenuated, likely due to underpowering, according tothe investigators.

The researchers adjusted Cox regression models for a range of confounders including age, sex, body mass index, C-reactive protein, triglycerides, medications (for diabetes, hypertension, and cholesterol), urinary phosphate, urea excretion, plasma albumin, and urinary albumin-to-creatinine ratio.

High FGF23 level has beenconsistently associated with cardiovascular morbidity and mortality in patientswith chronic kidney disease, Dr de Borst and his colleagues noted. The new observationaldata extend previous research.

Our data provide a rationalefor future studies on the specific role of FGF23 in patients with type 2 diabetesand normal kidney function.

Reference

Yeung SMH, Binnenmars SH, Gant CM, etal. Fibroblast growth factor 23 and mortality in patients with type 2 diabetesand normal or mildly impaired kidney function [published online September 5,2019]. Diabetes Care. doi:10.2337/dc19-0528

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Elevated FGF23 Linked to Mortality in Type 2 Diabetes - Renal and Urology News

Type 2 diabetes means a persons pancreas cannot produce enough insulin to regulate blood sugar levels. Overtime, unchecked blood sugar levels pose serious health risks, such as heart disease. Fortunately, certain dietary decisions can help to control blood sugar levels. Evidence singles out a particular fruit.

According to research presented at the American Diabetes Association's 72nd Annual Scientific Session, eating raisins three times per day may reduce post-meal sugar spikes significantly.

The research, conducted by Harold Bays, MD, medical director and president of Louisville Metabolic and Atherosclerosis Center (L-MARC), involved 46 adults who had slight increases in glucose levels, but no previous diagnosis of diabetes mellitus.

The researchers randomly assigned participants to two groups.

The first group was told to snack on raisins three times per day for 12 weeks, while the second group snacked on pre-packaged snacks that did not contain raisins or other fruits or vegetables.

The researchers found that raisins slashed post-meal glucose levels by 16 per cent and reduced mean hemoglobin A1c by 0.12 per cent from baseline.

Pre-packaged commercial snacks on the other hand, did not significantly reduce mean post-meal glucose or hemoglobin A1c.

As Diabetes UK explained, HbA1c is a persons average blood glucose (sugar) levels for the last two to three months. A high HbA1c means a person has too much sugar in their blood.

Commenting on the findings, Dr. Bays said: "Compared to the snacking control group, the group consuming raisins had a significant statistical reduction in their after-liquid meal blood sugar levels among study participants who had mean baseline fasting glucose levels between 90 and 100 mg/dl.

Adding: This favourable glucose effect of raisins was further supported by the statistically significant reduction in hemoglobin A1c (a standard test for overall blood sugar control in diabetes mellitus) in the within group comparison to baseline. The within group comparisons from baseline with snacks did not demonstrate a reduction in hemoglobin A1c."

Accounting for the results, James Painter, Ph.D., R.D., and nutrition research advisor for the California Raisin Marketing Board, said: "Raisins have a relatively low glycemic index and contain fiber and antioxidants, all factors which contribute to blood sugar control. Decreasing blood sugar and maintaining normal hemoglobin A1c levels is important because it can prevent long-term damage to the heart and circulatory system."

Why eat fruit?

As Diabetes UK explained, there is a popular misconception that the sugar content of fruit means it is off-limits for people with type 2 diabetes. But the sugar in whole fruit does not count towards free sugars, so it is not this type of sugar we need to cut down on, said the health body.

Adding: This is different to the free sugar in drinks, chocolate, cakes and biscuits.

In fact, carbohydrate intake has the biggest impact on blood sugar levels, and fruit is a low-carb alternative to sugary foods, noted the health site.

It said: A portion of fruit, such as a medium apple, generally contains about 15 to 20g carbs, a chocolate muffin has 55g carbs and a 500ml ordinary fizzy drink has 54g carbs.

Here is another superfood proven to lower blood sugar levels.

What are the symptoms of type 2 diabetes?

Symptoms of type 2 diabetes include:

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Type 2 diabetes: Eat this fruit three times a day to lower your blood sugar levels - Express

Pioglitazone in combination with insulin therapy reduces the risk for mortality and noncardiovascular death in patients with type 2 diabetes, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

The oral antidiabetic drug pioglitazone has been shown to improve glycemic control in insulin-treated patients with type 2 diabetes, but the long-term safety and benefits have not been evaluated. Researchers sought to characterize the risk for all-cause mortality and cardiovascular events in pioglitazone users and nonusers in patients with type 2 diabetes from the National Health Insurance Research Database in Taiwan.

A total of 2579 patients (47.23% women) with type 2 diabetes who were treated with pioglitazone were included in the retrospective study, along with 2579 matched comparators (nonusers). Patient information was collected from the Longitudinal Health Insurance Database 2000. The primary outcome of the study was all-cause mortality, including rates of cardiovascular-related death and noncardiovascular-related death. Incidence rates of cardiovascular events, including heart failure, hospitalization, and stroke, were also examined.

The all-cause mortality rate among pioglitazone users was 15.02 per 1000 person-years. This was significantly lower than the mortality rate among nonusers, which was 30.26 per 1000 person years (adjusted hazard ratio, 0.47; 95% CI, 0.38-0.58; P <.001). This was primarily driven by differences in the rates of noncardiovascular death for users and nonusers, which were 9.11 and 19.74 per 1000 person-years, respectively (adjusted hazard ratio, 0.50; 95% CI, 0.38-0.66; P <.001). There was no significant difference in the rates of and risk for cardiovascular death or events between pioglitazone users and nonusers.

The authors noted that the use of administrative data for analysis represented a limitation of the study, as insulin and pioglitazone dosage and adherence could not be confirmed.

[O]ur study demonstrated that the combination of insulin and pioglitazone lowered the all-cause mortality risk, the researchers concluded. Pioglitazone might be a beneficial complementary agent for insulin treatment. Additional studies are needed to establish its optimal application in real-world practice.

Reference

Yen FS, Wang HC, Pan CW, Wei JC, Hsu CC, Hwu CM. Pioglitazone exposure reduced the risk of all-cause mortality in insulin-treated patients with type 2 diabetes mellitus [published online September 23, 2019]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz026

This article originally appeared on Endocrinology Advisor

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Pioglitazone May Reduce Overall Mortality Risk in Patients With Type 2 Diabetes - Renal and Urology News

Type 2 diabetes is a condition that causes a person to lose control of the amount of sugar in their blood. It causes the body not to respond to insulin which is a hormone made in the pancreas. This can cause blood sugar levels to become too high. If the condition is left untreated, major health complications can occur including kidney failure, nerve damage, heart disease and stroke. This is why controlling the blood sugar levels is so important and according to a new study, cutting down on this food group will ensure blood sugar levels remain stable. What is it?

According to the Danish Health Authority, up to 85 per cent of newly diagnosed patients with type 2 diabetes are overweight, and they are typically advised to follow a diet focused on weight loss.

This means following a diet that contains less calories than one burns, eating low fat content and foods with a low glycemic index.

The central aspect in the treatment of type 2 diabetes is the patients ability to regulate their blood sugar levels, and new research now indicates that ahelp control blood sugar levels and keep the condition stable.

A study at the University of Copenhagen looked at patients with type 2 diabetes and how to improve their ability to regulate blood sugar levels if they eat food with a reduced carbohydrate content and an increased share of protein and fat.

The study involved 28 patients with type 2 diabetes who participated in the study over a total period of 12 weeks.

For six weeks, the patients were given a conventional diabetes diet with a high carbohydrate content, and, for the other six weeks, they were given a diet with a reduced carbohydrate content.

The study was published in Science Daily and noted: Patients with type 2 diabetes improve their ability to regulate blood sugar levels if they eat food with a reduced carbohydrate content.

This is shown by a recent study conducted at Bispebjerg Hospital, Aarhus University and the Department of Nutrition, Exercise and Sports at the University of Copenhagen.

Senior consultant Thure Krarup, from the Department of Endocrinology at Bispebjerg Hospital said: The study shows that by reducing the share of carbohydrates in the diet and increasing the share of protein and fat, you can both treat high blood sugar and reduce liver fat content.

Further intensive research is needed in order to optimise our dietary recommendations for patients with type 2 diabetes.

The study concluded that cutting back on carbohydrate can have major benefits to ones health, especially for type 2 diabetics.

Many are unaware of how sugary drinks are high in carbohydrates and avoiding them can significantly reduce your carbohydrate intake.

Other ways to reduce carbohydrates from the diet include cutting back on bread, reducing fruit juice, choosing low-carb snacks, eating eggs or other low-carb breakfast foods, and loading the plate with more vegetables instead of potatoes.

Its also advisable to check food labels which can provide valuable information about the carb content of packaged foods.

The key is knowing where to look and whether any calculations need to be done. Its also important to look at how many servings are included in the package and determine how many carbohydrates are in packaged foods.

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Type 2 diabetes: Cutting back on this food group can help to regulate blood sugar levels - Express

On average, the use of movement tracking devices increased the levels of physical activity among participants by around 1,700 steps a day. This number was greater when the use of pedometers and accelerometers was combined with regular face-to-face consultations with health professionals.

Commenting on the results, Dr Hodkinson, said; Receiving feedback and support by healthcare professionals, even if this is brief and through telephone, internet, or apps, is critical for ensuring that patients achieve the greatest benefits by using these devices.

Premature deaths could potentially be prevented by addressing very low levels of physical activity, more than any other risk factor such as smoking, alcohol or stress-related illnesses.

However, Dr Hodkinson notes that, while encouraging, these results remain below the targets set by clinical recommendations such as NICE.

Around 3.3 million people in the UK have been diagnosed with type 2 diabetes, the authors note, and many of them experience additional conditions such as raised blood pressure, and a heightened risk of developing thrombosis or CVD. The increasing prevalence of these conditions is estimated to account for over 20% of the NHS budget in the next 20 years.

The research was funded by theNIHR School for Primary Care Research Evidence Synthesis Working Group.

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Activity trackers can be useful tools in managing diabetes - The University of Manchester

The Legislature ended last session without a plan for providing emergency access to insulin to Minnesotans with diabetes, but Savages state legislators said this week an agreement among Democrats and Republicans could come before the years end.

The Minnesota Insulin Patient Assistance Program, a plan announced by the Minnesota Senate last month, would require insulin manufactures to provide insulin to Minnesota doctors.

Under the proposal, patients who arent covered by other state or federal health care programs and meet income requirements could obtain insulin for up to one year upon presenting a voucher to their physician, according to a news release from the Senate Republican Caucus.

Sen. Dan Hall, R-Burnsville, said the plan is a part of broader efforts by his party to address medicine affordability.

But Rep. Hunter Cantrell, DFL-Savage, said the Senates plan doesnt address people who need insulin immediately.

Rationing insulin is super dangerous, he said.

The Democrat-controlled Houses plan, known as the The Alec Smith Emergency Insulin Act, levies a fee on insulin manufacturers and allows pharmacies to provide up to 90 days of emergency insulin to those in need.

Under the proposal, patients are presumed to be eligible and can get insulin while their paperwork is processed by the Department of Human Services.

Gov. Tim Walz said in June he would consider calling a special session to sign an emergency insulin bill into law after plans fell off the table at the end of the budgeting process, according to MinnPost.

Cantrell said hes optimistic lawmakers can determine a final policy this year, but it will most likely end up on the 2020 agenda.

Hall said the Senates proposal offers a longer-term solution to patients rather than a quick bandaid. He said hes hopeful there will be a special session called in 2019.

I dont see any reason the governor wouldnt do that, he said. I think our plan is a compromise plan lets get this plan moving now.

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Savage reps say their party's insulin proposal can help those with diabetes - SW News Media