Patients with diabetes on Medicare Advantage were also less likely to be prescribed newer, more expensive medicine than patients on Medicare Fee-For-Service plans, indicating potential disparities in care.

Patients with diabetes on Medicare Advantage were more likely to have high blood pressure and worse blood glucose control compared with patients on Medicare Fee-For-Service plans, according to a study recently published in Diabetes Care.

Patients with diabetes on Medicare Advantage were also less likely to be prescribed newer, more expensive medications, though they were more likely to receive preventive treatment. The study foreshadows a potential trend toward poorer health outcomes and disparities in care for the growing number of patients on Medicare Advantage compared with those on Medicare Fee-For-Service plans.

Researchers used data from more than 5000 clinicians who participate in The Diabetes Collaborative Registry. The study included nearly 350,000 patients with type 2 diabetes 65 years of age or older on Medicare Advantage or Medicare Fee-For-Service plans.

The researchers compared quality metrics, preventive care, and prescription patterns between the 2 groups.

The study found that older, generic medicines, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), were appropriately prescribed to Medicare Advantage beneficiaries. However, patients on Medicare Advantage plans were less likely to receive newer, evidence-based medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i).

We saw a clear drop in Medicare Advantage enrollees getting those medications, despite unequivocal evidence that they benefit patients with diabetes by reducing kidney diseases, cardiovascular disease, and death, said lead author Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the VA Pittsburgh Healthcare System, in a press release.

Medicare Advantage limits access to newer and more expensive medications as a strategy to mitigate the costs of care. Additionally, the results showed that patients with Medicare Advantage were more likely to receive preventive treatments, including tobacco cessation, foot care, and other screenings.

However, despite this increased access to preventive care, Medicare Advantage patients were found to have poorer health outcomes.

Given the rising risk factors for diabetes among Americans, were going to see increasing numbers of Medicare Advantage enrollees needing high-quality diabetes care, Essien said. Im a general internistmy primary focus is on preventionbut our data suggest that is not enough.

Specifically, the study found that patients on Medicare Advantage plans were more likely to have higher blood pressure and poorer diabetes blood glucose control compared with patients on Medicare Fee-For-Service plans.

Preventive treatments are not enough to keep patients from utilizing the health care system down the road, Eissen said in a statement. We need to make sure the right patients are getting the right treatment, likely a combination of preventive and therapeutic interventions.

The researchers hope their findings can help guide improvements in the Medicare Advantage program, allowing the growing number of patients to access necessary care and treatments while keeping health care costs and utilization low.

With Medicare Advantage plans continuing to rapidly expand and now covering nearly half of all Medicare beneficiaries, these data call for ongoing surveillance of long-term health outcomes under various Medicare plans, senior author Muthiah Vaduganathan, MD, MPH, co-director of the Center for Implementation Science and staff cardiologist at Brigham and Womens Hospital and Harvard Medical School, concluded in the press release.

Reference

Diabetes patients on Medicare Advantage plans more likely to have worse health, study finds [press release]. Pittsburgh, PA: EurekAlert. July 7, 2022. https://www.eurekalert.org/news-releases/958085. Accessed July 7, 2022.

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Patients with Diabetes on Medicare Advantage More Likely to Have Worse Health Outcomes Despite Preventive Care Access - Pharmacy Times

A Halifax doctor's new approach to treatment-resistant bipolar disorder involves treating an underlying metabolic disorder to improve the psychiatric condition.

Dr. Cindy Calkin said herresearch represents a paradigm shift in psychiatry and was recently published in theJournal of Clinical Psychiatry. She spent thousands of her own dollars to make it publicly available.

Calkin worked as a family doctor for a decade before training as a psychiatrist. "I was told my medicine wouldn't be of any use to me, but it was a huge advantage because I could not stop treating the whole patient," she said.

Bipolar disorder is a conditionthat causesdramaticmood swings, from depressed lows to manicepisodes, along with changes in appetite and energy levels.

It's typically treated with lithium, and anti-epilepsy, anti-psychotic and anti-depressant drugs. But many people find the drugs lose effectiveness after a few years, throwing them back into bipolar disorder.

"What I was finding is it wasn't just patients with diabetes who had worse outcomes, it was other patients as well. I felt like there was something right in front of me that I was missing. And that ended up being insulin resistance," she told CBC News.

She launched a clinical trial in which people with treatment-resistant bipolar disorder were given metformin, a drug that's been used to treat diabetes in Canada for decades, to reverseinsulin resistance.

"Patients had been ill on average for 25 years," she said. "Most of these people had lost any hope of ever being better again."

Her research found 54 per cent of people who have bipolar also have insulin resistance, and half of those patients will be treatment resistant.

The results were stunning.

"By week six in the study, patients started to become well. And by week 14, which was study-end point, they remained well. Andeven 26 weeks out, they remained well."

MRI scans she did withDr. Alon Friedman show a dramatic difference in one of her first patients.

"So this one is an MRI of a patient who has extensive blood-brain barrier leakage. This is multiple [images]through his brain. And this is before treatment with metformin. He was insulin resistant and severely depressed. And this is three months on metformin. Blood-brain barrier has healed, he's no longer insulin resistant, and his depression has been in remission the last six years."

That barrier is supposed to keep viruses and bacteria out of the brain. "So I believe that patients with insulin resistance may have had inflammatory molecules crossing into the brain, making their brain disorder worse."

She compares it to how people once thought peptic ulcers were caused by stress, until two Australian researchers won a Nobel Prize in medicine for discoveringa bacteria in the gut caused them.

"This is a paradigm shift in our field. This is a completely new way of approaching psychiatry. It's been coined metabolic psychiatry."

An estimated 33,000 Maritimers suffer from treatment-resistant bipolar disorder. Worldwide, the number runs into the millions. Kellie Williams used to count herself among them.

People had described her as "moody" for most of her life, and she was diagnosed with bipolar disorder in her late twenties.

"My depression felt like if someone had passed away. That complete sadness, that complete despair. I would have this constant, all day long, and with no one passing away.I knew there was something very seriously wrong then," she said.

The symptoms impacted her life with family, friends and at work. She struggled to keep plans, and she never knew when she would be incapacitated by a mood disorder.

"There were some times, several times, where I contemplated suicide. To try and get rid of that despair or pain I felt, I actually started cutting as well, just to try and redirect that pain you feel inside in your head."

She saw Calkin's name on a bulletin board at a mental health clinic recruiting people with bipolar whose medication had stopped working. She was surprised when they tested her and told her she was insulin resistant. Calkin treated that condition, and the devastating disorder went away.Calkin thinks it lets the traditional drugs work again.

"I couldn't believe it was actually gone. I'd never felt such a sense of wellness in my life," Williams said. "This is truly a miracle. I have my life I want to say back, but I have my life better."

She's discovered she's an avid planner and loves filling her schedule up months in advance.

She says her bipolar is in remission, and she's hopeful it will stay that way. She said others should feel hope, too.

"Don't be afraid to go out and do some research. Go online, ask people," she said. "You do have that right to be healthy and happy."

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50-year-old diabetes drug helps patients with bipolar disorder, study finds - CBC.ca

Researchers have found that several traditional medicines commonly used in South Asia are effective in maintaining blood sugar levels in patients with type 2 diabetes.

Several traditional medicines commonly used in South Asia, are effective in maintaining blood sugar levels in patients with type 2 diabetes, according to a new study led by experts at the University of Nottingham.

Many South Asian countries, including India and Nepal, have been using the Ayurvedic natural medical system for thousands of years. Some of the herbs included in this traditional medical system are also used in other parts of the world including Iran, China, and Mexico to name a few.

It features a multi-pronged and individualized approach to managing health conditions that can include lifestyle modification (including diet), Ayurvedic detoxifying and purifying therapies (e.g. Panchakarma), and Ayurvedic medicines (containing plant, animal, or mineral-origin ingredients single or in combination).

In this new study, published recently in the journal Frontiers in Pharmacology, experts conducted an in-depth review to show that these medicines are effective in blood sugar control in people with type 2 diabetes. Other beneficial effects were also demonstrated in the research, including improvements in body weight, blood pressure, cholesterol, and other diabetes-related parameters.

According to the scientists, it is the first comprehensive systematic review of any traditional medicine (including Ayurveda), which included a wide range of Ayurvedic medicines. The research was led by Dr. Kaushik Chattopadhyay, Associate Professor in Evidence Based Healthcare in the School of Medicine and the Nottingham Center for Evidence Based Healthcare (A JBI Center of Excellence) at the University. The team members have expertise in Ayurveda, diabetes, and this type of research, and are based in top institutes in the UK, India, and Nepal.

As a complex disorder, type 2 diabetes has major health, social, and economic consequences. It is also one of the main diseases for which patients consult Ayurvedic practitioners and use Ayurvedic medicines, often continuously from the point of diagnosis.

Patients often choose ayurvedic medicine because it aligns with their cultural and health views. Its acceptability, satisfaction, and perceived relief are usually high, especially among rural, poor, older, and indigenous/minority populations. Many patients with type 2 diabetes prefer not to use Western medicines due to the associated side effects, cost, and mode of administration (e.g., injections).

Previous systematic reviews have shown the potential for managing type 2 diabetes with these medicines, however many need updating and none have provided a comprehensive summary of all the medicines evaluated for managing the condition.

As part of this review, the team searched a range of sources, including 18 electronic databases. Two hundred and nineteen articles were included in the review, which represented 199 randomized controlled trials (21,191 participants) and 98 Ayurvedic medicines.

Many Ayurvedic practitioners may view the inclusion of herb extracts and proprietary Ayurvedic medicines in this review as a deviation from the classical style of management. However, in reality, many Ayurvedic practitioners prescribe, and many people consume these types of medicines.

Dr. Chattopadhyay said: This is the first time a thorough review has taken place looking at all these medicines on a much larger scale. The current evidence suggests the benefits of a range of Ayurvedic medicines in improving glycemic control in type 2 diabetes patients. Given the limitations of the available evidence and to strengthen the evidence base, high-quality randomized controlled trials should be conducted and reported.

As part of the funded project, we have developed a clinical guidelinefor managing type 2 diabetes by Ayurvedic practitioners based on this evidence and will be evaluating it.

Reference: Effectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis by Kaushik Chattopadhyay, Haiquan Wang, Jaspreet Kaur, Gamze Nalbant, Abdullah Almaqhawi, Burak Kundakci, Jeemon Panniyammakal, Michael Heinrich, Sarah Anne Lewis, Sheila Margaret Greenfield, Nikhil Tandon, Tuhin Kanti Biswas, Sanjay Kinra and Jo Leonardi-Bee, 8 June 2022, Frontiers in Pharmacology.DOI: 10.3389/fphar.2022.821810

The research is funded by the UKs FCDO, MRC, NIHR, and Wellcome Trust under the prestigious Joint Global Health Trials scheme.

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Study Finds Traditional Native Indian Medicine Effective Treatment for Type 2 Diabetes - SciTechDaily

Alexandra drops TD1 kits off to a Yonkers school (Photo by Jason Malkin)

An Ardsley teen is working to make life with type 1 diabetes easier on local kids. Alexandra Malkin, a rising senior at Ardsley High School, started T1D Kits for Kids to provide free essential health supplies (along with a few small treats) to elementary-aged children. And people are taking notice she was recently named Hero of the Day by Good Day New York for her work.

Malkin saw firsthand what kind of hardships kids face with juvenile diabetes after her childhood friend was diagnosed with the condition at age 9. As I watched her life change extremely quickly, I began to understand the true impact that diabetes can have on someones life especially at a very young age, she told River Journal.

The experience stayed with her. Malkin decided to focus on diabetes once she was accepted into her schools science research program, a 3-year elective that allows students to dive into specific research areas. After reading various articles on past diabetic studies during the year, I was sure I wanted it to be what I would study for the remainder of my time in the program influencing the two summer research projects I have been a part of involving diabetes.

While immersing herself in the science, Malkin also discovered that the high costs associated with type 1 diabetes can be especially detrimental to children. More recently, I found out from a friend that their cousin who works at an elementary school in Michigan has seen a lot of diabetic students who arent able to afford the basic diabetic technology, she said. As I looked into this issue more, I noticed extremely high prices of diabetic kits sold by large diabetes companies more than any underprivileged family could afford.

This sparked the idea to provide children with the devices and medical supplies needed for free. Her kits include glucose monitors, lancets, Band-Aids, batteries, and glucose tabs, basic and necessary tools to stay healthy throughout the day. While those items will make many parents happy, Malkin doesnt forget her main focus: kids with juvenile diabetes. She tucks a few treats inside each basket to make them smile. I also wanted to address the desire for comfort from young type-1 diabetics by including teddy bears, sugar-free candy, and bracelets, pins, that help them embrace their T1D identity.

Since kicking off in January, Malkin has donated batches of kits to three different elementary schools, where she works with nurses to identify those who would benefit from them most. The greatest amount of newly-diagnosed type 1 diabetics usually are found within that age group (kindergarten 4th grade), she noted. The kits have been specialized to appeal to this

age group as well. Shes working to keep relationships with the schools, and has been sent photos of the recipients holding the kits and smiling ear-to-ear.

Malkin hopes to expand the program outside Westchester in the future and has applied for grants to continue funding and upgrading her kits. And she wants to help connect children with juvenile diabetes through their stories. I also have an idea to create a diabetes advice book that would include advice from experienced type 1 diabetics to help the younger diabetics make a smoother transition and feel like they arent alone.

To help keep the program going, Malkin said sharing her work with others and making a donation would go a long way. The only way to truly make my organization grow is to promote necessary funding and recognition for the work of T1D Kits for Kids and the concept behind it, she said. With these contributions, I can achieve the goals I have for the non-profit and expand my impact to the larger diabetic community.

Visit t1dkitsforkids.org to learn more or to make a donation.

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Local Teen Brings Smiles and Health Kits to Kids with Diabetes - River Journal Staff

When you are traveling by vehicle to your destination, you should:

Once you reach your destination:

One of the most important aspects of managing Type 2 diabetes is for the patient to test their blood glucose level, usually twice a day. This could be more for some patients, depending on the care plan from their physician.

In an article in Healthline, Lisa Harris, CDE, RN at Rush University Medical Center in Chicago said that many patients with type 2 diabetes would likely benefit from testing more frequently. "Testing your blood sugar can be extremely informative for people when they're trying to prevent the need for further medication, like insulin," Harris said. "Even if they're only taking metformin, seeing for themselves how certain types of foods affect their blood sugar can have the biggest impact on motivating them to make changes in their diet."

In addition, when traveling, healthy eating tends to become more difficult to regularly sustain. People will usually eat out more and have less time to plan healthy meals or have fewer healthy options from which to choose. There's also less time to ensure proper nutrition and exercise which is important for managing diabetes.

"For people with diabetes, having their blood glucose readings sent to a provider is even more important when they travel because their diet might not be as healthy, eating times and patterns may shift, and other metabolic stressors related to traveling," said Dr. Bill Lewis, a leading telehealth consultant. "The iGlucose is the perfect traveling companion for people with diabetes so their test results are still being transmitted seamlessly to their provider."

Many of today's devices for at-home remote patient monitoring (RPM) rely on Bluetooth technology or Wi-fi paired to an app on a smartphone. These connections especially low-energy Bluetooth, can fail and may not reliably or securely deliver health data to providers.

The iGlucose from Smart Meter has proprietary cellular technology that utilizes the fast and secure 4/5G AT&T IoT network for reliable transmissions every time. With the cellular-enabled iGlucose, the measurement is sent immediately to the patient's provider with no extra steps required by the patient.

About Smart Meter, LLC

Now serving more than 100,000 patients, Smart Meter is the leading supplier of cellular-enabled virtual care technologies that include the iGlucose, iBloodPressure, iPulseOx, iScale, and SmartRPMcloud platform, as well as data, and services. Smart Meter's remote patient monitoring solutions are recognized as the standard for the RPM industry and are regarded for their high patient retention and satisfaction. The unique combination of reliable health data, patient-friendly devices, and platform integrations enable and enhance RPM, CCM, Employee Wellness, Population Health, and Telehealth programs for more than 300 RPM distribution partners across the United States. For more information, visitSmartMeterRPM.com

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Diabetes Travel Essentials and Tips for the Approximately 21 Million Americans that Must Manage Their Diabetes While on Vacation - PR Newswire

News Release

Thursday, July 14, 2022

NIH-funded clinical trial finds that starting with a cheaper drug and switching to a more expensive drug as needed leads to good vision outcomes in diabetic macular edema.

Clinical trial results from the DRCR Retina Network suggest that a specific step strategy, in which patients with diabetic macular edema start with a less expensive medicine and switch to a more expensive medicine if vision does not improve sufficiently, gives results similar to starting off with the higher-priced drug. The main complication of diabetic macular edema, fluid build-up in the retina that causes vision loss, is commonly treated with anti-vascular endothelial growth factor (VEGF) drugs.

The trial was funded by the National Eye Institute (NEI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), both part of National Institutes of Health. Results of the trial, which examined a stepped regimen of anti-VEFG drugs Avastin (bevacizumab) and Eylea (aflibercept), were published today in the New England Journal of Medicine.

Our study showed that switching treatments when needed is a reasonable strategy, said Chirag Jhaveri, M.D., Austin Research Center for Retina, Texas, the lead study author. Insurance companies often require clinicians to start with the less expensive treatment, so we really wanted to see how a specific treatment strategy using this approach would affect patient care.

Diabetic macular edema is caused by diabetes-related alterations to retinal blood vessels. Symptoms include blurred vision. If untreated, vision loss can become permanent and progress to blindness. Retinal injections of anti-VEGF drugs can restore vision. The DRCR Retina Network previously showed that Avastin and Eylea improve visual acuity in people with diabetic macular edema. However, while Eylea is approved by the U.S. Food and Drug Administration to treat diabetic macular edema and results in better visual outcomes on average, off-label Avastin is much less expensive and is sometimes required by insurers as a first-line treatment.

The study enrolled 270 participants with diabetic macular edema, some of whom received treatments in both eyes. At enrollment, all had best-corrected visual acuity between 20/50 and 20/320. Half the study eyes were assigned to Eylea from the start, and half were assigned to start with Avastin. For participants who needed treatment in both eyes, each eye started treatment with a different drug. Participants received either Avastin or Eylea injections every four weeks for 24 weeks. If eyes assigned Avastin failed to reach the pre-set improvement benchmarks starting at 12 weeks, the eye was switched to Eylea.

After 24 weeks, physicians could taper down the frequency of injections as appropriate to maintain visual acuity. The study collected information about participants retinal structure and visual acuity for two years.

After two years, eyes in both groups had similar visual acuity outcomes, improving on average approximately three lines on an eye chart, compared to the trials start. In the Avastin group, 70% of eyes switched to Eylea during the study.

While most participants on Avastin eventually switched to Eylea, they still had improvement during those initial weeks, even if they didnt hit our pre-set benchmarks, said Adam Glassman of the Jaeb Center for Health Research and director of the DRCR Retina Network coordinating center. There are large cost disparities between these drugs, so differences in treatment strategies may have substantial cost implications.

Weve demonstrated here one method to managing a step treatment, where the outcomes are similar to the best existing treatment protocol with Eylea, said Jennifer Sun, M.D., M.P.H., of Joslin Diabetes Center and Harvard Medical School, Boston, and chair of diabetes initiatives for the DRCR Retina Network. Any time we can add to a clinicians toolbox, whether its a new medication or a new approach to using existing medications, as in this study, its a benefit for patients.

The study was supported by NEI (EY014231) and NIDDK through the Special Diabetes Program for Type 1 Diabetes Research. Clinical trial number NCT03321513.

NEI leads the federal governments research on the visual system and eye diseases. NEI supports basic and clinical science programs to develop sight-saving treatments and address special needs of people with vision loss. For more information, visit https://www.nei.nih.gov.

About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIHTurning Discovery Into Health

Jhaveri CD, Glassman AR, Ferris FL, Liu D, Maguire MG, Allen JB, Baker CW, Browning D, Cunningham MA, Friedman SM, Jampol LM, Marcus DM, Martin DF, Preston CM, Stockdale CR, Sun JK, DRCR Retina Network. Aflibercept monotherapy versus bevacizumab first followed by aflibercept if needed for treatment of center-involved diabetic macular edema. NEJM. July 14, 2022.

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A type of 'step therapy' is an effective strategy for diabetic eye disease - National Institutes of Health (.gov)

With temperatures set to hit 40 C across parts of the UK, people living with diabetes are being reminded about the dangers of hot weather.

Almost five million people in the UK have diabetes, a condition where the body cannot control blood sugar (glucose) levels.

If left unmanaged, excess blood glucose can cause serious short and long-term complications and increases the risk of heart disease, stroke and cancer.

Dan Howarth, Head of Care at Diabetes UK, said: Sitting in the sun for long periods can affect yourdiabetesbecause youre not being very active, making blood sugar levels higher than usual.

On the flipside, if you take insulin to treat your diabetes, it will be absorbed more quickly from the injection site in warm weather, and this increases the risk of hypos.

Hypo is short for hypoglycaemia which occurs when blood sugars fall too low. The heat can make symptoms of a hypo, such as tiredness, sweating and feeling dizzy harder to spot.

Depending on the severity of hypoglycaemia, it can be treated by consuming 15-20g of a fast-acting carbohydrate, such as glucose tablets, sweets, fizzy drinks or fruit juice.

People with diabetes who plan to spend time in the sun should increase the number of times they test their blood glucose levels and adjust their insulin intake accordingly.

Those who are going to be active during the hot weather should be extra vigilant and check their levels beforehand, eating something sugary if their glucose levels are low.

The heat can also affect equipment, with glucose monitors and test strips especially prone to damage.

Avoid putting your glucose monitor and test strips in direct sunlight and try to keep them at average room temperature.

If you travel to many hot countries, you might already be used to keeping your insulin cool, carrying it with you in a cool bag or carry case. However, with the current temperatures, its worth storing your insulin in the fridge, if you dont already, as this will prevent heat damage.

High blood sugar levels might be due to heat-damaged insulin, which is often cloudy, with the liquid turning grainy and sticking to one side of its glass container.

You should avoid using this insulin and any insulin exposed to direct sunlight, which takes on a brown hue.

Finally, its vital that you compensate for any fluids lost through sweating by keeping hydrated and increasing your fluid intake. Dehydration can lead to higher blood glucose levels and hyperglycaemia.

What the Diabetes Community Are Saying About the Heat:

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Experts warn people with diabetes of the dangers posed by hot weather - Diabetes.co.uk

Researchers, led by Yehuda Handelsman, conducted a post-hoc analysis of the ATHENA and EURIDIS/ADONIS studies and concluded that dronedarone reduced cardiovascular hospitalization/death and atrial fibrillation/atrial flutter recurrence and increased time to recurrence event in patients both with and without diabetes. Their study was published in the Journal of Diabetes and Its Complications.

This analysis focused on the patients who had diabetes, 945 of 4628 patients in ATHENA (dronedarone = 482; placebo = 463) and 215 of 1237 patients in EURIDIS/ADONIS (dronedarone = 148; placebo = 67). Patients were stratified based on baseline diabetes status. Time-to-event was assessed using the Kaplan-Meier method, and hazard ratios were estimated via Cox models.

According to the researchers, there were higher rates of cardiovascular hospitalization/death in patients with diabetes (39.5%) than in those without diabetes (34.7%). The incidence of first cardiovascular hospitalization/death was lower in patients with diabetes treated with dronedarone (35.1%) compared with placebo (44.1%), and the time to that event was longer in patients treated with dronedarone compared with placebo (P=.005).

Additionally, the median atrial fibrillation/atrial flutter recurrence time was longer with dronedarone compared with placebo in patients with diabetes (ATHENA = 722 vs. 527 days, P=.004; EURIDIS/ADONIS = 100 vs. 23 days; P=.15) and without diabetes (ATHENA = 741 vs. 492 days; P<.0001; EURIDIS/ADONIS = 120 vs. 59 days; P=.0002). Finally, the rate of treatment-related adverse events with dronedarone was comparable to placebo in patients with and without diabetes.

The researchers noted that the analysis was limited by the lack of data on blood glucose levels in the ATHENA study and whether or not diabetes treatments were changed during either study. Analysis was also limited by the differing diagnosis of diabetes between the 2 trials.

The investigators concluded that dronedarone demonstrated similar efficacy in reducing cardiovascular hospitalization rates, delaying time to first cardiovascular hospitalization and death, and reducing atrial fibrillation/atrial flutter recurrence in atrial fibrillation/atrial flutter patients with or without diabetes with a comparable safety profile relative to placebo.

Find more recent studies on the Atrial Fibrillation Knowledge Hub

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Dronedarone in Patients With Atrial Fibrillation and Diabetes - DocWire News

For blood sugar control, we need a balance of protein, fiber, and healthy fat alongside our carbohydrates to keep blood sugars stable after meals. You can do that by either paring your carbs with high-protein, -fiber, and -healthy fat foods, but you can also look for carbs that are naturally higher in these satiating, digestion-slowing macronutrients.

One of the most common carbs we eat is bread, and the bread aisle is often thought of to be a minefield for those with diabetes or prediabetes as many options can be particularly harmful to your blood sugar levels.

To help you navigate the bread aisle, we scoured the internet for loaves of bread that are standouts when it comes to lacking a balanced nutrition label and may be more likely to spike blood sugar than other options.

Although these breads may be some of the worst for blood sugar, it's worth noting that all foods belong in a balanced diet for blood sugar. While these recommendations are meant for individuals with diabetes or pre-diabetes, consider balancing these options with a protein source and high-fiber foods like vegetables to still incorporate them into your lifestyle in moderation.

PER 1 SLICE: 80 calories, 1 g fat (0 g saturated fat), 0 mg cholesterol, 230 mg sodium, 16 g carbs (<1 g fiber, <1 g sugar), 2 g protein

Similar to white bread, this Italian loaf delivers 80 calories per serving. Generally, this is lower in calories for a slice of bread, but the overall nutrition might not be the best for blood sugar control.

With 16 grams of carbs per slice and less than 1 gram of fiber, this bread doesn't deliver much staying power between meals.

If you love an Italian sandwich, be sure to balance out your carbs with protein options like turkey or ham, cheese, and veggies for a boost in fiber.

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PER 1 SLICE: 90 calories, 1.5 g fat (0.5 g saturated fat), 0 mg cholesterol, 95 mg sodium, 17 g carbs (1 g fiber, 6 g sugar), 3 g protein

This bread is super sweet in the mornings, but probably not doing your blood sugars any favors if you have diabetes or pre-diabetes. Two slices clock in at about 180 calories, 34 grams of carbs, and 8 grams of sugar.

Interestingly, turning this bread into French toast by dipping it in an egg wash would actually improve your blood sugar response. Be sure to choose a low-sugar syrup to top it off.

RELATED:The #1 Best Breakfast Habit for Diabetes, Say Dietitians

PER 1 SLICE: 130 calories, 1 g fat (0 g saturated fat), 0 mg cholesterol, 230 mg sodium, 26 g carbs (1 g fiber, 4 g sugar), 4 g protein

Kelsey Lorencz, RD with Zenmaster Wellness tells us that one slice of this bread has 26 grams of carbohydrate, 4 grams of added sugar, and only 1 gram of fiber.

She explains, "If you're eating a sandwich, you can double it for over 50 grams of net carbs just from the bread alone. The lack of fiber and large slices make it easy to eat more carbohydrates than intended, potentially spiking your blood sugar if you have diabetes."

PER 1 SLICE: 120 calories, 1.5 g fat (0 g saturated fat), 0 mg cholesterol, 150 mg sodium, 22 g carbs (1 g fiber, 2 g sugar), 3 g protein

Lorencz shares that potato breads might be another landmine to look out for if blood sugar is your concern.6254a4d1642c605c54bf1cab17d50f1e

She states, "With 22 grams of carbohydrate and less than 1 gram of fiber, this bread will quickly raise your blood sugar and potentially lead to a crash shortly after. The fiber in bread helps to slow the release of sugar into the bloodstream during the digestion process. With such little fiber, the carbohydrates are quickly broken down into sugar and released into the blood."

If you're eating bread that is higher in carbohydrates and not rich in fiber, pair it with another high-fiber food or a serving of protein and fat. These nutrients slow down digestion, so that blood sugar rises more steadily and is less likely to crash.

RELATED:4 Best Breads To Eat for Blood Sugar, Say Dietitians

PER 2 SLICES: 140 calories, 1.5 g fat (0 g saturated fat), 0 mg cholesterol, 180 mg sodium, 29 g carbs (2 g fiber, 5 g sugar), 4 g protein

Although this might be a nostalgic favorite, it is not the friendliest option for our blood sugar. With 29 grams of carbs per two-slice serving, this bread might cause blood sugars to rise quickly without a balance of protein, fiber, and healthy fat.

This bread does have 3 grams of fiber in two slices, which is higher than some! Wonder Bread also makes a Smart White that now contains 5 grams of fiber per serving and 5 grams of protein.

That little boost helps keep blood sugars more stable after your meal while still enjoying your favorite white bread.

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5 Worst Breads To Eat for Blood Sugar, Says Dietitian Eat This Not That - Eat This, Not That

Cherries score as low as 20 on the glycemic index and they can be eaten by diabetic people.

Photo : iStock

New Delhi: Fruits and vegetables are an important part of our diets as they are the source of several important vitamins and minerals. These nutrients help to keep the body healthy and fit. However, not every fruit or vegetable can be consumed by everyone because everyones body is not the same and people suffer from several diseases and conditions.

But first, what is glycemic index?

The glycemic index is a measure of the impact of foods on blood sugar levels after eating. It does so by comparing the amount of carbohydrate in a given food to the impact it has on blood sugar when eaten. Foods are given glycemic index scores, they are labelled as low, moderate and high. Foods with 55 and below GI score are low on the glycemic index, however, foods with 70 and above GI score are high on the glycemic index.

Fruits too are marked by their GI scores and ones with low glycemic index can be eaten by people with diabetes. Here take a look at the different fruits that are low on the glycemic index and can be eaten by people with diabetes.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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Fruits with low glycemic index that are healthy for diabetic people - Times Now