Category Archives: Diabetes

Indianapolis, IN - INDIANAPOLIS (WISH) From awareness, to education, Indiana lawmakers will soon study diabetes. And it's a personal fight for the Indiana lawmaker spearheading the committee.

For millions of Americans, a quick prick, and sugar reading, is a daily routine. But it's something State Representative Vanessa Summers (D-Indianapolis) would like to see go away. "It's just an unnecessary disease that has grown rapid and is at epidemic portions in our country, and especially in Indiana, State Rep. Summers said.

A disease the American Diabetes Association said impacts nearly 30 million Americans by attacking cells and how bodies produce insulin. To fix this problem, Representative Summers is behind a state study. "It's time to put a face and a name, and action to a condition that is treatable, State Rep. Summers said.

The Indiana Department of Health said more than half a million Hoosiers suffer from diabetes. Nearly 300,000 may not know they have it, and it's the seventh leading cause of death across the state.

A problem representative Summers knows well, because she's had the disease for a decade. "I started out with an A1C of 13. Your A1C should be under 6, State Rep. Summers said. A disease that's hit her family hard. "I've had one cousin to die, State Rep. Summers said. He had a foot amputated, and then he died from complications of diabetes."

To save her life, she's made major changes, including her diet, and teaching others as well. "They just have got to eat right, State Rep. Summers said. They've got to rainbow their colors. You need red, green, purple, yellow."

She's gone from four shots a day, to one. A success story she hopes will inspire her fellow lawmakers, and other Hoosiers as they tackle this issue because she knows how tempting it can be to veer off course.

Sometimes I take a bite because I'm human, State Rep. Summers said. I want to taste that cake."

The study committee was announced about a week ago, but it may take some time before the group may not meet until later this summer. Lawmakers use these off-season meetings to learn information that can help them draft bills for when the 2018 session starts.

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Diabetes Study in Indiana - MyWabashValley

New York Times

A Dilemma for Diabetes Patients: How Low to Push Blood Sugar, and How to Do It? New York Times Some diabetes drugs lower blood sugar, yet somehow can increase the chances of heart attacks and strokes. Other medications have no effect on heart risk, while still others lower the odds of heart disease but may have other drawbacks, like high cost or ...

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A Dilemma for Diabetes Patients: How Low to Push Blood Sugar, and How to Do It? - New York Times

A program sponsored by the Cherokee Nation has been successful in reducing the risk of diabetes in pre-diabetics.

"People with pre-diabetes who lose 7 percent of their body weight through a healthy lifestyle intervention reduce their risk for diabetes by 58 percent," said Tonya Wapskineh, Cherokee Nation diabetes prevention manager.

But those who took metformin, a diabetes medication, reduced their risk by 30 percent.The bottom line is that the healthy lifestyle group reduced their risk for diabetes twice as much as those who were placed on medication, Wapskineh said.

With that success, Wapskineh is looking for more Cherokees who qualify for the program. Some of the qualifications include having a history of gestational diabetes for women, a body mass index of over 24 or a history of diabetes in the family.

While joining the class is voluntary, some are referred by their medical provider. The program's goal is to get everyone to lose 7 percent of their body fat.

"It's kind of a wake-up call for them especially when their doctor tells them they can do something to prevent diabetes," said Karen Bryant, physical activity specialist.

A lot of participants have lost up to four pounds in a couple of weeks just by cutting back and not eating french fries every day.

Classes last a year with the first two months as weekly class, the next four months are bi-weekly classes and the remaining meetings are once a month,Wapskineh said.

Most Cherokees have a diet high in fat and fried foods with little vegetables and fruit, Bryant said. She says their eating habits were learned from childhood.

Participants are not told to stop eating that kind of food.

"Wegive them ways to enjoy these foods by cutting portion sizes, cutting fat out of food and replacing unhealthy cooking oil with healthier ones," Bryant said.

Using this program, one Cherokee man started out at 307 pounds, and a year later he is maintaining 175 pounds, Bryant said.

"When he first started his activity program he could barely get one-quarter around the track, and now he walks every chance he gets and still uses a food journal and that's been about five years ago," she said.

His main success was using a food journal and keeping track of what he ate.

Volunteers have a physical activity goal of 150 minutes per week.

"If they can sing or talk normally and are being active they need to work a little harder. If they can't talk they need to slow it down,"Wapskineh said.

For those who are pretty sedentary, Bryant recommends 15 minutes of walking twice a day and work up to 150 minutes a week. For faster weightloss, 60 minutes of brisk walking a day is recommended.

"From what I've seen through the program is that the more education they receive on how to correct their lifestyle, the more effective it is than going to the doctor and getting a pill,"Wapskineh said.

At the Cherokee Nation Wapskineh said she has actually seen their providers move into preventive medicine and are more supportive of promoting the healthy lifestyle program.

Wapskineh's budget is $400,000 and she would like to see that doubled to possibly establish diabetic prevention centers in all 14 counties within the Cherokee Nation jurisdiction.

"But our work is federally funded and the money is just not there that's just my dream," she said.

Information: (918) 207-3839.

Reach Mark Hughes at (918) 684-2908 or mhughes@muskogeephoenix.com.

What to do

The Cherokee Nation is looking for more Cherokees who qualify for the pre-diabetes program. Some of the qualifications include having a history of gestational diabetes for women, a body mass index of over 24 or a history of diabetes in the family.Information: (918) 207-3839.

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Cherokee Nation program benefits pre-diabetes patients - Muskogee Daily Phoenix

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Griffin to hosts talks on diabetes

The Diabetes Education & Support Group at Griffin Hospital will host two free presentations on managing diabetes during the summer holidays on Tuesdau, June 13 at 2:30 p.m. and 6:30 p.m. at the hospital, 130 Division St., Derby.

Certified Diabetes Educator Mary Swansiger will lead a discussion on managing diabetes during holidays, vacation and special events during the summer, including meal planning and strategies for making the summer happier and healthier.

Both presentations will be in Childbirth Education Classroom A. There will be free valet parking for the 2:30 p.m. presentation.

The Diabetes Education & Support Group meets September through June on the second Tuesday of each month to discuss the management of diabetes, its challenges, and day-to-day dietary concerns. Individuals with diabetes and their caregivers are welcome to attend.

No registration is required. For more information, call 203-732-1137.

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Griffin to hosts talks on diabetes - CT Post

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BEHAVIORAL MED & PSYCH CLIN. ENDO. HLTH CR & PUB HLTH COMPLICATIONS DIABETES IN YOUTH EDUCATION EPIDEMIOLOGY & STATISTICS EXERCISE FOOT CARE IMMUNOLOGY, IMMUNOGENETICS NUTRITIONAL SCIENCES & METABOL PREG AND REPRODUCTIVE HEALTH

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American Diabetes Association

M

ONTEGO BAY, Jamaica The man who boasts ofchanging the face of diabetes spreads his arms out wide, like the Christ the Redeemer statue, but in neon orange shorts and bare feet. He looks earnestly into the rolling camera.

Welcome to Reversed, he intones. Seated behind him are four of his disciples: Americans with type 2 diabetes whove flown to this tropical beach town to participate in a reality TV show marketed as a momentous opportunity to restore their health.Over eight days, theyll learn to exercise and eat right and bare their struggles in cathartic therapy sessions.

Their host, Charles Mattocks, is a smooth-talking, fast-moving entrepreneur, who has leveraged his family fame (his uncle was Bob Marley) and his own medical history (he uses diet and exercise, not insulin, to manage his diabetes) to set himself up as a guru to diabetics everywhere.

In an age where nearly 1 in 10 Americans has diabetes, a disease that can bring a lifetime of painful complications, patients are often desperate for miraculous turnarounds and theres a booming trade in supplements, diets, and self-help books that promise answers. Now, theres a TV show, too.

But Reversed is unlikely to prove anyones salvation.

The show,which will begin airing next month on cable, is at once a vehicle for Mattocks to proselytize his gospel of self-help, a marketing gambit by a pharma company thats running out of money, and a season-long advertisement for a luxury getaway at the sparkling resort where it was filmed.

The carefully choreographed, relentlessly upbeat atmosphere cultivatedunderthe Jamaican sun feels, well, unreal. Back at home, the shows stars like the viewers expected to tune in dont have in-house chefs to cook them healthy meals or mentors toguide them through yoga lessons.

This insulin maker is running out of money. Its solution? Reality TV

Instead, theyre grappling with the stubborn realities and compounding challenges so common inpatients with chronic disease: deteriorating vision, nerve damage in their feet,congestive heart failure, hypertension, high body fat, the inability to work and even to walk. Just before the show, one of the participantslost her home; two others, a married couple, had been relying on food banks because they hadnt been able to afford to go to a grocery store for months.

Mattocks, the shows executive producer and creator, said he originally imagined Reversedas The Biggest Loser meets diabetes a reference to the long-running weight-loss competition on NBC.

But the participants on Reversed arent competing. Judging from the two days of filming that STAT observed, the show has more in common with the reality TV tradition of putting a bunch of strangers in a house together and seeing what happens. Call it The Real World: Diabetes, featuring burned kale chips, frowned-on cigarette breaks, and one participants dramatic decision to quit the show. (I dont think he was coming here for the right reasons at all, Mattocks told STAT, borrowing the ultimate reality TV insult.)

So it went for the weekof filming, as Mattocks put his cast members through a quirky array of activities:There were massages, just steps from the glittering Caribbean. Trust exercises featuring blindfolds, a basketball, and a banana. Lessons about natural remedies and medicinal plants on a day trip to a nearby farm.

Where are all the new diabetes drugs?

The camera operators scurried on instinct toward any hint of drama or tears. And they didnt always abide by the shows lessons for good health: At lunch one day, for instance, the diabetics ate seasoned vegetablesand sipped water while some crew members chowed on hamburgers and swigged from plastic bottles of Ting, a sugary citrus soda popular in the Caribbean.

The debut 10-episode season airs this summer on Discovery Life, a cable channel that specializes in medical programming starring real people, like The Boy With No Brain and Untold Stories of the ER. Last year it drew an average of 88,000 viewers a night during prime time, according to Valeria Almada, a spokeswoman for the channel. That ranks around 97th among networks, by one recent estimate of viewership.

The shows primary sponsor is MannKind, an insulin manufacturer thats in bad financial shape. Neither the show nor the company would say how much the sponsorship cost, but MannKind willget advertising spots for its struggling insulin inhaler, Afrezza, during commercial breaks and perhaps a brief mention of the product on the show itself.

Mattocks makes a point of telling STAT that hes not promising anyone they can reverse their diabetes. But he has, in the past, said exactly that.

And one of the sponsors of his show expressly promised that, too on camera. The company, OneCare, makes software to help patients manage their diabetes. And in exchange for his $6,000 sponsorship, CEO Gary Austin got to film a segment on set in Jamaica in which he explains to the cast members how his product works and tells them it will help them vanquish diabetes. Its possible, he told them. You can reverse it.

Three of thepatients Mattocks recruited for the show are convinced.I truly believe that within the next year I will no longer be called a diabetic, said Lisa Campbell, cheerful and effortlessly expressive in her Southern drawl.

I truly believe that within the next year I will no longer be called a diabetic.

Lisa Campbell, cast member

At 54, she has a litany of health complaints so severe, they forced into retirement from her career as an elementary school teacher four years ago. Her right foot isswollen and her ankle deteriorated from complications ofdiabetic nerve damage, known as neuropathy. Her vision is so blurred by retinopathy that she recently went blind for four months. To get around her home near Atlanta, she juggles between a wheelchair, walker, and cane.

Her 49-year-old husband, Roger, who joined her on set, has also been ravaged by diabetes: His left leg was amputated a few inches below the knee in 2015 and shortly before the filming, hedbeen diagnosed with congestive heart failure. Hed also developed a wound on his stump, but didnt tell his doctor because he suspected hed get hospitalized and have to skipthe trip, his first ever out of the country. He refused to miss it.

For patients with such advanced conditions, the hope of vanquishing diseaseis often an unrealistic one. And criticsworryReversedwill add fuel to aflourishingcottage industry premised on the idea that diabetes can be reversed.

You can manage it. You can control it. You cant reverse it. All this talk about reversing diabetes is a huge load of BS, said David Kliff, who has type 1 diabetes and publishes the newsletter Diabetic Investor.

To be sure, diabetics, like everyone else, can only benefit from a healthy diet and exercise. But theres no cure for diabetes. Type 1 diabetics cant quit their medicine, ever. And its extremely difficult for type 2 diabetics to do so, barring bariatric surgery. More than 2,200 such patients went on an intense diet and exercise regimen for a studypublished in 2012; after one year, only 11.5 percent were able to get off their medicine or get their blood sugar levels down to a certain threshold. After four years, just 7 percent were still there.

The whole reversed idea is: run screaming from the meds, said Amy Tenderich, a vocal patient advocate with type 1 diabetes. She worries that it might send the wrong message that if you continue to need medication or have to go on insulin, that you have failed.

Rick Phillips, a blogger with type 1 diabetes, shares that concern. He wrote inablog postthat he saw the TV shows title as an affront,the latest in a line of rhetoric that blames diabetics for their own disease. He cited recent comments from White House budget director Mick Mulvaney suggesting that American taxpayers shouldnt have to pay for the health care of the person who sits home drinks sugary drinks, and doesnt exercise, and eats poorly, and gets diabetes.

Mattocks did not take kindly to Phillipss critique of his show. Instead, he jumped on Twitter to call Phillips irrelevant and a clown. He added: Go be miserable some other place.

Mattocks insists that his show demonstrates its possible to slow the progress of the disease by reversing the way patients live their lives. He brought ahandful of experts onto the set to dispensetips about healthy habits, like how to read nutritional labels on breakfast cereal and how to tell if blood sugar levels are in a safe range.

He also sought to effectively scare his stars straight.Cast memberswere taken on a day trip to a dialysis center and a diabetes clinic in Kingston, Jamaicas capital, where they gaped at local patients in the advanced stages of diabetes.

You can manage it. You can control it. You cant reverse it. All this talk about reversing diabetes is a huge load of BS.

David Kliff, publisher, Diabetic Investor

Then there wasthescene filmed on Day 6: Participants had toput on baggy jeans, a long belt, and a big checkered shirt using only one hand a challenge meant to show them what daily life is like for patients whove lost limbs due to complications from advanced diabetes.

Roll sound. And action!

Margie Rivera, a bubbly grandmother from Tampa, Fla., went first, though she hardly needed the exercise to introduce her to the debilitating effects of diabetes. She lost her job as a dialysis technician a year ago after diabetic retinopathy eroded her vision. Just before filming began, another blow: She and her husband lost the house they had been renting with intent to buy.

Now, Rivera, 53, used her teeth to get the big shirt on. The pants went on easily enough until she struggled to lace the belt through the belt loops. God, this is hard, she murmured.

Next up was Jerome Hughes, a 43-year-old former retail manager from Atlanta whos quick to crack jokes. He had the bright idea of lacing the belt through the pants before putting them on. But he struggled mightily to get the bulky denim up over his black high-top shoes. As he grew more and more frustrated, Mattocks put a supportive arm over his shoulder and stepped in to help. Hughes struggled some more with the shirt, never getting it fully on, until Mattocks marched him away from the cameras. Both of their faces were creased with emotion.

Everyone on this show has been reversed, Mattocks later told STAT. Mentally, physically, emotionally, and even spiritually in a sense.

Mattocks, 46, is the opposite of what youd expect Bob Marley to be like. Tightly wound and usually multitasking, Mattocks buzzes around his set, always intentional and in control. He talks in real life in much the same way he does on camera: in a quiet and soothing voice, peppering his speech with phraseslike healing and journey and changing lives.

Mattocks only met his famous uncle twice, in brief encounters as a child. But the reggae legend has been his inspiration to make a difference in this world, he said.

He started out as a rapper and actor, then turned to cooking, branding himself as The Poor Chef demonstratinghealthy meals that could be made for just $7.

Mattocks was diagnosed with type 2 diabetes at age 38. His doctor gave him no guidance about lifestyle changes, he said. But on his own, he was determined to turn his health around. He stopped bulking up in the gym. He started walking, and then running. He stayed away from fried foods. He lost about 20 pounds in 2 1/2months.

Once-promising diabetes breakthrough comes unglued with a major retraction

Mattocks never went on insulin, and spent just nine months on metformin before his doctor advised him he could stop, he said.

That led to yet another career pivot: He became an evangelist for managing diabetes.

To that end, he vouched foran energysupplement aimed at diabetics. He wrote a childrens bookabout a furry diabetic bear named Charlie B. Marley. At one point, he even created a sugar-free chocolate bar infused with coconut oil and called it the Charles Bar.

Mattocks, who lives in Tampa, was careful when he talked to STAT about his journey: He made clear that he has not reversed his own diabetes but simply has it under control. But hes been much more aggressive about dangling the promise of reversal in other public outreach.

What if I told you that you could reverse your diabetes? he wrote in a 2015 op-ed.

And in the trailer for his documentary The Diabetic You: We did it, he says, We proved that diet and exercise, lifestyle changes, you can reverse diabetes. Then he breaks down with emotion, hand over his eyes, as the screen turns to black.

His swaggering confidence in his ability to tame a chronic diseasecomes across especially clearly in the recently released first issue of his new Reversed Magazinefor diabetics. Hes listed as chief editor.

Its in large part a tribute to himself, an Oprah magazine with lower production standards and more self-flattery.

Mattocks poses on the cover wearing a cowboy hat, bandanna, and a big-buckled belt. The tagline: Theres a new sheriff in town. Under that: Charles Mattocks changes the face of diabetes. An article inside says we must admire Charles Mattocks.

There were no auditions for Reversed.Mattocks picked the five stars of his show by plucking out old friends and friends of friends with an eye toward appealing to a broad audience. (Shes going to be great for the Latin American community, he said of Rivera, who was born in Puerto Rico.)

In the spirit of marriage boot camp reality shows, the producers put the Campbells on camera together as much as possible.Theyre a match of opposites Lisa lively and talkative; Roger, quiet and concise and that dynamic was on display duringon-camera therapy sessions, trust exercises, and cooking scenes.

With cameras rolling and the on-set dietician murmuring encouragement, the couple tore kale into strips, sprinkled on some olive oil, and gently massaged the oil into the leaves during one such scene. Lisa chattered happily about how much she loves preparing kale chips. Roger, who used to manage a paint store before his worsening health put him on disability, dutifully lowered the pan layered with kale stripsinto the oven.

(That was acting. I made them just for the camera. I do not like them, he later confessed to STAT.)

The crew moved on to the next shoot helping Rivera prepare healthy ice cream made from frozen strawberries and bananas.

Then a producer jumped in. Theyd forgotten about the kale chips!

Sure enough, they were burning in the oven. Much of the batch was charred to a crisp.

The setting was undeniably gorgeous: Most of the show was filmed in a 14-bedroom villanestled in lush green hills, with aglistening turquoise swimming pool out backand, far below, the ocean.

Still, the filming wasnt always easy for the Campbells. After Lisa took a tumble walking up an outdoor ramp, she mostly stuck to a wheelchair on set. For his part, Roger had experienced an alarming low blood sugar episode on Day 2of filming. He was often claustrophobic and felt too hot to sleep. And he needed frequent breaks to smoke. (Mattocks and the others gently chastised him about his cigarettesbut never asked him to stop.)

Despite it all, both he and Lisa made it to the shows graduation ceremony in the nearby resort town of Negril, where they donned black caps and gowns to acceptcertificates of accomplishment.

Just before the cameras started rolling, a crew member spotted a problem: a telltale green bottle of Ting, resting on a ledge. Get that soda out of the shot! he bellowed.

Mattocks is betting big on Reversed. Hes funding the project in part with his own savings, though he wouldnt specify how much. The shows total budget is very low, he said. Its more of a work of love, you know what Im saying?

To help pay the bills, Mattocks secured a few sponsors, including the struggling pharma company MannKind.

It was an unusual fit, given that Mattocks has long been a self-described outspoken critic of drugcompanies and their advertising. And, indeed, despite the sponsorship, the vibe on the Reversed setwas markedly anti-pharmaceutical.For a few days of filming, Mattocks brought in a health coach (a doctor who doubles as a naturopath and uses his website tosell supplements) to work with the cast members.

Everyone on this show has been reversed mentally, physically, emotionally, and even spiritually in a sense.

Charles Mattocks, executive producer

The diabetic stars of the show spoke in often bitter terms about their distaste for the drug industry and their desire to get off drugs for good.

We are naturally getting ourselves weaned off of this insulin, Lisa Campbell confidently told STAT.

In phone interviews nearly two months after returning home, three ofthe participants said they were on their way to reversing their diabetes. (Hughes, for his part, said he thought in terms of reversing his mindset.) They raved about their double-digit weight loss, their new diets packed with vegetables, and their reduced need for insulin. They were undaunted by the long odds they face in their quest to restore their health, saying that the mentoring they got on the show would give them an edge.

Even Roger Campbell, who hasnt managed to cut all of his unhealthy habits, speaks with pride about his progress. Sure, hes still smoking cigarettes, but hes down to half a pack a day, compared to a full pack a day before filming. And, yes, he hasnt given up soda completely, but hes replaced his bottle of Diet Coke every other day with a Coke Zero once a week. He credits those and other changes with cutting in half his use of insulin.

I actually feel like I am reversing my diabetes, Roger Campbell said. I hope to eradicate it completely.

Yet many of the challenges that shape their lives are unchanged: Roger Campbells congestive heart failure makes it hard for him to do much exercise. Lisa Campbell still struggles to see clearly and cooks her (newly healthy) breakfasts from her wheelchair. And money is still painfully tight. The couple remains reliant on food banks, where fresh produce can be limited.

Mattockss team recently released an pathos-heavytrailer for Reversed,which debuts at 7 p.m. on July 18.

Theres Rivera honing her arm muscles by stretching a resistance band. Hughes meditates, his eyes closed and hands clasped. Lisa Campbell splashesin the swimming pool. Gloved hands clean theopen wound on Roger Campbells leg stump. The cast member who quitwalksout the front door.

Five lives came for HOPE, banner text reads. Five lives will NEVER be the same.

New diabetes tech is coming. But will it make much difference?

Mattocks is already planning a second season. Another producer said theyrethinking about setting it in Latin America this time. Especially if next season we have a bigger budget and a bigger crew and a different location, I think we can rival any show out there, Mattocks mused.

In the meantime, hes begun marketing a new offering: a diabetes getaway, branded as the Reversed retreat, in the Jamaican resort house where the show was filmed.

For a week in September (just before the season finale of Reversed), instructors will be on hand to guide vacationers through the many of the same exercises the cast carried out for the cameras: early morning yoga. A juicing workshop. Group meditation.

The cost: up to $4,000 for the week, for those who spring for a private suite.

Airfare is not included.

Rebecca Robbins can be reached at rebecca.robbins@statnews.com Follow Rebecca on Twitter @rebeccadrobbins

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The Real World, Diabetes: As cameras roll at a Jamaican resort, desperate patients seek healing - STAT

HUNTINGTON Dr. Holly Cyphert of the Marshall University College of Health Professions has received a $10,000 grant from the West Virginia IDeA Network of Biomedical Research Excellence Chronic Disease Research Program toward her research of evaluating the role of bile acids in diabetes and obesity, according to a news release from the university.

Cyphert, a faculty member in the college's Department of Health Sciences, said she will be using patient samples to understand the distribution and concentration of bile acids and how they relate to body mass index and other indicators of cardio-metabolic health.

"In regard to bile acids, I have found multiple targets in multiple tissues, such as the liver and pancreas, that could aid in the reversal of diabetes," Cyphert said in the release. "My Ph.D. work focused on how FGF21 was enhanced with bile acid administration. Here at Marshall, I have data to support the notion that bile acids target insulin signaling in the pancreas."

Marshall students will have the opportunity to be involved in this research project, and Cyphert said she hopes through their work they will enhance their ability to perform research independently.

"I will have two to three students involved in this project. Some are involved in the blood donation from the study subjects, while others are involved in the analysis of mass spectrometry data," Cyphert said. "I hope my students will learn the scientific method and new techniques by assisting me with this project. Many students have a preconceived notion as to what research is (or is not). I hope to elaborate on their scientific curiosity and strengthen their ability to perform research on their own."

Cyphert said she has always been interested in diabetes and obesity research, especially growing up in the state that was once deemed the fattest in the nation.

"Growing up in West Virginia, I have witnessed firsthand the devastation of the disease and have been aiming toward making an impact in the community through the discovery of new therapeutic techniques."

Original post:
Obesity, diabetes research earns $10K - Huntington Herald Dispatch

Keeping blood glucose levels as close to normal as possible is important for people with type 2 diabetes, as it lowers the risk of serious complications. However, despite a long list of treatment options, patients still struggle with glucose control, especially when working out meal-specific doses. Treatments that cut down on injections are seen as a way to overcome this problem. Now, in a paper in Nature Biomedical Engineering, scientists describe a new biopolymer injection that could potentially replace daily or weekly insulin shots with one that need only be given once or twice per month.

Untreated diabetes results in high levels of blood sugar, or glucose, which in the long-term can lead to blindness, kidney disease, heart disease, stroke, and amputation of lower limbs.

Diabetes arises because of a problem with insulin, which is a hormone that is made in the pancreas and which helps cells to absorb glucose so that they can use it for energy.

In type 1 diabetes, the body does not make enough insulin, while in type 2 diabetes - which accounts for 90 to 95 percent of diabetes cases - it cannot use it properly.

Although the incidence of newly diagnosed diabetes is starting to drop in the United States, it is still a huge public health problem that affects more than 29 million people.

In 2013, the Centers for Disease Control and Prevention (CDC) suggested that diabetes was the seventh leading cause of death in the U.S., and that more than a fifth of the country's healthcare costs are for people diagnosed with diabetes.

In their study paper, biomedical engineers from Duke University in Durham, NC, explain that "despite the long list of treatment options," nearly half of type 2 diabetes cases in the U.S. "are not properly managed."

The researchers suggest that one reason for such a high rate of failure in the management of type 2 diabetes is that patients struggle to keep to treatment regimens, especially when they are required to frequently deal with complicated meal-specific doses.

Another reason they give is that many of the widely used treatments bring unwanted side effects, such as raising the risk of low blood sugar, known as hypoglycemia, or weight gain.

From a drug development point of view, one of the biggest challenges in treating diabetes is that insulin demands in the body are always changing.

In order to address this challenge, there are now treatments for type 2 diabetes that use a new class of drugs called glucagon-like peptide-1 (GLP1) receptor agonists. These drugs use GLP1, a signaling molecule, to trigger insulin release in the pancreas.

Because GLP1 does not last long in the body, drug developers have used various ways to extend its half-life - such as fusing it with various synthetic and biological compounds. These attempts have succeeded in extending the drug's active life in the human body for up to a week.

However, the researchers note that despite this improvement, so far none of the current treatments have solved the problem of the drug's effectiveness gradually decreasing over time.

The new approach that the Duke researchers describe fuses GLP1 with a heat-sensitive biopolymer called elastin-like polypeptide. Held in a solution, the biopolymer drug can be injected into the skin with a normal needle.

Once it is in the bloodstream, the heat of the body causes the biopolymer to form a biodegradable gel that releases the drug slowly and steadily, without the "peaks and troughs" associated with other forms of GLP1 delivery.

Using results from previous work on GLP1 for glucose control, the team tried different molecular designs of the new delivery solution.

They eventually found a design of the biopolymer that could control glucose levels in mice for up to 10 days with a single injection. This was a great improvement on previous attempts, after which the controlled release had only lasted for 2 or 3 days.

In tests on rhesus monkeys, the team found that the optimized formulation resulted in glucose control lasting for more than 14 days from a single injection. Also, the drug was released at a constant rate, without "peaks and troughs," during the whole period.

Senior author Ashutosh Chilkoti, a professor of biomedical engineering at Duke, says that they "managed to triple the duration of this short-acting drug for type 2 diabetes, outperforming other competing designs."

At present, patients using dulaglutide - the longest-lasting controlled release treatment for type 2 diabetes - have to inject themselves once per week. Patients on standard insulin treatments must inject themselves at least twice each day.

The team now plans to test the biopolymer on other animals and investigate how the immune system reacts to repeated injections. They also want to find out how well it performs for the controlled release of drugs in other areas, such as pain management.

"What's exciting about this work was our ability to demonstrate that the drug could last over 2 weeks in non-human primates. Because our metabolism is slower than monkeys and mice, the treatment should theoretically last even longer in humans, so our hope is that this will be the first bi-weekly or once-a-month formulation for people with type 2 diabetes."

First author Kelli Luginbuhl, Ph.D., student at Duke University

Learn how a gut bacteria compound may help to prevent type 2 diabetes.

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June 5, 2017 by Alvin Powell HMS instructors and Joslin doctors Elvira Isganaitis (left) and Florence Brown are co-authors of a JAMA op-ed urging the federal WIC program to cut out fruit juices. "When youre drinking a cup of apple juice, youre having a lot more calories than you would if you just ate a whole apple," Isganaitis said. Credit: Kris Snibbe/Harvard Staff Photographer

The twin epidemics of diabetes and obesity sweeping the country have forced a re-evaluation of the American diet, including the notion that fruit juice is a healthy alternative to soda.

That topic was taken up in a recent op-ed in the Journal of the American Medical Association. The article was written by Harvard Medical School Assistant Professor Florence Brown, director of the Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program; HMS instructor in pediatrics Elvira Isganaitis, a research associate and staff endocrinologist at the Joslin Diabetes Center; and Heather Ferris, a former Joslin research associate and now an assistant professor at the University of Virginia Medical School. The three recommended that fruit juice be cut from the federal WIC (Women, Infants, and Children) supplemental nutrition program for low-income families.

The change would make the WIC program healthier for the 25 percent of pregnant American women and 50 percent of children it benefits, Isganaitis said in an interview.

GAZETTE: What is wrong with juice? When I was growing up, people always thought fruit juice was healthy.

ISGANAITIS: Juice has some healthy aspects to it. It's a good source of vitamin C. If you're talking about 100 percent fruit juice, it contains a lot of the vitamins and phytonutrients that fruit contains. But if you've ever squeezed your own juice or tried to make apple cider, you'll know that it takes a lot of fruit to make a glass of juice. When you're drinking a cup of apple juice, you're having a lot more calories than you would if you just ate a whole apple. You're boosting calories and reducing the amount of fiber, so it winds up being a less healthful choice than eating the whole fruit.

GAZETTE: We've heard about avoiding extra calories, but how important is the fiber we miss by choosing juice over whole fruit?

ISGANAITIS: Higher fiber intake is healthful for lowering cholesterol levels and the risk of certain cancers. Higher fiber intake at a given meal is associated with a greater feeling of fullness or satiety. It's thought to reduce the degree to which your blood sugar levels will spike in response to a meal and help control your appetite at the next snack or meal. In general, North American diets, in particular the diets of kids, are pretty poor in fiber. So when you choose juice rather than a whole fruit you're really missing out on a lot of the fiber.

GAZETTE: When we talk about calories, fiber, and satiety, are we really talking about obesity?

ISGANAITIS: Absolutely. Just thinking of obesity in energetic terms, it stems from a mismatch between your energy in and your energy output. So that's really what's happened to Western/North American food patterns over the last 30 to 40 years. There are just so many opportunities to max out your energy intake while at the same time we have become more and more sedentary. With juice being a ready source of quickly absorbed calories, it's being scrutinized for its contribution to obesity. It's been shown to contribute to excessive weight gain in the Nurses' Health Study, based at the Harvard T.H. Chan School of Public Health, as well as weight gain during early childhood.

GAZETTE: Should people get it out of their heads that juice is healthy?

ISGANAITIS: Absolutely. They should continue to view fruits and vegetables as healthy, but in processing those things into juice, you really miss out on a lot of their healthful nutritional aspects. The reason we got together and wrote this op-ed is that, as diabetes and obesity specialists, we spend a lot of our time trying to dispel nutritional myths. People will often come to us having already received some nutritional information. They're aware that they're dealing with a weight problem or they have prediabetes. Oftentimes they will say, "I've cut out soda, now I only drink juice." But you can potentially pack in the same amount of calories drinking juice as soda. Sure, you get a little bit more vitamin C, but in terms of combating obesity, you don't really make much progress that way.

GAZETTE: The op-ed focuses on juice in the federal government's WIC program.

ISGANAITIS: WIC is a supplemental nutrition program specifically targeting pregnant and nursing women, [different from] SNAP, the food stamp program. They're managed a little bit differently. The food stamp program is basically a voucher program and participants are free to choose whatever grocery items they would normally buy. The WIC program is set up really to promote the consumption of healthy and nutritious foods. You actually can't use WIC to buy junk food. The types of bread and cereals, for example, that you can buy through WIC have to be high in fiber, whole grain, no added sugar. Given that it's set up to improve the nutritional quality of the diet of these mothers and their children, it caught our attention that WIC continues to provide juice, which I, as a pediatric endocrinologist, and my colleagues Dr. Brown and Dr. Ferris just don't really view as a healthy food.

GAZETTE: And does the WIC population have a greater obesity problem than the general population?

ISGANAITIS: Unfortunately, yes. In this country, obesity disproportionately affects low-income populations, who are by definition the populations that are targeted by this nutritional assistance program. Food insecurity, which the USDA defines as a situation of "limited or uncertain availability of nutritionally adequate and safe foods" is increasingly recognized to be a risk factor, not for being underweight, as was previously thought, but rather for obesity and diabetes. So, even though the amount of juice that has been provided by WIC historically has gone down, by continuing to provide some juice, this is just adding one more risk factor to the many obesity risk factors this population is already known to have.

GAZETTE: Is there a review coming up during which these changes could be suggested?

ISGANAITIS: There is. The WIC food package is congressionally mandated to be reviewed every 10 years, and the framework for revisions will be released later this year. The National Academies of Science, Engineering, and Medicine recently reviewed the current WIC food package and recommended that the program increase the amounts of vegetables, fruits, fish, and whole grains, and reduce the subsidy for fruit juice.

GAZETTE: Is this an opportunity to make a dent in the broader obesity problem?

ISGANAITIS: Absolutely. Unfortunately, a really large percentage of children and mothers in the U.S. live in poverty. Children in the U.S. are 1.5 [times] more likely to live in poverty than adults. Sadly, children are overrepresented in the poor. Whereas children accounted for 24 percent of the total U.S. population in the 2010 census, they made up 36 percent of individuals living in poverty.

WIC is a program that really has the potential to impact multiple generations at once. Increasing data, including some from my research group at Joslin Diabetes Center and others in the Harvard Medical School community, are supporting the concept that a healthy mom who's at an optimal weight as she enters pregnancy is less likely to have children who are overweight or obese or develop diabetes in later life. So, by fine-tuning a mom's nutrition when she's pregnant and nursing her child, you have the ability to benefit her nutrition and health as well as her children's. It's a really high-impact intervention.

Explore further: No fruit juice before age 1, pediatricians say

More information: Heather A. Ferris et al. Time for an End to Juice in the Special Supplemental Nutrition Program for Women, Infants, and Children, JAMA Pediatrics (2017). DOI: 10.1001/jamapediatrics.2017.0134

This story is published courtesy of the Harvard Gazette, Harvard University's official newspaper. For additional university news, visit Harvard.edu.

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Diabetes specialists seek to push WIC program away from juice - Medical Xpress

Dr. Tiffany Pankow, Special for The Republic | azcentral.com 7:00 a.m. MT June 2, 2017

Dr. Tiffany Pankow(Photo: HonorHealth)

Question: What can I do to prevent becoming diabetic?

Answer: More than one in three Americans has prediabetes, and 90 percent of them dont know it.

With prediabetes, your blood sugar levels are impaired but arent high enough to be diagnosed as diabetes. Because most people dont have symptoms, it can go undetected without screening.

Unfortunately, many with this condition will develop diabetes within a short time if the condition isnt addressed.

If you have prediabetes, youre at increased risk for heart disease and stroke. If diabetes develops, add blindness, kidney failure, and loss of limb from amputation to the risk list.

The good news is that you often can prevent diabetes with healthy lifestyle modifications, education, and sometimes, medication.

Identifying the early stages of glucose impairment before diabetes develops is an important way to reverse and prevent chronic disease.

If you have one or more of the following risk factors, talk to your doctor about screening for prediabetes with a blood test:

If you have prediabetes or are at risk for developing diabetes, several lifestyle changes can greatly decrease your risk. Although making lifestyle changes can be challenging, even small adjustments can have lasting results:

Losing 5-7 percent of your body weight can prevent or delay the progression to diabetes.

Replacing processed and packaged food with vegetables, fruits and lean protein such as chicken, fish, and turkey improves nutrition and decreases calories.

Avoiding white flour in pasta, pastries and bagels and instead choosing whole-grain options for carbohydrates can improve blood sugar levels.

Increasing exercise to a goal of 150 minutes per week and getting enough restful sleep can also help lower glucose levels and prevent diabetes.

Managing stress is another important component of a healthy lifestyle.

Limiting added sugar in foods to 25 grams (6 teaspoons) a day for women and 37.5 grams (9 teaspoons) for men is an American Heart Association recommendation.

For more information or to find a doctor to help you with screening or treatment for prediabetes, visit honorhealth.com/medical-services/primary-care.

Tiffany Pankow, MD, specializes in family medicine with HonorHealth Medical Group. She can be reached at 480-882-7360 or visit https://www.honorhealth.com/physicians/tiffany-pankow

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Ask a Doc: At risk for diabetes? Simple lifestyle changes could save your life - AZCentral.com