Diabetes is one of the most prevalent chronic diseases in Nevada. More than 12 percent of Nevadans have diabetes and, in 2012, diabetes was the seventh leading cause of death in the state. Legislative leaders could work to help address the diabetes epidemic in Nevada, yet some in Carson City are pursuing ill-advised policies. When I recently read SB 265, a state bill that aims to tackle drug costs for people with diabetes, it became quite clear to me our public officials, while well intentioned in their desire to help patients, don't realize what is truly driving the costs associated with the disease.

Caring for people with diabetes involves more than what they pay for insulin or another medication. In fact, most of the medical costs a person living with diabetes incurs has to do with other ailments, but having diabetes increases complexity of treatment and the costs of treatment with it. Also, diabetes seldom occurs alone. It's often accompanied by complications relating to high blood pressure, dyslipidemia, heart failure, kidney disease, and obesity. The complications relating to diabetes are the leading causes of lower limb amputations not relating to accidents or trauma and blindness.

Proponents of SB 265, led by some unions, casinos, and big health insurers, assert price controls will help lower drug costs for patients. That simply isn't the case. The proposal sets arbitrary price limits on certain diabetes medicines, with a focus on insulin, and requires drug makers to pay health insurance companies the difference. In fact, multiple witnesses at a recent hearing for the bill stated there's no guarantee patients will benefit. Even the bill's sponsor indicated there's much work yet to be done and the language is intentionally vague because it's unclear how the legislation might actually work. If this bill goes through, patients would pay the same for medications, insurers would increase their profits, and drug companies would have less reason and capital to invest in the innovative drugs for diabetes that are desperately needed. This is concerning.

The number of people diagnosed with diabetes has tripled in the last three decades. This increase means more patients need high-quality care, including different medication options, to help manage their disease. Innovative treatments, including oral medications and new forms of insulin, are absolutely critical. Unfortunately, SB 265 singles out diabetes patients, creates the high probability of access restrictions, and undermines their overall needs. With SB 265, patients would have fewer options when it comes to fully managing their disease and, as a result, every Nevadan would pay the price.

Instead of restricting access to care, Nevada should be exploring public policies that help us get in front of rising diabetes rates through prevention and actions to reduce the toll of diabetes on those already affected. This can be accomplished through greater access to innovative care, education and awareness initiatives, and bringing all stakeholders to the table to work together to reverse the growth in diabetes prevalence.

Patients must have information needed to choose the right insurance plan to help achieve positive results. Insulin research must continue to evolve, allowing patients superior control, less frequent injections, and better outcomes.

As a lifelong patient advocate, I know Nevadans expect more out of their elected officials.

Larry Hausner was chief executive officer of the American Diabetes Association from 2007 to 2014. He served as chief operating officer for The Leukemia & Lymphoma Society, and also worked for 15 years at the National Multiple Sclerosis Society. He currently serves on the Research America Board and Executive Committee and is chairman of the Campaign for Medical Discovery. In 2010, he received the Impact Award from the Invisible Disabilities Association for leading the charge in helping people living with diabetes through local and national education, research and support.

Go here to see the original:
Larry Hausner: A misguided proposal that sets Nevada back in fight against diabetes - Nevada Appeal

In a special issue of the journal Current Diabetes Reviews, an article addresses the link between diabetes and depression as a likely cause for the increased self-harm rates seen in those with both type I and type II diabetes.

The authors, Professor Madhuker Trivedi from the University of Texas Southwestern Medical Center and endocrinologist Dr. Alyson Myers of Northwell Health in New York, discuss the importance of managing diabetes medications in self-harming or suicidal diabetic patients.

They suggest that individuals with diabetes be screened for both depression and suicidality, as rates of both may be higher than in the general population. They also address the management goals of such patients and the need for further research in this area.

The review is a follow-up to a study the authors published in 2013 in which they found that 9.7 percent of patients with newly diagnosed diabetes (less than 24 months) had a history of suicide attempts. Half of those patients tested positive for depression at the time of the study.

Insulin is considered a high risk medication, because it can be manipulated to cause severe hyper- or hypoglycemia, both of which can lead to death. Oral agents such as sulfonylureas or metformin have also been used in overdoses with or without insulin.

Persons with both type I and type II diabetes have been known to have higher rates of depressive disorders; as a result suicidal ideation should be assessed in such patients. In addition, death by insulin may be misclassified as an accident, when it was in fact a suicide attempt. The manner in which to distinguish between the two, as well as how to manage these high-risk patients is described in this article.

The authors also discuss cases involving overdose by continuous subcutaneous insulin infusion, also known as insulin pump therapy. The acuity of medical therapy in such overdoses is significant as some of the agents used can have hypoglycemic effects for up to 72 hours.

Frequent glycemic monitoring and a multi-disciplinary approach to patient care with a behavioral health and medical team is needed.

The article comes in light of a recent statement released by the American Diabetes Association (ADA) in regards to the importance of assessing the psychosocial issues that impact individuals with diabetes, such as co-morbid mood disorders, food insecurities or lack of social support.

Diabetes affects roughly 30 million Americans, and is one of the leading causes of disability and mortality. As a result, organizations such as the ADA, Endocrine Society and American Association of Clinical Endocrinologists (AACE) have made efforts to move away from the one size fits all management of diabetes.

Instead, diabetes management is now customized based on patient variables such as age, life expectancy, co-morbid conditions, finances, and patient goals.

Source: Bentham Science Publishers

APA Reference Pedersen, T. (2017). Depression in Diabetes Patients May Be Linked to Rise in Self-Harm. Psych Central. Retrieved on April 9, 2017, from https://psychcentral.com/news/2017/04/08/depression-in-diabetes-patients-may-be-linked-to-rise-in-self-harm/118804.html

Read the rest here:
Depression in Diabetes Patients May Be Linked to Rise in Self-Harm - PsychCentral.com

By Arlene Karidis By Arlene Karidis April 7 at 2:05 PM

Nearly four times as many Americans may die of diabetes as indicated on death certificates, a rate that would bump the disease up from the seventh-leading cause of death to No. 3, according to estimates in a recent study.

Researchers and advocates say that more-precise figures are important as they strengthen the argument that more should be done to prevent and treat diabetes, which affects the way sugar is metabolized in the body.

We argue diabetes is responsible for 12 percent of deaths in the U.S., rather than 3.3 percent that death certificates indicate, lead study author Andrew Stokes of the Boston University School of Public Health said in an interview.

About 29 million Americans have diabetes, according to the Centers for Disease Control and Prevention. There are two forms of the disease: Type 1, in which the pancreas makes insufficient insulin, and the more common Type 2, in which the body has difficulty producing and using insulin.

Using findings from two large national surveys, the study looked mainly at A1C levels (average blood sugar over two to three months) and patient-reported diabetes. In the latest study, researchers compared death rates of diabetics who had participated in these surveys to information on their death certificates.

The authors also found that diabetics had a 90 percent higher mortality rate over a five-year period than nondiabetics. This held true when controlling for age, smoking, race and other factors.

[Women with diabetes are especially prone to developing heart disease]

These findings point to an urgent need for strategies to prevent diabetes in the general population. For those already affected, they highlight the importance of timely diagnosis and aggressive management to prevent complications, such as coronary heart disease, stroke and lower-extremity amputations, Stokes said.

We hope a fuller understanding of the burden of disease associated with diabetes will influence public authorities in their messaging, funding and policy decisions, such as taxation of sugar-sweetened beverages and use of subsidies to make healthy foods more accessible, he said.

When they embarked on the study, the investigators were curious about two findings from earlier research. The first was a higher obesity rate and shorter life expectancy among Americans than Europeans. (The researchers already knew that obesity and diabetes were related.) The second revelation was a rise in deaths by any cause among middle-aged white Americans.

We tried to piece together causes of mortality in the U.S., looking closer at diabetes, which we knew was underreported, Stokes said.

Mortality rates attributed to diabetes are imprecise largely because death results from both immediate and underlying causes, and not every one of them gets recorded. For example, cardiovascular disease might be recorded as the cause of a persons death even though that disease may have been caused by diabetes.

Further challenging the task of identifying cause of death is that diabetics have a long history of problems before serious complications occur.

When diabetes started 10 to 30 or more years before a patient died, the disease may not be in the forefront of the attending physician at time of death, explains Catherine Cowie, an epidemiologist at the National Institute of Diabetes and Digestive and Kidney Diseases. And there are no clear guidelines about which conditions should be cited as cause of death.

Detailed electronic medical records may help pinpoint the primary cause. But still, its hard [to get the full picture] in this day and age when health care for diabetics is divided between different practitioners, she said.

She advises patients to report their diabetes to all their health providers, whether they are having complications at the time or not.

Weve been trying to promote healthy lifestyle to prevent diabetes and complications for a long time. This includes paying attention to the ABCs, which are to bring down A1C, blood pressure and cholesterol. But I think this [study] is new evidence that its important to focus on these things. Its more data to show what diabetes can lead to, Cowie says.

In 2016, diabetes accounted for about $1.04 billion in National Institutes of Health funding, compared with about $5.65 billion spent on cancer research. Having a better gauge on the mortality figures could have an effect on research dollars, said Matt Petersen, managing director of medical information for the American Diabetes Association.

But the true death rate means only so much.

Whats most important is why it is and what we can do about it. The goal of research is prevention and, if possible, cure. Short of uncovering a cure, key is figuring out how do we best treat it and reduce complications, Petersen said.

For Type 2 diabetes, new drugs that work in combination and in different ways to address differing patient cases have rolled out in just the past two years. Healthy lifestyle choices can also affect outcomes.

So I think the public should hear [that] yes, diabetes can be deadly, but that we have the ability to reduce the chance for this disease, Petersen says. And for those who have diabetes, we can treat it well and reduce the risk for debilitating and deadly complications.

[Why treating diabetes keeps getting more expensive]

[The man who knows more about death than anyone else]

[The scary reason why doctors say kids need HPV vaccinations]

[New research identifies a sea of despair among white, working-class Americans]

See the original post here:
Diabetes is even deadlier than we thought, study suggests - Washington Post

Dr. Tonatiuh Barrientos Gutierrez, an epidemiologist in Mexico City, jogs near his home in the southern part of the capital. He says it's hard to run on the city's streets. Meghan Dhaliwal/for NPR hide caption

Dr. Tonatiuh Barrientos Gutierrez, an epidemiologist in Mexico City, jogs near his home in the southern part of the capital. He says it's hard to run on the city's streets.

Let's say you'd like to go for a run in Mexico City.

Dr. Tonatiuh Barrientos, an epidemiologist with Mexico's National Institute of Public Health, thinks that's a good idea in theory. An expert on diabetes, he'd like to see more people in the Mexican capital get out and exercise to combat the disease.

But as a runner himself, he knows that Mexico City isn't an easy place to jog. In a metropolis of 22 million, there are only a handful of parks where people can run.

"Look, this is a fairly crowded street. It's a pretty noisy street. It's polluted," Barrientos says walking through the Tlalpan neighborhood that lies between his office and his home. "Now just imagine trying to convince yourself to get out there and run."

Runners in the wooded park of Viveros in Coyoacan, Mexico City. Mexico City has few runner-friendly spaces. The altitude discourages exertion and the air quality is often so bad some runners wear face masks. Yet health officials urge people to exercise more. Meghan Dhaliwal/for NPR hide caption

Runners in the wooded park of Viveros in Coyoacan, Mexico City. Mexico City has few runner-friendly spaces. The altitude discourages exertion and the air quality is often so bad some runners wear face masks. Yet health officials urge people to exercise more.

It's a tough sell. "I mean the only place for you to really run is on the sidewalk. You can't run on the street because you'll probably get run over," he says.

The sidewalk is an uneven mix of broken cement slabs and cobblestones. Street vendors have set up little tables and carts to sell everything from electrical supplies to fried pork cracklings.

There are so many people that it's hard to even walk at a fast clip.

And if you do manage to find a stretch of sidewalk, the elevation in Mexico City combined with the smog and the chances of getting mugged make running a hard thing to get excited about.

"There are a lot of obstacles," Barrientos says as he dodges his way past low-hanging awnings. "And you need to deal with that if you wanted to try to run here."

Professionally, Barrientos has tracked the slow, steady rise in Type 2 diabetes in Mexico. Roughly 14 million Mexicans are now living with diabetes nearly triple the number who had the disease in 1990.

Barrientos says for too long health officials considered it the responsibility of patients to change their diet and exercise routines. They either did it or didn't. He says now it's become clear that addressing one of Mexico's biggest health crises requires changes at a much higher level and includes lobbying for healthier public spaces where people can easily get out and exercise.

Exercise equipment, often placed in public parks like this one in the Tlalpan area of Mexico City, encourages residents to be more active. Meghan Dhaliwal/for NPR hide caption

Exercise equipment, often placed in public parks like this one in the Tlalpan area of Mexico City, encourages residents to be more active.

"How do we change the world so that making healthy decisions is a lot easier than it is right now?" he asks.

Diabetes has mushroomed as Mexicans' lifestyles have changed dramatically over the last 40 years. Several generations ago diabetes was almost unheard of in Mexico. Now it's the leading cause of death, according to the World Health Organization. Mexicans with indigenous ancestry have a genetic predisposition for the condition that makes them even more likely to develop it than Caucasians. But a key driver of Type 2 diabetes in Mexico and globally is still a person's diet.

Barrientos says current projections show that by 2030, 17 percent of all Mexican adults will have diabetes.

"And that of course opens a lot of questions about sustainability," he says. "Can you really sustain a public health system with 17 percent of your population being diabetic? Especially if you are not prepared to control that diabetes."

Some epidemiologists predict that by 2050, half the adults in the country could suffer from diabetes in their lifetime.

Diabetes can be reversed with weight-loss surgery in some cases. Uncontrolled, the metabolic disorder can have grave health consequences. It can lead to blindness, nerve damage, kidney failure and, in some cases, foot amputations.

Barrientos and others are now saying the focus of diabetes prevention in Mexico needs to shift away from shaming individuals to looking at new government policies to tackle this mounting health crisis.

"With tobacco we faced the same thing for many, many years. We were trying to encourage people to quit: Because if you don't quit you're going to die!" he says. "The only time that we started to see real change was when we said, 'We are going to change the rules of the game.' The more expensive it is the less you're going to be willing to spend your precious money on something that isn't good for you."

A variety of fried snacks and soft drinks are for sale in Mexico City's Centro Historico neighborhood. Meghan Dhaliwal/for NPR hide caption

In an effort to reduce soda consumption, the government in 2014 imposed a 1 peso per liter tax on sugar sweetened beverages, the equivalent of about 10 U.S. cents on a standard 2 liter bottle.

At the time Mexico was the leading per capita consumer of soda in the world. In regulatory filings in 2015, Coca-Cola said that the annual consumption of its beverages in Mexico was more than 600 8-ounce servings per person per year. That means that, on average, every Mexican was drinking nearly two glasses of Coke beverages every day. And that doesn't even count the amount of Pepsi or other brands of soda being consumed.

Alejandro Calvillo, the head of a consumer group called El Poder del Consumidor, says soda is making Mexicans sick.

Walking just outside his office in Mexico City, he points out little shops selling Coke and junk food on just about every block. In fact, the red Coca-Cola logo has become a symbol that declares snack shop.

"Coke in Mexico has more than 1.5 million places that sell Coke," Calvillo says. "The presence of these products is everywhere." Calvillo was one of the advocates behind the 2014 soda tax, although he would have liked the tax to have been even higher. A higher tax, he argues, would have pushed down consumption even more and given the government more resources to combat the lifestyle that's linked to diabetes. In indigenous communities in Chiapas, he says, parents put Coke in baby bottles for their infants "and the government isn't doing anything. It's crazy."

Like Barrientos, he says that if Mexico is going to successfully combat diabetes, the rules of the game need to change.

His efforts to get the soda tax increased even more, however, have so far been unsuccessful.

But Jorge Terrazas, the head of ANPRAC, the carbonated beverages trade association in Mexico City, says soda is unfairly blamed for Mexico's extremely high rates of obesity and diabetes.

"There's not conclusive scientific evidence demonstrating the relation between the intake of soft drinks with overweight," he tells NPR.

The average Mexican's daily intake of calories far exceeds the World Health Organization recommendation of 2,000, and Terrazas says the majority of those calories are coming from things other than soda.

But anti-soda campaigners says sugar is a big part of the problem. They say calling for solutions that rely on individuals alone to change their lifestyles won't solve Mexico's diabetes crisis.

Barrientos, the epidemiologist and runner, says the solution is going to require major changes to the way Mexicans live, eat and exercise.

Read more:
In Diabetes Fight, Lifestyle Changes Prove Hard To Come By In Mexico - NPR

South Asians, Hispanics of Normal Weight Most Likely to Have High Glucose, Hypertension

Namratha Kandula, MD, MPH, associate professor of Medicine in the Division of General Internal Medicine and Geriatrics, was a co-author of the study, which found that Americans of South Asian descent are twice as likely as whites to have risks for heart disease, stroke and diabetes.

See coverage of this research at the University of California, San Francisco (UCSF).

Americans of South Asian descent are twice as likely as whites to have risks for heart disease, stroke and diabetes, when their weight is in the normal range, according to a study published in the Annals of Internal Medicine.

Namratha Kandula, MD, MPH, associate professor of Medicine in the Division ofGeneral Internal Medicine and Geriatrics, and Kiang Liu, PhD, professor of Preventive Medicine in the Division ofEpidemiology, co-authored the study, which was headed by investigators at Emory University and UCSF.

Americans of Hispanic descent were 80 percent more likely than whites to suffer from so-called cardio-metabolic abnormalities that give rise to heart disease, stroke and diabetes, compared with 50 percent more likely for those who were Chinese and African-American.

These risks include high blood pressure (hypertension), elevated glucose, low HDL, the good cholesterol, and high triglycerides, a fat found in blood. In the study, participants, who were aged between 45 and 84, were classified as having cardio-metabolic abnormalities if they had two or more of these four risk factors.

So much of what is known about cardiovascular disease and diabetes risk is from research in white populations, despite the fact that race/ethnic minorities have a high burden of these common diseases, Kandula said. This paper challenges the established idea of using body mass index as the main predictor of cardiovascular and diabetes risk. This matters because most clinicians use BMI cut-points as practical markers for detecting overweight and as a criteria for screening patients for cardiovascular and diabetes risk. Our study suggests that a BMI-based approach may miss a large proportion of individuals who have cardiovascular risk factors and could increase disparities among racial and ethnic minority populations.

The study included 803 South Asian residents of San Francisco Bay and Chicago areas, who traced their ancestry to India, Pakistan, Nepal, Bangladesh or Sri Lanka. Also enrolled in a parallel study were approximately 6,000 residents of New York, Baltimore, Chicago, Los Angeles, Minneapolis-St. Paul and Winston-Salem areas, who identified as Chinese, white, Hispanic or African-American.

For whites, Hispanics and African-Americans, normal weight was categorized as having a body mass index (BMI) between 18.5 and 24.9 kg/m2. For Chinese and South Asians, the range was narrower: from 18.5 to 22.9 kg/m2.

Questionnaires were given to assess participants activity levels and eating habits.

While other studies have looked at race and cardio-metabolic risk, this is the first that looks at the relative differences between five races, said senior author Alka Kanaya, MD, professor of medicine, epidemiology and biostatistics in the Division of Internal Medicine at UCSF. Its also the first that compared risk between two different Asian populations.

The investigators found that for non-whites to have the same number of cardio-metabolic risk factors as whites with a BMI of 25 kg/m2 the equivalent of 150 pounds for a woman measuring 5-foot-5 they had to have much lower BMI levels. These were 22.9 kg/m2 for African-Americans, 21.5 kg/m2 for Hispanics, 20.9 kg/m2 for Chinese and 19.6 kg/m2 for South Asians the equivalent of 118 pounds for a woman measuring 5-foot-5.

These differences are not explained by differences in demographic, health behaviors or body fat location, said first author Unjali Gujral, PhD, a postdoctoral fellow at the Global Diabetes Research Center at Emory University in Atlanta. Clinicians using overweight/obesity as the main criteria for cardio-metabolic screening, as currently recommended by the U.S. Preventive Services Task Force, may fail to identify cardio-metabolic abnormalities in many patients from racial/ethnic minority groups.

Kanaya, who is also the principal investigator of the MASALA study (Mediators of Atherosclerosis in South Asians Living in America), which enrolled the South Asians, said that the results of the study should not be interpreted as a call to those with normal BMI to lose weight.

We hope the results will enable patients and their healthcare providers to see that race/ethnicity alone may be a risk factor for cardio-metabolic health in minority Americans, she said.

The study was funded by the National Institutes of Health and the National Heart, Lung and Blood Institute.

Co-authors of the study included Eric Vittinghoff, PhD, of UCSF; Morgana Mongraw-Chaffin, PhD, of Wake Forest School of Medicine in Winston-Salem, N.C.; Dhananjay Vaidya, PhD, of Johns Hopkins University School of Medicine in Baltimore; Matthew Allison, MD, MPH, of UC San Diego; Jeffrey Carr, MD, of Vanderbilt University in Nashville, Tenn.; and KM Venkat Narayan, MD, of Emory University.

Read the original:
Race Ranks Higher Than Pounds in Diabetes, Heart-Health Risks - Northwestern University NewsCenter