Category Archives: Diabetes

In a recent meta-analysis, researchers found that new direct oral anticoagulants (NOACs) demonstrated lower rates of stroke or systemic embolism (SSE), ischemic stroke, and hemorrhagic stroke in patients with nonvalvular atrial fibrillation (NVAF) and diabetes mellitus compared with warfarin. Additionally, NOACs did not significantly increase the risk of major bleeding. The results were published in the Journal of Translational Medicine.

The researchers assessed 5 retrospective studies and 4 subgroup analyses of randomized controlled trials from the PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases. The pooled cohort included 267,272 patients.

According to the authors, NOACs significantly reduced SSE risk compared with warfarin (pooled hazard ratio [HR], 0.80; 95% CI, 0.74-0.85) in both types of studies. NOACs also appeared to reduce major bleeding risk for patients with atrial fibrillation and diabetes mellitus (pooled HR, 0.85; 95% CI, 0.73-0.99), though the authors noted there was significant heterogeneity among the included studies.

Additionally, the researchers found differences between NOACs and warfarin in risk for the following outcomes:

Despite limitations, including not assessing additional diabetes mellitus biomarkers, as well as potential biases across the included studies, the authors ultimately suggested NOACs may be a better choice for anticoagulation in patients with NVAF and diabetes.

Find Related Articles and Interviews at the Atrial Fibrillation Knowledge Hub

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NOACs or Warfarin in Atrial Fibrillation With Diabetes - DocWire News

New research reports that type 1 diabetes may be tougher on girls than boys due to higher blood sugar levels, weight issues, and higher cholesterol.

Girls may also deal with higher rates of depression and have lower overall scores gauging quality of life.

The review of 90 previous studies done by researchers at Amsterdam University Medical Centers stated there are some consistent patterns in how type 1 diabetes affects girls and boys differently.

The findings were presented at the annual meeting of the European Association for the Study of Diabetes in Stockholm.

The review has not been published yet in a peer-reviewed journal.

In their review, the researchers reported, girls showed higher A1C levels a measure of blood sugar control over the previous three months than boys. Girls also had a higher rate of obesity and high cholesterol, along with lower scores on the quality of life surveys.

Type 1 diabetes usually occurs in childhood and affects more than 1.45 million people in the United States

It involves a persons immune system mistakenly attacking pancreatic cells that produce insulin a hormone responsible for moving food sugar into body cells for energy. Without insulin, sugar builds up in the blood, starving body cells. That requires people with type 1 diabetes to take synthetic insulin.

In terms of this research about type 1 diabetes being tougher on girls than boys, when it comes to weight gain and blood sugar levels, this information is new to the medical community, but its not necessarily surprising Dr. Abiona Redwood, an instructor in the Family Medicine residency Program at Community Health of South Florida, told Healthline. Thats because when it comes to weight gain, girls and women experience three periods of weight gain: puberty, which the report touched on, pregnancy, and menopause. Its a lot harder for girls and women to lose weight when they go through those things.

Just imagine adding to that type 1 diabetes and the different hormonal changes caused by menstruation that can also have an effect and happens 12 times a year for girls and women with ordinary period cycles, Redwood added. Girls also arrive at puberty two years before boys do, and as early as age eight.

Girls, especially during puberty, experience frequent hormonal changes, whereas with boys, hormonal changes tend to be gradual, and they dont experience these monthly changes, Redwood noted. A lot of this is physical, especially when the hormonal changes affect blood sugar. The up-and-down hormonal movements are going to prove a significant factor when it comes to weight gain.

Also, historically, girls have had greater issues about body image, she added. What I have seen among my patients, is that as girls with type 1 diabetes enter their teens the pressures of family and social obligations can make them prone to neglecting their diabetes treatment. Too often parents assume, as their girls enter their teens, they will be more responsible about their diabetes, but quite often its the opposite and this is precisely the time when these girls need extra parental support when it comes to maintaining medication discipline. This is a time of increasing and competing concerns for these girls, after all.

Dana Ellis Hunnes a senior clinical dietitian at UCLA Medical Center and assistant professor at UCLA Fielding School of Public Health, told Healthline that women and girls have typically not received as much attention as study subjects as men.

That could explain why girls having more difficulty with type 1 diabetes is only now coming to light.

I believe there are more pressures on girls, even at a younger age, to appear in certain ways or behave in certain ways, Hunnes said. There is, of course, also the biological component, girls according to this study had higher BMI at diagnosis and poorer glucose control so some of that may be biological insulin/hormone production -and some of it may be psychological.

Girls may have earlier onset of beta-cell destruction the cells that secrete insulin than boys do, which is why they are diagnosed at a younger age, she added. It may also be that they live with the condition longer before diagnosis and so that could leave them with higher blood sugar levels. It may also be psychological in the sense that girls may want to fit in more at a younger age than boys and so, may be more willing to assimilate their eating habits to the crowd.

Dr. Eva Shelton, a physician at Brigham and Womens Hospital in Seattle, told Healthline there could also be a body composition issue.

Women tend to have more adipose tissue (used for fat storage) as opposed to lean muscle, compared to men, Shelton said. Women are also more likely to eat as a coping mechanism than boys. The increase in adipose tissue and lipid content in women predisposes to insulin resistance, and that combined with uncontrolled snack eating leads to high blood sugars and more severe diabetes.

Dr. Robin Dickinson is a family practitioner in Englewood, Colorado. Shes also the founder of Dr. Robins School, a human biology program for children in third to eighth grade.

Dickinson told Healthline that teaching kids about type 1 diabetes stands out to her, and not just because she pokes her finger with a lancet to demonstrate how kids check their blood sugar.

More than any other condition, the kids with diabetes are constantly receiving messages from people around them teachers, friends parents, other kids about what they should and should not be doing, Dickinson said. Kids with diabetes, especially girls, are often told that they shouldnt eat particular foods or shouldnt be exercising or should worry about their blood sugar or weight by anyone who knows they are diabetic or sees them checking their sugars.

Dickinson said its important not to alienate children who do develop diabetes.

As in so many other areas, girls come in for more of this, Dickinson said. People worry more, try to limit their physical activity more, try to limit their eating more. Yes, they need to watch their sugars, but that isnt everyones business. The best way to be a friend to a girl with diabetes is to treat them like a normal kid and not invade their privacy with lots of shoulds and shouldnts.

Hunnes added that the research shows doctors should treat girls with type I diabetes differently than boys.

We know from adults that women experience heart attacks differently than men do and, as such, should be treated differently, as far as determining the diagnosis, she said. We know that women have menstrual cycles each month (on average) that can affect hormones all over their body, and as such, may need different varieties of treatment than boys, psychologically, and possibly medically/biologically as well.

If there are psychological components to higher blood sugars, then I also think it is important for the doctor to understand what is happening there as well. Medicine cannot be one-size-fits-all, Hunnes added.

Excerpt from:
Why Type 1 Diabetes Is Tougher on Girls Than Boys - Healthline

STOCKHOLM Recent study results confirm that two agents from the sodium-glucose cotransporter 2 (SGLT2) inhibitor class can significantly cut the incidence of adverse cardiovascular events in patients with heart failure with reduced ejection fraction (HFpEF), a disease especially common in people with type 2 diabetes, obesity, or both.

And findings from secondary analyses of the studies including one reported last week during the European Association for the Study of Diabetes (EASD) 2022 Annual Meeting show that these SGLT2 inhibitors work as well for cutting incident adverse events (cardiovascular death or worsening heart failure) in patients with HFpEF and diabetes as they do for people with normal blood glucose levels.

But delivering treatment with these proven agents, dapagliflozin (Farxiga) and empagliflozin (Jardiance), first requires diagnosis of HFpEF, a task that clinicians have historically fallen short in accomplishing.

When a year ago, results from the EMPEROR-Preserved trial with empagliflozin and when a few weeks ago results from the DELIVER trial with dapagliflozin established the efficacy of these two SGLT2 inhibitors as the first treatments proven to benefit patients with HFpEF, they also raised the stakes for clinicians to be much more diligent and systematic in evaluating people at high risk for developing HFpEF because of having type 2 diabetes or obesity, two of the most potent risk factors for this form of heart failure.

"Vigilance for HFpEF needs to increase because we can now help these patients," declared Lars H. Lund, MD, PhD, speaking at the meeting. "Type 2 diabetes dramatically increases the incidence of HFpEF," and the mechanisms by which it does this are "especially amenable to treatment with SGLT2 inhibitors," said Lund, a cardiologist and heart failure specialist at the Karolinska Institute, Stockholm.

HFpEF has a history of going undetected in people with type 2 diabetes, an ironic situation given its high incidence as well as the elevated rate of adverse cardiovascular events when heart failure occurs in patients withtype 2 diabetes compared with patients who do not have diabetes.

The key, say experts, is for clinicians to maintain a high index of suspicion for signs and symptoms of heart failure in people with type 2 diabetes and to regularly assess them, starting with just a few simple questions that probe for the presence of dyspnea, exertional fatigue, or both, an approach not widely employed up to now.

Clinicians who care for people with type 2 diabetes must become "alert to thinking about heart failure and alert to asking questions about signs and symptoms" that flag the presence of HFpEF, advised Naveed Sattar, MBChB, PhD, a professor of metabolic medicine at the University of Glasgow, United Kingdom.

Soon, medical groups will issue guidelines for appropriate assessment for the presence of HFpEF in people with type 2 diabetes, Sattar predicted in an interview.

"You can't simply ask patients with type 2 diabetes whether they have shortness of breath or exertional fatigue and stop there," because often their first response will be no.

"Commonly, patients will initially say they have no dyspnea, but when you probe further, you find symptoms," noted Mikhail N. Kosiborod, MD, co-director of Saint Luke's Cardiometabolic Center of Excellence in Kansas City, Missouri.

These people are often sedentary, so they frequently don't experience shortness of breath at baseline, Kosiborod said in an interview. In some cases, they may limit their activity because of their exertional intolerance.

Once a person's suggestive symptoms become known, the next step is to measure the serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker considered to be a generally reliable signal of existing heart failure when elevated.

Any value above 125 pg/mL is suggestive of prevalent heart failure and should lead to the next diagnostic step of echocardiography, Sattar said.

Elevated NT-proBNP has such good positive predictive value for identifying heart failure that it is tempting to use it broadly in people with type 2 diabetes. A consensus report from the American Diabetes Association that was published earlier this year says that "measurement of a natriuretic peptide [such as NT-proBNP] or high-sensitivity cardiac troponin is recommended on at least a yearly basis to identify the earliest HF [heart failure] stages and implement strategies to prevent transition to symptomatic HF."

But because of the relatively high current price for an NT-proBNP test, the cost-benefit ratio for widespread annual testing of all people with type 2 diabetes would be poor, some experts caution.

"Screening everyone may not be the right answer. Hundreds of millions of people worldwide" have type 2 diabetes. "You first need to target evaluation to people with symptoms," advised Kosiborod.

He also warned that a low NT-proBNP level does not always rule out HFpEF, especially among people with type 2 diabetes who also have overweight or obesity, because NT-proBNP levels can be "artificially low" in people with obesity.

Other potential aids to diagnosis are assessment scores that researchers have developed, such as the H2FPEF score, which relies on variables that include age, obesity, and the presence of atrial fibrillation and hypertension.

However, this score also requires an echocardiography examination, another test that would have a questionable cost-benefit ratio if performed widely for patients with type 2 diabetes without targeting, Kosiborod said.

A prespecified analysis of the DELIVER results that divided the study cohort on the basis of their glycemic status proved the efficacy of the SGLT2 inhibitor dapagliflozin for patients with HFpEF regardless of whether or not they had type 2 diabetes, prediabetes, or were normoglycemic at entry into the study, Silvio E. Inzucchi, MD, reported at the EASD meeting.

Treatment with dapagliflozin cut the incidence of the trial's primary outcome of cardiovascular death or worsening heart failure by a significant 18% relative to placebo among all enrolled patients.

The new analysis reported by Inzucchi showed that treatment was associated with a 23% relative risk reduction among those with normoglycemia, a 13% reduction among those with prediabetes, and a 19% reduction among those with type 2 diabetes, with no signal of a significant difference among the three subgroups.

"There was no statistical interaction between categorical glycemic subgrouping and dapagliflozin's treatment effect," concluded Inzucchi, director of the Yale Medicine Diabetes Center, New Haven, Connecticut.

He also reported that among the 6259 people in the trial with HFpEF, 50% had diabetes, 31% had prediabetes, and a scant 19% had normoglycemia. The finding highlights once again the high prevalence of dysglycemia among people with HFpEF.

Previously, a prespecified secondary analysis of data from the EMPEROR-Preserved trial yielded similar findings for empagliflozin that showed the agent's efficacy for people with HFpEF across the range of glucose levels.

The DELIVER trial was funded by AstraZeneca, the company that markets dapagliflozin (Farxiga). The EMPEROR-Preserved trial was sponsored by Boehringer Ingelheim and Eli Lilly, the companies that jointly market empagliflozin (Jardiance). Lund has been a consultant to AstraZeneca and Boehringer Ingelheim and to numerous other companies, and he is a stockholder in AnaCardio. Sattar has been a consultant to and has received research support from AstraZeneca and Boehringer Ingelheim, and he has been a consultant to Eli Lilly, Afimmune, Amgen, Hammi, Merck Sharpe & Dohme, Novartis, Novo Nordisk, Pfizer, Roche, and Sanofi-Aventis. Kosiborod has been a consultant to and has received research funding from AstraZeneca and Boehringer Ingelheim and has been a consultant to Eli Lilly and numerous other companies. Inzucchi has been a consultant to and has given talks on behalf of AstraZeneca and Boehringer Ingelheim. He has also been a consultant to or has served on trial committees for Abbott, Esperion, Lexicon, Merck, Novo Nordisk, Pfizer, and vTv Therapetics.

European Association for the Study of Diabetes (EASD) 2022 Annual Meeting:Presented September 22, 2022.

Mitchel L. Zoler is a reporter with Medscape and MDedge based in the Philadelphia area. @mitchelzoler

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

You can also follow Medscape on Instagram, YouTube and Linkedin.

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Improve Diagnosis of Type of Heart Failure Common in Diabetes - Medscape

DUBLIN, Sept. 30, 2022 /PRNewswire/ -- The "Next Generation Diabetes Therapy and Drug Delivery Market By Product, By Demographic, By Indication, By End User: Global Opportunity Analysis and Industry Forecast, 2020-2030" report has been added to ResearchAndMarkets.com's offering.

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The global next generation diabetes therapy and drug delivery market was valued at $7,080.6 million in 2020 and is projected to reach $28,044.23 million by 2030, registering a CAGR of 14.28% from 2021 to 2030.

The next generation diabetes therapy and the drug delivery devices are the advanced form of diabetic products that improve the quality of life of diabetic patients. These products help in the management of the blood glucose level of diabetic patient in minimally invasive manner. Oral and inhalable insulin introduce a different mode of insulin delivery in diabetic patients. It is a painless mode of introducing insulin than the injectable insulins, reducing the risk of skin irritation caused due to needles.

In addition, the dose volume is easily calculated in oral & inhalable insulin and helps to maintain the dosage time. Advanced diabetic therapy in the form of insulin patches, continuous glucose monitoring systems (CGMS), and artificial pancreas helps to improve management of blood sugar level and reduces the risk of any diabetic-related complications.

The main factors that drive the growth of the next generation diabetes therapy and the drug delivery market include, the benefits of using these advanced devices over conventional products and rise in the healthcare expenditure.

In addition, rise in incidences of diabetes globally and increase in the disposable income among the diabetic patients, further supplement the global next generation diabetes therapy and drug delivery market growth.

Conversely lack of awareness, cost restrains in the developing regions, and less variability in products are expected to obstruct the growth of the market during forecast years. On the other hand, development of affordable products with fewer side effects and presence of undiagnosed diabetic patients globally are expected to offer profitable opportunities for the growth of the market during the forecast period.

The global next generation diabetes therapy and drug delivery market is segmented based on product, demographic, indication, end user, and region. On the basis of product, it is classified into inhalable insulin, oral insulin, insulin patches, CGM systems, and artificial pancreas. On the basis of demographics, it is bifurcated into adult population (>14 years) and child population (?14 years). By indication, it is divided into type 1 diabetes and type 2 diabetes. On the basis of end users, it is categorized into diagnostics/clinics, ICUs, and home healthcare. Region-wise, the market is analyzed across North America, Europe, Asia-Pacific, and LAMEA.

The key market players profiled in the report include Abbott Laboratories, Medtronic, Inc., Sanofi S.A., Novo Nordisk, MannKind Corporation, Eli Lilly and Company, Dexcom, Inc., Senseonics Holding, Inc., Glysens Incorporated, and Johnson & Johnson.

Story continues

Key Benefits For Stakeholders

This report provides a quantitative analysis of the market segments, current trends, estimations, and dynamics of the next generation diabetes therapy and drug delivery market analysis from 2020 to 2030 to identify the prevailing next generation diabetes therapy and drug delivery market opportunities.

The market research is offered along with information related to key drivers, restraints, and opportunities.

Porter's five forces analysis highlights the potency of buyers and suppliers to enable stakeholders make profit-oriented business decisions and strengthen their supplier-buyer network.

In-depth analysis of the next generation diabetes therapy and drug delivery market segmentation assists to determine the prevailing market opportunities.

Major countries in each region are mapped according to their revenue contribution to the global market.

Market player positioning facilitates benchmarking and provides a clear understanding of the present position of the market players.

The report includes the analysis of the regional as well as global next generation diabetes therapy and drug delivery market trends, key players, market segments, application areas, and market growth strategies.

Key Topics Covered:

CHAPTER 1: INTRODUCTION

CHAPTER 2: EXECUTIVE SUMMARY

CHAPTER 3: MARKET OVERVIEW3.1. Market definition and scope3.2. Key findings3.2.1. Top investment pockets3.3. Porter's five forces analysis3.4. Top player positioning3.5. Market dynamics3.5.1. Drivers3.5.2. Restraints3.5.3. Opportunities3.6. COVID-19 Impact Analysis on the market

CHAPTER 4: NEXT GENERATION DIABETES THERAPY AND DRUG DELIVERY MARKET, BY PRODUCT4.1 Overview4.1.1 Market size and forecast4.2 Inhalable Insulin4.2.1 Key market trends, growth factors and opportunities4.2.2 Market size and forecast, by region4.2.3 Market analysis by country4.3 Oral Insulin4.3.1 Key market trends, growth factors and opportunities4.3.2 Market size and forecast, by region4.3.3 Market analysis by country4.4 Insulin Patches4.4.1 Key market trends, growth factors and opportunities4.4.2 Market size and forecast, by region4.4.3 Market analysis by country4.5 CGM Systems4.5.1 Key market trends, growth factors and opportunities4.5.2 Market size and forecast, by region4.5.3 Market analysis by country4.6 Artificial Pancreas4.6.1 Key market trends, growth factors and opportunities4.6.2 Market size and forecast, by region4.6.3 Market analysis by country

CHAPTER 5: NEXT GENERATION DIABETES THERAPY AND DRUG DELIVERY MARKET, BY DEMOGRAPHIC5.1 Overview5.1.1 Market size and forecast5.2 Adult Population (>14years)5.2.1 Key market trends, growth factors and opportunities5.2.2 Market size and forecast, by region5.2.3 Market analysis by country5.3 Child Population (14years)5.3.1 Key market trends, growth factors and opportunities5.3.2 Market size and forecast, by region5.3.3 Market analysis by country

CHAPTER 6: NEXT GENERATION DIABETES THERAPY AND DRUG DELIVERY MARKET, BY INDICATION6.1 Overview6.1.1 Market size and forecast6.2 Type 1 Diabetes6.2.1 Key market trends, growth factors and opportunities6.2.2 Market size and forecast, by region6.2.3 Market analysis by country6.3 Type 2 Diabetes6.3.1 Key market trends, growth factors and opportunities6.3.2 Market size and forecast, by region6.3.3 Market analysis by country

CHAPTER 7: NEXT GENERATION DIABETES THERAPY AND DRUG DELIVERY MARKET, BY END USER7.1 Overview7.1.1 Market size and forecast7.2 Diagnostic/Clinics7.2.1 Key market trends, growth factors and opportunities7.2.2 Market size and forecast, by region7.2.3 Market analysis by country7.3 ICUs7.3.1 Key market trends, growth factors and opportunities7.3.2 Market size and forecast, by region7.3.3 Market analysis by country7.4 Home Healthcare7.4.1 Key market trends, growth factors and opportunities7.4.2 Market size and forecast, by region7.4.3 Market analysis by country

CHAPTER 8: NEXT GENERATION DIABETES THERAPY AND DRUG DELIVERY MARKET, BY REGION

CHAPTER 9: COMPANY LANDSCAPE9.1. Introduction9.2. Top winning strategies9.3. Product Mapping of Top 10 Player9.4. Competitive Dashboard9.5. Competitive Heatmap9.6. Key developments

CHAPTER 10: COMPANY PROFILES10.1 Abbott laboratories10.1.1 Company overview10.1.2 Company snapshot10.1.3 Operating business segments10.1.4 Product portfolio10.1.5 Business performance10.1.6 Key strategic moves and developments10.2 Dexcom, Inc10.2.1 Company overview10.2.2 Company snapshot10.2.3 Operating business segments10.2.4 Product portfolio10.2.5 Business performance10.2.6 Key strategic moves and developments10.3 Eli Lilly and Company10.3.1 Company overview10.3.2 Company snapshot10.3.3 Operating business segments10.3.4 Product portfolio10.3.5 Business performance10.3.6 Key strategic moves and developments10.4 Glysens Incorporated10.4.1 Company overview10.4.2 Company snapshot10.4.3 Operating business segments10.4.4 Product portfolio10.4.5 Business performance10.4.6 Key strategic moves and developments10.5 Johnson & Johnson10.5.1 Company overview10.5.2 Company snapshot10.5.3 Operating business segments10.5.4 Product portfolio10.5.5 Business performance10.5.6 Key strategic moves and developments10.6 MannKind Corporation10.6.1 Company overview10.6.2 Company snapshot10.6.3 Operating business segments10.6.4 Product portfolio10.6.5 Business performance10.6.6 Key strategic moves and developments10.7 Medtronic plc10.7.1 Company overview10.7.2 Company snapshot10.7.3 Operating business segments10.7.4 Product portfolio10.7.5 Business performance10.7.6 Key strategic moves and developments10.8 Novo Nordisk A/S10.8.1 Company overview10.8.2 Company snapshot10.8.3 Operating business segments10.8.4 Product portfolio10.8.5 Business performance10.8.6 Key strategic moves and developments10.9 Sanofi S.A.10.9.1 Company overview10.9.2 Company snapshot10.9.3 Operating business segments10.9.4 Product portfolio10.9.5 Business performance10.9.6 Key strategic moves and developments10.10 Senseonics Holdings, Inc.10.10.1 Company overview10.10.2 Company snapshot10.10.3 Operating business segments10.10.4 Product portfolio10.10.5 Business performance10.10.6 Key strategic moves and developments

For more information about this report visit https://www.researchandmarkets.com/r/1ixrhs

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Insights on the Next Generation Diabetes Therapy and Drug Delivery Global Market to 2030 - Rising Incidences of Diabetes Globally and Increase in the...

Knockout of TXNIP improves diabetes-associated hyperglycemia and hyperglucagonemia.

Anath Shalev, M.D.In groundbreaking diabetes research over the past two decades, Anath Shalev, M.D., has shown that the protein TXNIP regulates survival and function of beta cells, the pancreatic cells that produce the hormone insulin to lower levels of glucose in the blood. Downregulation or inhibition of TXNIP in beta cells protects against diabetes in mouse models, and a repurposed clinical drug that inhibits TXNIP shows promising results in people with recent-onset Type 1 diabetes.

Beta cells play a key role in the pathogenesis of both Type 1 and Type 2 diabetes. However, pancreatic islets also have alpha cells that produce the hormone glucagon, which acts to raise glucose blood levels. Together, insulin and glucagon keep blood glucose levels stable.

To further understand the role of TXNIP in pancreatic islet biology and glucose control, Shalev and colleagues at the University of Alabama at Birmingham now report the effect of knocking out TXNIP in alpha cells.

While not as dramatic as beta-cell TXNIP knockouts, the alpha-cell knockout improved diabetes-associated hyperglycemia and hyperglucagonemia in a mouse model of streptozotocin-induced diabetes. Hyperglycemia and hyperglucagonemia excess levels of glucose and glucagon in the blood are hallmarks of diabetes.

The alpha-cell knockouts, known as aTKO mice, had normal glucose homeostasis and no gross abnormalities when fed on regular chow food. However, when the aTKO mice were fed a high-fat diet for 30 weeks to create glucose intolerance, they had a reduced high-fat diet-induced glucose intolerance compared to control mice on the high-fat diet. Glucose intolerance is an impaired ability to respond to a surge of dietary glucose.

In the knockout mice, there was no change in the architecture of the aTKO islets and the alpha cell numbers were unchanged. Furthermore, the expression levels of the glucagon gene and key islet transcription factors showed no change. However, glucagon secretion was decreased more than twofold in the aTKO islets compared to controls.

Out of five proteins recently reported to be involved in alpha cell glucagon expression, only one, Grp78, had significantly changed expression in the aTKO islets. This protein was recently confirmed to interact with glucagon in secretory granules, and it acts as a molecular chaperone in the cells endoplasmic reticulum, the transportation system of the cell where proteins are produced.

Thus, it appears that downregulation of alpha cell TXNIP can inhibit alpha cell glucagon secretion, which in turn may help explain the improvement in hyperglucagonemia and hyperglycemia observed in diabetic aTKO mice.

Interestingly, we recently found that pharmacological inhibition of TXNIP with a small molecule inhibitor also resulted in decreased alpha cell glucagon secretion in vitro in alphaTC1-6 cells and in vivo in different diabetes mouse models, said Shalev, director of the UAB Comprehensive Diabetes Center and professor in the Department of Medicine Division of Endocrinology, Diabetes and Metabolism. These findings strongly support our current results using genetic TXNIP deletion and together suggest that alterations in TXNIP regulate alpha cell glucagon secretion.

Co-authors with Shalev on the paper, Alpha cell TXNIP deletion improves diabetes-associated hyperglycemia and hyperglucagonemia, published in the journal Endocrinology, are Brian Lu, Junqin Chen, Guanlan Xu, Truman B. Grayson, Gu Jing and SeongHo Jo, all members of the UAB Comprehensive Diabetes Center and the UAB Department of Medicine, Division of Endocrinology, Diabetes and Metabolism.

Support came from National Institutes of Health grants DK078752 and Human Islet Research Network DK120379.

At UAB, Shalev holds the Nancy R. and Eugene C. Gwaltney Family Endowed Chair in Juvenile Diabetes Research. Medicine is a department in the Marnix E. Heersink School of Medicine.

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Diabetes: TXNIP involved in increased secretion of glucagon from pancreatic alpha cells - University of Alabama at Birmingham

Background

Type 2 diabetes mellitus (T2DM) is a common disorder worldwide. Impaired control of glucose levels predisposes to renal dysfunction, detected by a diagnosis of microalbuminuria. Several other risk factors have been identified in the development of microalbuminuria, such as hypertension, smoking, dyslipidemia, and obesity.

Assessment of microalbuminuria and cardiovascular risk factors in type-II diabetic patients who attended the outpatient clinic for the internal medicine department at King Fahd University Hospital, Al-Khobar.

A retrospective cross-sectional and an observational study included data from 2014 to 2022 collected from medical records. Patients with diabetes type-II and aged 18 years were included. The following were reviewed (age, sex, height, weight, body mass index, waist, hip, waist-hip ratio, systolic and diastolic blood pressure, smoking, sedentary lifestyle, diagnosis of dyslipidemia/hypertension, diabetes duration in years) and laboratory results (fasting blood glucose, HbA1C%, estimated glomerular filtration rate, serum creatinine, serum cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides). Microalbuminuria was measured by the urine albumin to creatinine ratio and was diagnosed if levels were 30-300 mg/g.

Among 301 studied patients, the prevalence of microalbuminuria was found at 36.8%. The mean age was 57.8 12.6 years, and females were 45%. The mean SD fasting blood glucose was 165.9 71.9 mg/dL, while HbA1C% was 8.8 5.6. Microalbuminuria was significantly associated with age, diabetes duration, systolic blood pressure, HbA1C%, fasting blood glucose, and triglyceride levels (p0.05).

Microalbuminuria in T2DM patients was high in this study, which emphasizes the need for early detection of microalbuminuria. The study suggests the need for effective diabetes control and the prevention of associated cardiovascular risk factors.

Microalbuminuria is an early representative of renal damage or nephropathy in diabetic patients. Microalbuminuria is defined as the increase in urine albumin excretion (30-300 mg/day) or (20-200 mg/day). Urine albumin/creatinine ratio (urine ACR) is the preferred screening approach. Microalbuminuria is diagnosed when urine ACR levels range from 30 to 300 mg/g [1]. Diabetic nephropathyaffects around one-third ofpatients with type 2 diabetes mellitus (T2DM) in Saudi Arabia [2].It has the highest rate when compared to the global incidence of end-stage renal disease caused by diabetic nephropathy [3]. Hence, screening for microalbuminuria in diabetic patients can help in the early detection of diabetic nephropathy and the prevention of further complications.

Hypertension, smoking, hyperglycemia, dyslipidemia, and overweight or obesity are all cardiovascular risk factors that have been associated with the development ofmicroalbuminuria [4]. Glycation of the glomerular basement membrane can occur as a consequence of chronic hyperglycemia and inadequate glycemic management. This, in turn, leads to the progression of diabetic nephropathy as a result of a high glomerular filtration rate and low filtration capacity [5]. Hypertension has been associated with a higher risk of cardiovascular disease. As a result, it causes proteinuria and reduced renal function. Albumin exertion in the urine has been linked to hydrostatic pressure alterations in the afferent glomerulus, increased leakage of the glomerular basal membrane, and poor tubular function in hypertensive patients [6].

Recent studies have concluded that diabetic nephropathy progression is associated with dyslipidemia. High levels of blood total cholesterol (TC), low-density lipoprotein (LDL), serum triglycerides (TG), and low levels of high-density lipoprotein (HDL) characterize diabetic dyslipidemia [7]. Since albuminuria is substantially related to high levels of total cholesterol, the presence of dyslipidemia can be used as an assessment tool for microalbuminuria among patients with T2DM[8]. Cigarette smoking has an independent association with increasing levels of urine albumin. When compared to non-smokers, patients with T2DM who were current smokers had an increased incidence of microalbuminuria per year [9].

Body mass index (BMI) and waist-to-hip ratio (WHR) have been significantly associated with microalbuminuria[10]. The specific pathogenesis regarding obesity-related glomerulopathy is hyperfiltration, which is mediated by excessive protein and salt intake, high blood insulin levels, and increased feedback of the tubuloglomerular component. Central obesity is associated with the secretion of active proteins and proinflammatory cytokines, which play a role in renal injury [11]. Although the previously mentioned metabolic irregularities contribute to renal impairment, there is little evidence regarding the relationship between WHR and microalbuminuria in patients with T2DM as has been established in one study [12]. Hence, studying the association between central obesity and microalbuminuria is one of the main goals of our research. The current study aims to estimate microalbuminuria prevalence and assess the related cardiovascular risk factors among patients with T2DM in Al-Khobar, Saudi Arabia.

This study is a retrospective, cross-sectional study conducted on patients with T2DM who attended the department of internal medicine at King Fahd University Hospital (KFUH) Al-Khobar, Eastern Province, Saudi Arabia from January 2014 to December 2021. Ethical approval from the Imam Abdulrahman Bin Faisal University Institutional Review Board was obtained.

The study comprised 301 patients with T2DM. Inclusion criteria: patients diagnosed with T2DM, aged 18 years, both males and females were included. Exclusion criteria: patientsaged <18 years, previously diagnosed with diabetes type-I, congestive heart failure, chronic kidney disease, or nephrotic syndrome, any patient with a history of steroid use, exposure to radiocontrast agents, active urinary tract infection, fever or pregnancy at the time of urine ACR test was excluded from the study.

Demographic, anthropometric, clinical and laboratorical information for the included patients were reviewed and retrieved from the KFUH database, Quadra Med Computerized Patient Record (QCPR).Past medical history including the duration of diabetes and the diagnosis of hypertensionand dyslipidemia were taken from outpatient clinic visit notes. Age, gender, height, weight, and body mass index (BMI), which was calculated and classified into normal (<25), overweight (25-29.9), obese (30-39.9), and morbidly obese (>40), the circumference of waist and hip, waist-hip ratio, smoking status, sedentary lifestyle (inactive) [13]. The readings included were systolic blood pressure, diastolic blood pressure, and pulse pressure. HbA1C% and fasting blood glucose (FBG) were used for the assessment of glucose control. HbA1C% was classified as controlled (<7%) and uncontrolled (7%), while fasting blood glucose readings were divided into normal (<130 mg/dL) and abnormal ( 130 mg/dL) [14]. Patients lipid profiles for dyslipidemia assessment included total cholesterol, LDL, HDL, and triglycerides. Other important laboratory data for renal profile were serum creatinine and estimated glomerular filtration rate (eGFR), which were calculated by the Modification of Diet in Renal Disease (MDRD) study equation (175 standardized Scr 1.154 age0.203 1.212 (if black) 0.742 (if female)) [15]. eGFR results were classified by the National Kidney Foundation into the following (normal/high 90, mildly decreased 60-80, mildly-moderately decreased 45-59, moderately-severely decreased 30-44) [16]. Microalbuminuria was detected according to hospital policy by using a random spot urine sample. The urine albumin-creatinine ratio was calculated by dividing albumin concentration in milligrams by creatinine concentration in grams. A value of 30-300 mg/g was considered positive microalbuminuria [17]. Statistical analysis was performed by using SPSS Statistics for Windows, version 26.0 (IBM SPSS Statistics for Windows, IBM Corp, Armonk, NY).

Table 1shows the demographic features and associated variable characteristics of all 301 included patients. The mean age was 57.76 12.64 years. Males (55.1%) were slightly more than females in number. The majority of the patients never smoked, while (25.6%) were smokers. Most of the patients (64.1%) had dyslipidemia. About 57% had hypertension, which is less than expected. Sedentary lifestyle was noticed among more than half of the patients. Most of the participants had high BMI readings. The mean waist-hip ratio was 0.9, which is in the high-risk category for metabolic complications. As for the T2DM duration, most of the patients (64.1%) had been diagnosed with T2DM for more than five years. While diastolic and pulse pressure were in the normal range with values of 78.91 11.55 and 55.38 18.21, respectively. The mean systolic blood pressure was high at 136.2 19.43. For blood glucose control, the majority had uncontrolled diabetes (HbA1C of 7%) with a mean level of 8.82 5.58. While fasting blood glucose was abnormal at 66.1%, with a mean level of 165.9 71.94. The mean urine albumin, urine creatinine, and urine ACR were in accordance with microalbuminuria findings. While serum creatinine was within the normal range for most of the patients, about 43.5% had a mildly decreased (60-80) eGFR (mL/min/body surface area (BSA)) with a mean level of 81.11 25.33. More than half of the patients (64.1%) had high cholesterol, LDL, TG levels, and low HDL levels.

Table 2 shows a prevalence of 36.8% for microalbuminuria. Patients with older age, T2DM duration of more than 15 years, elevated systolic BP, high HbA1C (7%), abnormal FBG (130 mg/dL), and high TG levels were found to have a significantly higher percentage of microalbuminuria (p 0.05). Whereas the relationship between microalbuminuria and other patients socio-demographic or disease-related characteristics was found to be non-significant (p 0.05).

Table 3 represents the correlation of urine ACR levels and microalbuminuria with all the numerical variables. A correlation with age, T2DM duration, pulse pressure, FBG, HbA1C, and TG levels was found to be significantly positive (p 0.05).

Table 4 represents the correlation of FBG and HbA1C levels with all the numerical variables. A correlation with T2DM duration, hip-waist-ratio, urine creatinine, urine albumin, total cholesterol, and TG was found to be significantly positive (p 0.05).

Detection of microalbuminuria is one of the crucial steps in managing diabetic patients as it is considered an early sign of renal impairment and subsequent diabetic nephropathy [1]. In this study, 301 diabetic patients were investigated for microalbuminuria and its associated risk factors. The screening for microalbuminuria was conducted using a random sample of urine to test for urine ACR, which is the recommended screening method for microalbuminuria [1]. This studys microalbuminuria prevalence was 36.8%. Previous studies showed a similar result, which was reported in multiple cross-sectional studies in Saudi Arabia ranging from 33.2% to 41.3%, 31.8% to 34.2% in Egypt, and 39% in the DEMAND study globally [17-22].

Despite the similar microalbuminuria prevalence in the current study, there is a possibility of variation in prevalence based on a number of factors related to differences in the population characteristics, microalbuminuria definition, measurement methods, and collection of urine [17]. Gender-specific association with microalbuminuria has been reported in several studies. However, there were a few studies that reported no statistical significance between gender and microalbuminuria [19,22-24]. Our study shows a similar result, in which there was no statistical significance between gender and microalbuminuria. A male predominance in the prevalence of microalbuminuria was reported [8,25,26]. While many other studies reported that the female gender was associated with microalbuminuria [17,18,21,27].

Multiple cross-sectional studies found no association between age and microalbuminuria [17,19,23-26,28]. On the contrary, a few studies reported a statistical significance betweenage and microalbuminuria [8,21]. In the present study, age was observed to be significantly related to microalbuminuria. The present study showed a significant association of longer diabetes duration with the presence of microalbuminuria, which was similar to a previous study [18]. This could be justified by how theperpetuation of hyperglycemia would result in the build-up of glycosylation end products and the presence of protein in urine [5].

Chronic hyperglycemia leads to a decline in renal function by glycation of glomerular basement membranes and stiffening of efferent arterioles. This will adversely increase the glomerular filtration rate, regress filtration capacity and give rise to diabetic nephropathy [5]. HbA1C 7% is an indicator of poor glycemic control. The mean value of HbA1C% for the microalbuminuria group was (8.95 1.79) compared to (8.4 1.84) in patients with normal urine ACR. This study showed a significant association of uncontrolled HbA1C with microalbuminuria similar to a study done in Taif, Saudi Arabia [23]. The mean value of abnormal FBG 130 among patients with microalbuminuria was (176.5 71.87) while for non-microalbuminuria patients it was (159.99 81.63). A significant relationship was noticed among the microalbuminuria group as it was found in other studies [19,20]. Poor glycemic control is a widely known cause of diabetic nephropathy. Our findings were consistent with a previous study [25].

Hypertension is a recognized risk factor for renal impairment [6]. This study has shown a nonsignificant relationship between hypertension diagnosis and microalbuminuria. A similar finding was noted in Alzaid et al., where hypertension had no significance on microalbuminuria [19]. While the contrary was found in several studies [21,23,25,29]. On the other hand, high systolic blood pressure was found to be significantly associated with the presence of microalbuminuria in this study, as seen in a similar study [29]. Increased systolic blood pressure negatively impacts renal function by affecting the systemic arterioles and constant insult to the glomerular filtration membrane resulting in microalbuminuria [30].

Dyslipidemia is a well-studied risk factor for diabetic nephropathy [7]. Previous studies demonstrated a statistical significance regarding the high levels of LDL with the occurrence of microalbuminuria [17,27]. Showail et al. reported a statistical significance between the high levels of total cholesterol, triglycerides, and microalbuminuria [8]. Our study shows a similar result in which high levels of triglycerides were statistically significant with microalbuminuria. However, many studies showed non-statistical significance between lipid profile parameters and microalbuminuria [17,19,23,24,28].

Obesity-related glomerulopathy has been associated with hyperfiltration, which is mediated by excessive protein and salt intake, high blood insulin levels, and increased feedback on the tubuloglomerular component [11]. A few earlier studies demonstrated a statistical significance between BMI and microalbuminuria [17,21,28,26]. Many studies, on the contrary, have not reported statistical significance. This finding was seen in the DEMAND study globally, which was possibly supported by the fact that the Asian population had the lowest BMI despite the highest rates of microalbuminuria [22]. Other studies done in the Middle East showed a similar result of non-significance [8,18,19,23-26]. In the present study, BMI and microalbuminuria did not have a statistically significant relationship.

Central obesity, measured by waist-to-hip ratio, is associated with the secretion of active proteins and proinflammatory cytokines that have a role in renal injury [11]. Based on the literature review, only one study showed a statistical significance between high WHR and microalbuminuria in females with T2DM[12]. Most of the participants in the study were in the higher risk group for WHR. Our study failed to show an association of WHR with microalbuminuria.

Tobacco smoking is one of the independent risk factors for increasing levels of urine albumin [9]. Our study has shown a non-significant relationship with microalbuminuria as seen in other studies [22,24]. On the contrary, many studies reported tobacco use as a risk factor and had linked smoking to the development of microalbuminuria [21,22,25]. Our controversial findings could be attributed to the small sample size and low prevalence of female smokers.

Despite thegood preparation of this study, there were a few limitations. The study participants were from a single hospital in the Al-Khobar area. Due to time restrictions, the sample size was very small to represent the prevalent number of diabetic patients in society. Furthermore, the data collection was clinic-based, so the result was exclusively observed for patients who were following up on a regular basis.

Microalbuminuria is one of the important tests for early renal damage in T2DMpatients. A prolonged duration of diabetes, an increase in age, poor diabetes control, an increased level of triglycerides, and high systolic blood pressure were associated with microalbuminuria. Thus, annual screening for microalbuminuria, maintaining good glycemic control, and managing cardiovascular risk factors can help in reducing microalbuminuria and the progression into diabetic nephropathy. This study encourages regular and early screening of microalbuminuria and the prevention of irreversible kidney damage that results from poor diabetic control. Moreover, the renal injury could be exacerbated by other cardiovascular risk factors such as dyslipidemia and hypertension. This study implements educational material to enhance patient awareness and understanding of their condition and how crucial diabetic control is for reducing complications.

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A registered nurse explains how peanut butter and diabetes can coexist in a healthy meal plan. In fact, the salty snack may even help you control your blood sugar.

Rich and creamy with the right amount of salty sweetness, peanut butter is a staple for a reason. It adds a punch of protein to quick snacks and keeps you full until dinnertime.

Its also a high-calorie food, so it can be confusing for people with diabetes. Here are a few tips to keep in mind before scooping up a spoonful of healthy peanut butter.

Yes, in moderation. Natural peanut butter is considered safe for people with diabetes. Its best to avoid the low-fat varieties of peanut butter. They sound healthybut most brands simply add more sugar to make up for less fat. This can spike blood sugar levels and leads to more daily carbohydrates.

Studies have shown that when people with type 2 diabetes follow a low-carb diet, they can reap health benefits from adding peanuts to their diets. By replacing certain foods with peanuts or natural peanut butter, its possible to lose weight, improve blood sugar control and regulate the amount of fat in the blood (also known as blood lipid level).

Peanut butter also helps control blood sugar in those who dont have diabetes. In fact, eating peanut butter may even lower the risk of developing type 2 diabetes. Peanut butter is rich in unsaturated fats that help the body regulate insulin and blood sugar levels. Peanuts are also rich in magnesium. Research shows that diets rich in magnesium can be protective against diabetes.

Not a fan of peanut butter? You can reap many of the same benefits with almond butter.

Peanut butter can get a bad rap for being high in calories. A two-tablespoon serving of peanut butter contains about 188 calories, 7.7 grams of protein, 6.9 grams of carbohydrates and 2.4 grams of saturated fat. When enjoyed in moderation, peanut butter can be a healthy part of your diabetes-friendly meal plan.

No, natural peanut butter will not raise blood sugar. In fact, it could stabilize your numbers.

A 2018 study found that eating two tablespoons of peanut butter with white bread and apple juice led to a significantly lower blood glucose spike when compared with white bread and juice alone. The protein and healthy fats in peanut butter help our bodies avoid a blood sugar spike (and eventual crash).

Adding peanut butter to your breakfast routine may aid in blood sugar control throughout the day. A 2012 study found that when women with obesity ate peanuts or peanut butter in the morning, they were more likely to be able to manage their blood sugar levels throughout the day.

Peanut butter is a high-calorie food, so its important to enjoy in moderation. Try replacing some refined carbs or processed meats with peanut butter. This will help avoid adding too many calories to your healthy eating plan.

When choosing peanut butter at the store, opt for a natural variety with as few ingredients as possible. Avoid any brands that add sugar or other sweeteners. Ditch any low-fat varieties because they are typically loaded with sugar. Some brands use partially hydrogenated oils in their peanut butter. These oils have been linked to heart disease, so skip those as well.

To choose the best peanut butter for you and your health, start by reading the ingredient list. Crazy Richards 100% Peanuts Peanut Butter has one ingredient: peanuts! Learn more about how to shop for healthy peanut butter.

You can eat peanut butter with all kinds of healthy diabetes snacks. Here are a few of our favorite ideas:

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Peanut Butter and Diabetes: Can They Work Together? - Taste of Home

TheTexas A&M AgriLife Extension Serviceoffice inMcLennan Countywill present a free Do Well, Be Well with Diabetes program beginning on Oct. 6 in Waco.

The five-week program is for people with Type 2 diabetes. It will be held from 5:30-7:30 p.m. on Thursdays through Nov. 3 at the AgriLife Extension office in McLennan County at 4224 Cobbs Drive.

There is no cost to attend, but preregistration is required by calling the AgriLife Extension office at 254-757-5180.

The program will be taught by Colleen Foleen, AgriLife Extension family and community health agent, and Ashley Cox, AgriLife Extension family and community assistant agent, both serving McLennan County.

We will explore a new topic each week, and this is also a good opportunity to get the encouragement to make positive changes and meet others who have the same concerns about diabetes as you, Cox said.

For additional information or questions, contact Foleen at colleen.foleen@ag.tamu.edu or Cox at ashley.cox@ag.tamu.edu.

The Do Well, Be Well with Diabetes program will provide participants with:

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Do Well, Be Well with Diabetes program starts Oct. 6 in Waco - AgriLife Today

We found that more than one-third of our study sample suffered from substantial diabetes-related distress. Previous studies showed that elevated diabetes-related distress affects 2030% of people with T1DM, with the range difference recorded in prevalence across different populations and healthcare systems from 8 to 65%5. Our results are concordant with the study in the USA which reported prevalence of diabetes-related distress in T1DM of 42.1%20. The same study showed that, among those with elevated diabetes-related distress at baseline, 71% report similarly high levels at nine month follow-up. Interestingly, we found that the duration of the disease did not predict diabetes-related distress. Several explanations are possible. For example, the source of distress could have changed over time, as in the example where duration is strongly associated with both complications and hypoglycemia risk. Alternatively, it may indicate that adaptation to distress in persons with T1DM is not a matter of time, as a passive process, but that it requires the person to actively cope with the illness and accept the changes in life that are associated with the occurrence of DM. For example, to accept their own fears of the complications instead of denying it and not adhering to the diet, new healthy lifestyle etc. This may indirectly indicate that a psychosocial intervention may be needed to help the person cope with diabetes-related distress. This may be especially important for those with prolonged distress, as it can predispose to problematic self-care behavior7. Indeed, severe diabetes-related distress increases the chances of poor treatment outcomes and the risk of diabetes-related complications21. Of course, other factors such as general coping abilities and life circumstances (for example poor socioeconomic status) not assessed in this study that relate to diabetes distress may explain these results.

The mean PAID total score in our study was 31.92 (21.14)and is comparable to the results of SAGE study22.

The results of our study indicate that the presence of elevated HbA1c levels is a significant predictor of diabetes distress. This is concordant with the results of the T1 Exchange Clinic Registry in which HbA1c was one of the strongest predictors significantly associated with diabetes-related stress when adjusting for all other variables15.

It is possible that uncontrolled diabetes, defined by high HbA1c levels, elevates the distress in patients, as patients may be worried about the consequences of diabetes and the lack of success in the treatment, especially over a course of time. However, it is also possible that other features, such as anxiety or overwhelming distress in life, may confer to both the increase of stress related to diabetes and to elevated levels of HbA1c.

Concordant with our finding which indicates that the presence of elevated HbA1c levels is a significant predictor for diabetes distress, we also found that the presence of microvascular complications is also a significant predictor. First, we may assume that those with higher levels of HbA1c will also have a higher probability to develop microvascular complications23, indicating that (psychological) factors contributing to elevated HbA1c may result in contributing to microvascular complications over time. Secondly, it is also possible that acquiring microvascular complications lead to impairment of organ functioning that the patient feels through loss or impaired functioning or limitation in everyday life, and thus the fear of disease and potential impact on ability in the future as well distress increase. No other significant predictors for higher diabetes-related distress among sociodemographic and disease characteristics were found. While associations between diabetes-related distress and gender, decreased age, and diabetes duration were demonstrated elsewhere15, our study findings yield no difference in the level of diabetes-related distress among genders and age groups. A possible explanation could be the higher mean age of our study sample which was 48.11 (15.53) vs 37.64 (16.33) in T1 Exchange Clinic Registry. The second possibility is the different method of calculation, which in our study was binary logistic regression with the main variable being categorized as either above cut-off score or below, while the mentioned study used the original continuous PAID score variable. Interestingly, most of our study participants were worried about complications, (e.g., neuropathy, retinopathy, and nephropathy) and hypoglycemia, which are described as the most prevalent diabetes-specific fears in people with diabetes24, so intervention in patient education is justified.

In our study we found that some individual items in the PAID questionnaire were highly scored by majority of studied population, pointing to moderate or severe distress regarding a particular topic25. Worrying about the future and chronic complications and feeling guilty when off-track with diabetes management were the most prominent concerns, and these findings are comparable with the results of a previous study of diabetes-related distress made in Croatian population with both type 1 and type 2 diabetes participants26. Interestingly, feeling guilty when off-track with management was the most prominent description of feelings associated with distress, followed by feeling burnt-out by the constant effort needed to manage diabetes and feeling scared and depressed when thinking about living with diabetes, coping with complications and blood sugar levels, which may indicate the formation of the vicious cycle in which the patients with DM are caught in, by trying and failing to control their illness and future of it27. For example, their constant worrying about the complication of diabetes due to non-optimal glycemia levels and the negative predictions about the future of their illness increasing their level of fear/anxiety may result in the patients feeling burnt by the constant effort needed to manage diabetes (to control their illness glycemia levels) leading to increased depression and fear due to living with diabetes, which then increases the negative perceptions of the future forming the vicious cycle28. Alternatively, constant worrying about the complications and negative predictions about the future of their illness, fear and depression may also lead to denial of the potential effects of chronic diabetes mellitus, which results in them failing to adhere to diet/medication and leading to non-optimal glycemia and ultimately increasing the possibility of complications of DM, followed by feelings of guilt when off-track with diabetes management29. This will again increase their worrying about complications closing the vicious cycle. The way how diabetes-related distress manifests in the two different populations may be contextually different due to differences in age, predisposing conditions, treatment outcomes, and type of treatment. Our findings on commonly perceived distress items solely in T1DM population could be a signal to the clinicians on what to address in clinical consultation.

The importance of psychosocial care and a call for improved psychosocial outcomes are recognized by the American Diabetes Association which issued recommendations to integrate psychosocial care within patient-centered medical care, stressing that such care should be provided to all diabetic patients30. Furthermore, the recent Consensus Report on the management of T1DM acknowledged ongoing psychosocial support as a relevant component of T1DM management, as treatment outcomes are highly dependent on a persons ongoing self-care behavior9. Notably, our findings suggest that social support availability is perceived as highly relevant by our study participants as more than 80% of participants reported scores<3 to the associated item 18. Thus, psychosocial support could be a protective factor from diabetes related distress and perceived problems with self-management in adults with diabetes31. Screening and monitoring for psychosocial problems using patient-appropriate standardized and validated tools are recommended at the initial visit, and periodically thereafter if glycemic targets are not met and/or at the onset of diabetes complications. While the treatment of psychological aspects related to T1DM may be as important as the medical management in improving living with diabetes32, the method of delivering it is still unclear33.

The screening should be used to detect the overall levels of diabetes-related distress, at the very beginning of the treatment. Depending on the PAID scores, several interventions should be offered, in addition to the standard treatment, including education. For those with low to moderate levels of diabetes-related distress, education should be provided in an empathic form by the health care team treating diabetes, seeing as 67% of participants expressed satisfaction with their diabetes physician. For highly distressed adults with T1DM, having poor glycemic control, diabetes-related distress can be successfully addressed using both educational and emotion-focused approaches34. In addition, psychological or psychiatric liaison consultations should be available.

Considerable strengths of the study are the inclusion of a representative sample of T1DM patients treated at secondary and tertiary centers in Croatia and the usage of standardized, diabetes-specific measure that allows for replication of the study findings. Our results made solely in T1DM patients give greater clarity of understanding this condition in specific patients. Lastly, according to our knowledge, this is the first study of this kind in Croatia.

Limitations of this study include a cross-sectional design which implies interpretation and clinical recommendations should be made with caution. The sample size is likely too small to confirm the lack of association among many of the variables. Other comorbidities or life events that could influence distress levels were not assessed and evaluated in this study.

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Prevalence and predictors of diabetes-related distress in adults with type 1 diabetes | Scientific Reports - Nature.com

Navratri fasting tips 2022: Managing blood sugar levels remains an everyday struggle for people with diabetes and when it comes to planning diabetes diet during Navratri fast, it is advised to be mindful of what you are eating and when you are eating during the day to prevent experiencing spike or drop in glucose levels. Stocking on low GI items is a good idea and there is no dearth of such vrat-friendly foods which will prevent sugar spikes. From singhara flour, buckwheat flour, roasted makhanas, peanuts, nuts and seeds, vegetables to fruits, there is a lot that diabetes can safely include in their Navratri diet. (Also read: Navratri 2022: Benefits of fasting)

"People with diabetes need to structure their meals and plan in advance to enjoy the full benefit of Navratri fasts. The main goal is to keep the blood sugar levels within normal range," says Dietician and Nutritionist Dr Poonam Duneja Founder of Nutrifybypoonam Diet & Wellness clinic.

Dr Duneja also offers the following fasting tips for people with diabetes.

- Keep your body hydrated and try to walk for 15 minutes after every meal.

- The navratri plate should have complex carbs and low-calorie drinks and meals distributed throughout the day. Do not eat heavy meals.

- Include low GI carbs like buckwheat roti in your meals. Add vegetables and also include a salad before all your meals to keep your post prandial sugar levels in check.

- Include good fats to reduce the glycemic load of the meals.

- Include low fat dairy proteins in buttermilk, yogurt, paneer to eliminate any sugar cravings and replenish your energy levels throughout the day.

- Mattha, vegetable raita, lassi, chaach, nuts and seeds can be added as an excellent protein source for people with diabetes during fasting.

- Including fruits and veggies result in better plasma carotenoids and Vitamin C levels, deliver antioxidants and phyto compounds. Try salads, fruit chaat, vegetable smoothies, vegetable soups and avoid readymade soups mix, fruit juices and sugary preparations.

"Researches show adding less than 30% calories from fat results in reducing glycated hemolobin levels (HBA1C levels). Include high fibre diet, less saturated fat and cholesterol less than 300 mg. Include omega-3 fatty acids (flax seeds, chia seeds, pumpkin seeds) to provide unsaturated heart healthy fats which results in elevated HDL levels, better serum lipids LDL and HbA1C," says Dr Duneja.

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Navratri fasting tips 2022: Dos and don'ts for people with diabetes during fasts - Hindustan Times