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Nine things you need to know why fighting diabetes must start in cities



Urban areas are complex environments. A large number of environmental, social, cultural and economic factors have an impact on individual and population health. In the following, we will take a look at how urbanisation impacts lifestyle.
1. Diabetes is an emergency in slow motion
It may not have the immediacy of communicable diseases, such as malaria, tuberculosis, and HIV, but diabetes is a bigger killer globally than all of the above combined. (1) It is estimated that 415 million people, or about one in every 11 people, are living with the condition worldwide–that is 33 million adults more than in 2013. (2)
 A young girl visits a Mexico City hospital with her mother. Will she ever see a decline in the rise of urban diabetes?
2. Cities are the frontline of the battle against diabetes
Already today, two-thirds of all people with diabetes live in urban environments. Urban diabetes is on the frontline of the diabetes challenge. Without urgent action, the trajectory is clear:
•           In Mexico City, where diabetes is already the leading cause of death, the number of people with the condition could rise to over 6 million people–nearly 1 in 5 of the population–by 2040.
•           In Houston, diabetes rates are expected to jump from nearly one person in 10 to one person in 5 over the next 25 years. (3)
3. There are underlying social and cultural drivers
 By 2035 as many as half a billion people will have type 2 diabetes. (4)Medical treatment is essential but will not halt its rise. If we’re serious about changing the rise of type 2 diabetes, we must look at the problem in a different way. This means looking to the nearly 2 billion people worldwide who are at risk of developing type 2 diabetes. (5) It means looking at the social factors and cultural determinants that make people vulnerable in the first place–before they ever see a doctor.
4. Loneliness
One of the striking findings in the Cities Changing Diabetes study is the impact of living alone and lack of social support.
Living alone is an indicator of vulnerability to diabetes–influencing people’s ability to take care of their own health and prepare healthy meals. Instead they end up choosing easy solutions such as bread, frozen products or takeaways. (6) In Copenhagen, researchers found those living alone are nearly twice as likely to have diabetes. (7)
5. New normal
Obesity seem to impact the normative body images, and when these change, so do the perceptions of what ‘a healthy body’ might look like. In Houston, where there are high levels of obesity, the study found that when comparing your own body size and physical shape favourably to others, this can create a scenario where change can be perceived as un-necessary. (8)
 Habits are hard to break: “If she can, I can too”
6. Urban myths and misconceptions
The study found popularly held misconceptions about what causes diabetes. In Mexico City, where 74% of the adult population is either overweight or obese, people talked about the fear and stress of living in the city; Diabetes was an emotional or psychological issue. (9) In Tianjin, a huge city powered by petrochemical, car manufacturing and metalworking industries, beliefs about what causes diabetes was sometimes linked to water and air quality as well as hormones and chemical additives in food.(10)
7. Time pressures
 Do you manage your health as well as you manage your inbox?
Time constraints have a direct impact on diabetes vulnerability, as they dictate what is feasible in terms of prevention and management of diabetes. In Tianjin, researchers found that many did not see diabetes as a serious disease, and therefore do not pay much attention to everyday diabetes care. However, once diabetes-related complications occur, beliefs and attitudes towards the illness dramatically change; suddenly, diabetes is taken much more seriously. (11)
8. Sedentary lifestyles
Urban living encourages sedentary lifestyles. Overpopulation, road traffic density, excessive use of motorised transportation, poor air quality and too few green public spaces make physical activity difficult in cities. At the global level, absence of physical exercise and sedentary lifestyles are the fourth-largest risk factor for mortality. (12)
9. Inequality
Today’s urban areas are also characterised by increasing health inequalities.(13) In Copenhagen, for example, there are disparities in average lifespan of almost 7 years between areas of the city. People not in employment are almost 7 times more likely to have diabetes than those in employment. (14)
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Source:
1: http://www.huffingtonpost.com/entry/diabetes-deaths_5643e784e4b08cda348777bf
2: Diabetes atlas, 2013 and 2015
3: Cities changing diabetes briefing book
4: IDF Diabetes Atlas,
5: http://care.diabetesjournals.org/content/34/6/1249.full
6: Cities changing diabetes briefing book;

7, 8, 9, 10, 11: ibid

New diabetes screening recommendation misses more than half of high-risk patients


Latest screening guidelines don't identify many patients with diabetes, prediabetes, say experts

Northwestern University

Summary:
Fifty-five percent of high-risk patients were missed by diabetes screening guidelines, according to a new study. Not identifying patients with diabetes and prediabetes prevents them from getting the necessary preventive care. This is the first study to examine how the latest diabetes screening guidelines, issued in October 2015, may perform in practice.
The latest government guidelines doctors follow to determine if patients should be screened for diabetes missed 55 percent of high-risk individuals with prediabetes or diabetes, a new Northwestern Medicine study found.
The 2015 screening guidelines from the United States Preventive Service Task Force (USPSTF) recommend patients be screened for diabetes if they are between 40 and 70 years old and are overweight or obese. But the study found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities.
Not identifying individuals with dysglycemia (prediabetes or diabetes) in these high-risk groups means they will miss out on taking preventive measures, such as eating right and exercising or taking medications. This is the first study to examine how the new USPSTF guidelines, issued in October, may perform in practice.
Under a provision in the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. Therefore, a patient who falls outside the diabetes screening guidelines and requests a test may have to pay out of pocket.
"Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly," said study senior author Dr. Matthew O'Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. "If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes."
The study will be published in PLOS Medicine on July 12.
Fifty-four percent of white patients who developed dysglycemia fell within the screening guidelines, compared to only 50 percent of African-American patients and 37 percent of Latino patients, according to the study.
"Say I'm caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy. She shouldn't be screened, according to the guidelines, but she's very likely to have either prediabetes or diabetes," O'Brien said.
The study looked at electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013.
O'Brien said the USPSTF is on the right track with their guidelines because they focus on the two risk factors -- age and weight -- that are most predictive of developing dysglycemia. However, physicians should be aware of this study's findings, so they can understand who may be missed by the USPSTF's criteria and decide whether to screen those patients, he said.
"We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites," O'Brien said.
With these findings, O'Brien said next steps are to decide what other factors should be taken into account when determining who is at risk for diabetes and to use electronic health records to automatically prompt providers to screen patients who have those risk factors.
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Story Source:
The above post is reprinted from materials provided byNorthwestern University. The original item was written by Kristin Samuelson. Note: Materials may be edited for content and length.
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Journal Reference:
1.         Matthew J. O’Brien, Ji Young Lee, Mercedes R. Carnethon, Ronald T. Ackermann, Maria C. Vargas, Andrew Hamilton, Nivedita Mohanty, Sarah S. Rittner, Jessica N. Park, Amro Hassan, David R. Buchanan, Lei Liu, Joseph Feinglass.Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients.PLOS Medicine, 2016; 13 (7): e1002074 DOI:10.1371/journal.pmed.1002074


Can treating the brain help in the fight against diabetes?


Melissa Healy

In research that may point the way to new treatments for Type 2diabetes, obese and diabetic mice who got a single shot of a growth-promoting peptide directly into their brains experienced lasting remission from the metabolic disorder without any sustained changes to their diet or their weight.
A week after researchers injected a low dose of synthesized mouse Fibroblast Growth Factor 1 — FGF1 — directly into the ventricles of diabetic mouse brains, the mice’s erratic blood glucose levels stabilized at normal levels. Then they stayed normal for 17 weeks — effectively curing the mice of their diabetes.
See the most-read stories in Science this hour >>
It was a level of remission until now seen only in the wake of bariatric surgery, the authors reported Monday in the journal Nature Medicine. The study was led by endocrinologist Michael W. Schwartz, gastroenterologist Jarrad M. Scarlett and molecular physiologist Jennifer M. Rojas. Schwartz directs the University of Washington’s Diabetes and Obesity Center of Excellence and Scarlett and Rojas conduct research there.
The success of a direct-to-the-brain treatment for diabetes in mice is unlikely to prompt such radical treatments for humans — not anytime soon, at least. But it does highlight a little-appreciated surmise about Type 2 diabetes: that it may be, to some extent at least, a brain disease, and that treatments that go to the source of the metabolic dysfunction may lead to “cures” that have not been achieved by treating its downstream effects in the pancreas, blood, liver, muscles and fat.
"That's a novel perspective," Schwartz said. The ways in which the brain influences diabetes are not understood, he added. But "there's enough data to take a good look at" the relationship.
The introduction of FGF1 into the brain’s fluid-filled caverns appeared to unleash a sequence of changes in the mice. Production of a powerful neuroprotective protein surged in the brain. That, in turn, fostered the robust growth of brain connections in the hypothalamus — the source of many hormones that play a role on appetite and metabolism. Outside the brain, the skeletal muscles and livers of the diabetic mice quickly improved their uptake of post-meal glucose. As glucose clearance improved, the high blood-sugar levels that are a hallmark of Type 2 diabetes quickly normalized.
Researchers saw no evidence that the treated mice were plagued by hypoglycemia — a problem of over-correction that many on Type 2 diabetes treatments experience. Nor, they concluded, were the metabolic improvements the result of weight loss: while treated mice briefly dialed back their intake and lost some weight, their appetites and their weight quickly returned.
But their Type 2 diabetes was gone.
To ensure that the effect they were seeing was real, the authors of the new research repeated the experiment on rats, as well as on mice that were bred to develop Type 2 diabetes by a different means than did the first set of mice. In both cases, a single infusion of FGF1 had the same anti-diabetic effect.
“Except for certain bariatric surgical procedures, we are unaware of any intervention capable of inducing sustained remission of Type 2 diabetes in humans or rodents,” the authors wrote. The administration of FGF1 directly into the brain, the authors wrote, “unmasks the brain’s inherent capacity to induce sustained diabetes remission.” And all, they added, “without the need for surgical revision of the gastrointestinal tract.”
While pumping growth factor directly into human brains may seem unwieldy, diabetes treatment that focuses on the brain is not out of reach, the authors wrote. Working with mice and rats, scientists have demonstrated that the intranasal delivery of FGF1 to the brain is feasible.
"We are entering an era where, really, when it comes to treating diabetes using insulin or insulin-related treatments — which they all are — we've gotten as far as we're going to get," Schwartz said. Increasingly, drug developers "understand there probably are not going to be breakthroughs by hammering away at the same drug targets," he added.
"So if there's going to be a paradigm shift in finding treatments that might complement or make other drugs more effective, then targeting the brain might be the way to do this," he said.
Close to 30 million Americans — more than 9% of the U.S. adult population — suffer from Type 2 diabetes, and new diagnoses are surging as obesity soars and the U.S. population ages.
A wide range of medications are available, and under development, but remission most often requires substantial weight loss. In recent years, bariatric surgery has been recognized as highly effective in allowing diabetic patients to reduce or discontinue medication, but its high cost has limited access to such treatment.

Diabetes drug found no better than placebo at treating nonalcoholic fatty liver disease


Diabetes drug found no better than placebo at treating nonalcoholic fatty liver disease
But randomized, double-blind clinical trial suggests better way to conduct future trials
Date:
May 12, 2016
Source:
University of California - San Diego
Summary:
A diabetes medication described in some studies as an effective treatment for nonalcoholic fatty liver disease (NAFLD) works no better than a placebo, report researchers after conducting the first randomized, double-blind, controlled clinical trial of sitagliptin, an oral antihyperglycemic marketed under the name Januvia.
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A diabetes medication described in some studies as an effective treatment for nonalcoholic fatty liver disease (NAFLD) works no better than a placebo, report researchers at University of California San Diego School of Medicine, after conducting the first randomized, double-blind, controlled clinical trial of sitagliptin, an oral antihyperglycemic marketed by Merck & Co. under the name Januvia.
Writing in the Journal of Hepatology, a multidisciplinary team headed by study senior author Rohit Loomba, MD, professor of medicine in the Division of Gastroenterology and director of the NAFLD Translational Research Unit at UC San Diego School of Medicine, found that sitagliptin was not significantly better than a placebo in reducing liver fat, as measured by magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and other technologies.
The team included Claude Sirlin, MD, professor and vice chair (translational research) of radiology at UC San Diego School of Medicine, and Richard Ehman, MD, professor of radiology at Mayo Clinic. The labs, led by Sirlin and Ehman, invented and validated the advanced noninvasive imaging techniques applied in this study.
NAFLD is the accumulation of fat in the livers of people who drink little or no alcohol. It is the leading cause of chronic liver disease in the United States. Roughly one-quarter of Americans -- an estimated 100 million adults and children -- have NAFLD, which can progress to a more serious form called nonalcoholic steatohepatitis, which in turn can develop into cirrhosis, liver cancer and liver failure.
Currently, there are no approved, specific therapies for NAFLD. However, it is commonly associated with diabetes, which has prompted researchers to test diabetes medications, such as metformin, rosiglitazone and liraglutide, as potential treatments.
Sitagliptin is another possibility. In clinical trials conducted in patients with type 2 diabetes, sitagliptin has been shown to be effective in improving glycemic (blood sugar) control, cholesterol, lipoproteins and other health measures compared to placebo.
"But human trials of sitagliptin have been limited to date because they have lacked important tools like a placebo arm and allocation concealment (in which researchers do not know what the next treatment allocation will be, further preventing selection bias in testing)," said Loomba.
In the new study, 50 NAFLD patients with pre-diabetes or early diabetes were randomized into two groups: one received a 100 milligram oral dose of sitagliptin daily for 24 weeks, the other received a placebo. Primary outcome was assessed by changes to liver fat measured by MRI-PDFF, conducted by the Liver Imaging Group in the Department of Radiology at UC San Diego Health.
At end-of-treatment, Loomba and colleagues found no significant differences between sitagliptin and placebo across a range of measures. Neither study group experienced any adverse effects.
While the study did not support earlier findings that sitagliptin was an effective treatment for NAFLD, Loomba said it provided new evidence that clinical trials with patients at higher risk of diabetes do not necessarily need a liver biopsy to be efficiently screened for potential therapeutic agents.
"Biopsies present their own complications, such as possible pain and infection," said Loomba. "MRI-PDFF, and magnetic resonance elastography (a non-invasive imaging technique that measures the stiffness of soft tissues) proved to be accurate, quantitative, and useful over the study duration in measuring the state and progression of disease. These technologies should be further investigated in clinical trials, especially those of longer duration."
Added Sirlin: "These advanced magnetic resonance imaging techniques continue to be refined. Although they remain mainly in the research domain now, we anticipate they will become part of standard clinical care within a few years."
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Story Source:
The above post is reprinted from materials provided byUniversity of California - San Diego. The original item was written by Scott LaFee. Note: Materials may be edited for content and length.
________________________________________
Journal Reference:
1.         Jeffrey Cui, Len Philo, Phirum Nguyen, Heather Hofflich, Carolyn Hernandez, Ricki Bettencourt, Lisa Richards, Joanie Salotti, Archana Bhatt, Jonathan Hooker, William Haufe, Catherine Hooker, David A. Brenner, Claude B. Sirlin, Rohit Loomba. Sitagliptin versus placebo in the treatment of nonalcoholic fatty liver disease: A randomized controlled trial. Journal of Hepatology, 2016; DOI: 10.1016/j.jhep.2016.04.021
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University of California - San Diego. "Diabetes drug found no better than placebo at treating nonalcoholic fatty liver disease: But randomized, double-blind clinical trial suggests better way to conduct future trials." ScienceDaily. ScienceDaily, 12 May 2016. <www.sciencedaily.com/releases/2016/05/160512160657.htm



Blood pressure drugs may raise heart attack risk for diabetes patients


While patients with systolic pressure above 140 saw health benefits, those with pressure at or below 140 saw potential risks go up.
By Stephen Feller   |
UMEA, Sweden, Feb. 25 (UPI) -- Although many with diabetes have high blood pressure, and it is important for these patients to keep blood pressure under control, a new study suggests aggressive treatment may increase risk for heart attack.
Researchers in Sweden found in a large study that diabetic patients with systolic blood pressure lower than 140 before treatment with antihypertensive drugs had a higher chance for heart attack.
More than 70 million people in the United States have high blood pressure, considered a systolic pressure above 140 and diastolic pressure above 90. Recommendations for controlling blood pressure have long aimed for 140, howeverrecent research found more aggressive treatment -- setting a goal for systolic pressure of 120 -- can significantly lower the risk of cardiovascular events and death.
Health benefits have been seen when aiming for an even lower blood pressure, but diabetic patients face other health concerns that complicate such strong treatment goals.
"In practice, it is important to remember that undertreatment of high blood pressure is a bigger problem than overtreatment," Mattias Brunström, a doctoral student at Umeå University, said in a press release. "Many treatment guidelines, both Swedish and international, will be redrawn in the next few years. It has been discussed to recommend even lower blood pressure levels for people with diabetes -- maybe as low as 130. We are hoping that our study, which shows potential risks of such aggressive blood pressure lowering treatment, will come to influence these guidelines."
For the study, published in the British Medical Journal, researchers reviewed 49 trials including 73,738 participants, most of whom had type 2 diabetes, to find the effects of varying levels of blood pressure treatment.
For patients with systolic pressure above 150, aggressive blood pressure treatment lowered the risk of any type of death, death from a cardiovascular event, heart attack, and kidney discharge. With a baseline systolic pressure between 140 and 150, treatment also was seen to reduce death, heart attack, and heart failure.
Patients with systolic pressure lower than 140, however, saw an increased risk of heart attack, a cardiovascular event leading to death, or any cause of death.
"Our study shows that intensive blood pressure lowering treatment using antihypertensive drugs may be harmful for people with diabetes and a systolic blood pressure less than 140 mm Hg," Brunström said. "At the same time, it is important to remember that blood pressure lowering treatment is crucial for the majority of people with diabetes whose blood pressure measures above 140."


A Do-It-Yourself Revolution in Diabetes Care


 By PETER ANDREY SMITH
FEB. 22, 2016
John Costik got the call at the office in 2012. It was his wife, Laura, with terrible news: Their 4-year-old son, Evan, was headed into the emergency room.
His blood sugar reading was sky high, about 535 mg/dl, and doctors had discovered he had Type 1 diabetes. The first three days in the hospital were a blur during which the Costiks, engineers in Rochester, received a crash course in managing the basics of diabetes care.
For starters, they were told to log their son’s numbers on paper forms. It was their first hint that diabetes management did not occupy a place on technology’s bleeding edge. The methods for guesstimating carbohydrate intake also seemed imprecise, Mr. Costik found, and the process generated a lot of wasted data.
“The last thing you want to do is find some form and fill it out,” he said. “You’re really just emotionally trying to cope with it, and that data in that book isn’t necessarily useful to the people with diabetes.”
Several months later, Mr. Costik fitted his son with a Dexcom G4 continuous glucose monitor. A hair-thin sensor under Evan’s skin recorded an exact blood sugar reading at five-minute intervals, 24 hours a day.
But all that data left with Evan every morning when he headed off to day care. Mr. Costik wanted something better: continuous access to his son’s glucose readings.
So he examined the device’s software code and wrote a simple program that transmitted the monitoring data to an online spreadsheet he could view on a Web browser, Android mobile phone or, eventually, his Pebble smartwatch.

“I wanted our lives to be simple,” Mr. Costik said, “and I wanted Evan to live a long time, and diabetes to be a nuisance, not a huge struggle.”
Mr. Costik shared a photograph of his simple hack on Twitter — and discovered a legion of parents who were eager to tailor off-the-shelf devices into homemade solutions. Together, they have set in motion a remarkable, egalitarian push for improved technology to manage diabetes care, rarely seen in the top-down world of medical devices.
In 2014, the last year for which data is available, the Centers for Disease Control and Prevention estimated that 29 million adults were living with diabetes. Of these, 5 to 10 percent had Type 1, which develops when the body’s immune system destroys pancreatic beta cells.
Now, as consumer gadgets weave themselves ever more tightly into everyday life, patients and their families are finding homespun solutions to problems medical-device manufacturers originally did not address. Industry executives say the pace of user-driven innovation was one reason the Food and Drug Administration recently reclassified remote glucose-monitoring devices, hastening approval for new models by big companies like Dexcom and Medtronics.
James Wedding, a civil engineer who lives outside Dallas, saw Mr. Costik’s Twitter post and used his code to set up a remote monitor system for his daughter, Carson, who is now 12.
“Once I got all the pieces together, I remember crying — not quite in sadness, just in utter amazement — the first time I could see her numbers displayed on my computer screen and she was on the other side of the house,” Mr. Wedding said.
 “It is such a change in your relationship when the first question out of your mouth when you talk to your son, your daughter, your spouse, your brother, whatever, is no longer, ‘Hey, what’s your number?’ It’s ‘How was math class? How was work? What are you up to today?’”
Lane Desborough, an engineer in California, got in touch with Mr. Costik after seeing his tweet, ultimately creating an open-source system based in part on Mr. Costik’s code. It allows anyone to hack existing glucose monitors so they transmit readings to the cloud, where they can be read by patients and caregivers.
Mr. Desborough called the project Nightscout. The Nightscout group on Facebook, known as CGM in the Cloud, provides free tech support for users trying to improve on monitoring devices.
About two dozen users have even started a project called Open APS, in which they are pairing insulin pumps with glucose monitors in an effort to create an open-source artificial pancreas system. These wearable devices, which automate insulin delivery, are being tested in academic settings, but these early adopters are not waiting for the results of those continuing clinical trials.
Mr. Costik now works at the Center for Clinical Innovation at the University of Rochester, where he works to improve management options for all patients; Mr. Desborough is now the chief engineer atBigfoot Biomedical, a start-up in Palo Alto, Calif., that plans to create an artificial pancreas.
More recently, the home tinkering projects have buoyed a patient-led initiative to make generic insulin. Anthony Di Franco, a founder of the biotech hacker space Counter Culture Labs in Oakland, Calif., has had diabetes for 10 years. Mr. Di Franco saw what parents with diabetic children were doing with glucose monitoring devices and wondered why, even with insurance coverage, a three-month supply of insulin often totaled hundreds of dollars.
 “I was frustrated with the situation,” he said.
With available laboratory tools, and a wealth of available academic literature, he set out to learn whether insulin could be home-brewed on a small scale. After some research, Mr. Di Franco realized, “We can do it, and we can do it now. All of the tools already exist.”
Last year, the Open Insulin Project raised $16,656 in one of the more ambitious efforts to radically transform diabetes care. So far, the small team of researchers has inserted the genes that make proinsulin (the form of insulin produced by the human body) into E. coli bacteria and began culturing the organism on a larger scale.
The intent is not to make insulin at home, or on an industrial scale. Any drug that is injected comes with substantial risks and would face considerable regulatory scrutiny. Rather, the hackers hope to be able to demonstrate the technological feasibility. Within a year or two, Mr. Di Franco said he envisions handing off the protocols and any intellectual property to a generics manufacturer.
“One thing that would make me happy,” he said, “is that if more people who needed insulin got ahold of it by whatever means necessary.”
Dr. Jeremy A. Greene, a physician and historian at Johns Hopkins University, who recently wrote in The New England Journal of Medicine about the lack of generic insulin, said patients with diabetes had a long history of tinkering with existing technology, even in ways that were not officially sanctioned.
Dr. Greene argues that while manufacturers in insulin are making innovations — the newest forms of insulin are substantial improvements over earlier products — they stop producing the older forms once they lose patent protection. Patients and their insurers pay a high price for patented insulin or go without.
Biohackers are attempting to resurrect an older product to address the lack of generic insulin, Dr. Greene said.

“I don’t think that we should be surprised that a population of technologically savvy patients, whose lives are dependent on access to a supply of a biological agent, should be interested in taking means of production into their own hands, especially at time when insulin prices have risen at unpredictably alarming rates.”

Many Living with Symptoms of Diabetic Nerve Pain Are Undiagnosed Despite Severe and Constant Pain



By Staff Editor
(HealthNewsDigest.com) - NEW YORK & ALEXANDRIA, Va.---Pfizer Inc. (NYSE:PFE) in collaboration with the American Diabetes Association today announced results of a joint multicultural survey,Community Health Perspectives, which found significant gaps in awareness, diagnosis and management of a serious diabetes-related complication known as painful diabetic peripheral neuropathy or diabetic nerve pain. The findings were particularly pronounced among African American and Hispanic American communities that experience symptoms of diabetic nerve pain, including burning, shooting pain in the feet or hands. Community Health Perspectives was conducted to support Step On UpTM, an educational program about diabetic nerve pain that encourages people to speak with a health care provider.
"I got involved with Step On Up because I saw firsthand how the pain impacted my father, who has type 2 diabetes and diabetic nerve pain. Results from this survey show he's not alone, especially in the African American community," said Cedric "The Entertainer," award-winning actor and comedian. "Nearly half of African Americans surveyed had not talked to a health care provider about their nerve pain in the feet and/or hands. I want to encourage people experiencing symptoms of diabetic nerve pain to take action and speak with a doctor about their pain."
Community Health Perspectives surveyed a main sample of 1,000 adults ("general respondents") in the United States who had been diagnosed with diabetes and experienced symptoms of diabetic nerve pain in their feet and/or hands. Among the general respondents, 76 percent reported feeling nerve pain in the feet or hands most or all of the time.
The main sample included African American and Hispanic American respondents. An additional sample of African American (n=452) and Hispanic American (n=467) adults were then surveyed for further analysis. The results below represent the combined African American and Hispanic American samples, which found:
•           On average, African American and Hispanic American respondents showed that more than 50 percent were not diagnosed with the condition.
•           More than half of African Americans surveyed said that nerve pain in their feet and/or hands impacts their day-to-day life more than any other symptom of their diabetes.
•           Hispanic American and African American respondents (74 percent and 80 percent, respectively) were also less likely than Non-Hispanic Whites (97 percent) to agree that nerve pain is a common complication of diabetes.
•           Of those African American and Hispanic American respondents who had discussed their nerve pain symptoms with their health care provider and were diagnosed with diabetic nerve pain, the majority wished they had spoken up sooner (80 percent and 85 percent, respectively).
"Diabetes-related complications are common and debilitating, and seven out of ten general respondents diagnosed with diabetic nerve pain said that their nerve pain makes them feel like they are not successfully managing their diabetes," said Jane Chiang, MD, Senior Vice President for Medical Affairs and Community Affairs of the American Diabetes Association. "Community Health Perspectivesconfirms the need for ongoing education to motivate more people living with diabetes and symptoms of diabetic nerve pain to visit their doctor and seek some pain relief."

About Diabetic Nerve Pain

More than 29 million people in the United States have diabetes. Nearly half of people with diabetes have some form of nerve damage, but many don't know it. For one out of five people with diabetes, nerve damage can cause burning, shooting, pins-and-needles pain - a condition known as painful diabetic peripheral neuropathy, or diabetic nerve pain, which most often occurs in the feet or hands. For more information, visit http://www.steponup.com. 

Eating cactus can regulate glucose levels in diabetics



Nopal, or cactus, consumption reduces the risk of diabetes complications, has no side effects, and is inexpensive, reported Ph.D. in Basic Biomedical Research of the National Autonomous University of Mexico (UNAM).
The nopal has an antihyperglycemic effect that prevents the elevation of glucose, helping the pancreas to not overproduce insulin and thus reducing the risk of diabetes and diabetic complications, detailed the researcher at the National Institute of Medical Sciences.
In an interview with the news agency of the National Council of Science and Technology (CONACYT), the specialist said that frequent consumption of foods like prickly pear, soy and chia are helpful in fighting diabetes.
“Regularly consuming these foods can also decrease postprandial glucose peaks and control the disease,” he added.
The doctor explained that the nopal has a lot of fiber, so it is considered a prebiotic food and does not digest the enzymes of the human genome, but can be fermented by microorganisms in the gut to modify the microbiota.
Therefore, he said nopales should not be cooked for more than 10 minutes because they can lose their health benefits.

How to cook nopal?
Sauteed Nopalitos
Step 1
Prepare the cactus pads by scraping off the cactus spines, rinsing the cactus and then cutting it into strips or dice.
Step 2
Heat 2 tbsp. of oil in a skillet and add the nopalitos. Add 1/2 cup of diced onion. Saute the mixture, stirring frequently, over medium heat. Like okra, nopalitos have a viscous texture, and cooking removes the liquid that causes that. After the nopalitos have exuded their liquid and it has evaporated, they are ready to use.
Step 3
Season the sauteed nopalitos with salt and pepper, and dress them with lime juice and olive oil. Serve as a side dish or garnish, or incorporate into other recipes. For scrambled eggs, add some sauteed onions and peppers to the nopalitos and pour beaten eggs over the mixture. Scramble the eggs as usual.
This seven-year-old boy's life was saved by his diabetes-sniffing dog
Sasha Brady
When a 7-year-old boy with type 1 diabetes had a sudden drop in blood sugar, his dog, Jedi, knew right away and acted fast to save the child's life.
Luke Nuttall was diagnosed with type 1 diabetes when he was just two-years-old.
His mother Dorrie has to check his blood sugar levels up to ten times a day, even during the night when her son is sleeping.
The family brought in Jedi, a black Labrador 'diabetes dog' to help them. The dog monitors Luke's blood sugar level by smell, and alerts other members of the family when it becomes too high or too low.
On one particular night, Jedi jumped on and off the bed in an attempt to wake Dorrie who was fast asleep.
"No alarms were going off, no one was checking blood, no one was thinking about diabetes," she wrote on Facebook.
Dorrie checked Luke's Dexcom device, used to monitor his blood glucose levels without a finger prick. She saw that it reported his glucose level at 100, a stable number, and attempted to return to sleep.
However, Jedi continued to attempt to wake her up and ignored her attempts to push him off the bed - that's when Dorrie knew that something must be wrong.
In the four years that Luke has had diabetes he has never woken up on his own to notice how low his blood sugar levels have dropped - which is why he relies on his parents to wake him up and for Jedi's alerts, which often become before his monitor's.
On her Facebook page, Dorrie wrote: "So she pricked his finger and found out that his blood sugar was low - and likely dropping fast. Luke has never woken up on his own when his blood sugar drops, so his mom and his dog are his two safeguards.
"Luke was laying right next to me, just inches from me, and without Jedi I would have had no idea that he was dropping out of a safe range. His CGM would have caught up and alerted in the next 20 minutes or so and I had an alarm set for an hour from then to get up and check, but Jedi's early alerts help us prevent dangerous situations."
The Nuttall family, from Los Angeles, California, have been training Jedi since he was just an 11-month-old puppy to recognise the change in Luke's blood sugar. The dog can smell the chemical compounds in the little boy's blood changes from as far as across a playground, according to Dorrie.
The clever dog was trained to bring a stick to alert Luke’s parents, to wave a paw if his blood sugar is too high, or to bow if it’s too low.
Complications that arise as a result of hypoglycemia, the deficiency of glucose in the blood stream, can be fatal and Jedi's alerts are live-saving.
"It's in those moments when our guards are down, when we are just living life, when we let our minds drift from diabetes, that [the disease] has the upper hand and things can get scary very fast," Mrs Nuttall wrote in her Facebook post. "But thankfully we have Jedi."
Could a common blood pressure drug reverse diabetes?
Tuesday, March 8th 2016, 7:52 pm EDTTuesday, March 8th 2016, 11:38 pm EDT
By Karen Abernathy
An old drug used to treat high blood pressure may soon have a new use in fighting diabetes. Researchers at UAB Birmingham are hoping the high blood pressure medication Verapamil works as well in humans as it did in mice, by completely reversing diabetes.
Ryan Teague, 26, knows how important it is to stay on top of his diabetes. He's a registered nurse who has lived with the disease since he was diagnosed with type one diabetes when he was only 11-months-old. In addition to regular visits to see a specialist at the Diabetes Center in Ocean Springs, Teague has his own daily routine.
"My day consists of waking up in the morning and checking my blood sugar and acting off of those results throughout the day," Teague said.
But that constant care could become a thing of the past if a new study pans out.
Adult Nurse Practitioner and diabetes specialist KC Arnold takes care of Teague and other diabetes patients on the coast. She's watching the study closely.
"This is hopeful. It has worked in mice and now the human trials are going on, so we just have to wait for the outcome of that," Arnold said. 
According to Arnold, the promising clinical trial at UAB is now in phase two.
"This trial will prove or disprove whether taking this medication will produce more insulin."
The keys to the groundbreaking approach are beta cells, which researchers say are critical in type one and type two diabetes. In animal studies, Verapamil lowers levels of a protein called TXNIP in those beta cells.
"When the blood sugar goes up, this protein goes up," Arnold explained. "What Verapamil does is it lowers the TXNIP in the body in the pancreas, and by lowering that protein the pancreatic cells don't get destroyed."
If the results of the UAB Verapamil trial are favorable, Arnold said a bigger trial will follow. And patients like Teague and countless others could one day be free of diabetes.
Teague said it's hard to imagine life without diabetes, but he's encouraged by the study. 
"It's exciting. I'm looking forward to it. I'll be watching the research."
The results from this trial should be complete a little over a year from now.  If you'd like to learn more about the details of this trial and others, go to https://clinicaltrials.gov/
Diabetes is now the seventh leading cause of death in the US, affecting more than 12 percent of Americans.

How diabetes can lead to limb loss


by Ilene Raymond Rush
Poorly controlled diabetes can spawn a host of medical problems that can lead to amputations, but generally, a triad of issues tend to be present.
Neuropathy, a nerve condition that numbs the feet and toes, can prevent people with diabetes from feeling pain in their toes or feet, which which could lead to their not knowing about injuries, or neglecting them.
Circulation problems may interfere with wound healing, which, in turn, can lead to sepsis, or overwhelming infections.
And a slowed down immune response means that many with diabetes have trouble fighting off infections, which can lead to amputations.
Early signs of circulation problems include cramps in lower legs or thighs while walking or a loss of hair on legs or toes. To combat this, Ronald Renzi, an Abington podiatrist, recommends a simple once-a-year blood pressure test on the ankle to check blood flow.

Blood pressure drugs may raise heart attack risk for diabetes patients



While patients with systolic pressure above 140 saw health benefits, those with pressure at or below 140 saw potential risks go up.
By Stephen Feller  

Previous studies have shown more aggressive treatment of blood pressure is beneficial for most patients, however a new study from Sweden shows diabetes patients face greater health risk with the tougher approach. Photo by Rido/Shutterstock
UMEA, Sweden, Feb. 25 (UPI) -- Although many with diabetes have high blood pressure, and it is important for these patients to keep blood pressure under control, a new study suggests aggressive treatment may increase risk for heart attack.
Researchers in Sweden found in a large study that diabetic patients with systolic blood pressure lower than 140 before treatment with antihypertensive drugs had a higher chance for heart attack.
More than 70 million people in the United States have high blood pressure, considered a systolic pressure above 140 and diastolic pressure above 90. Recommendations for controlling blood pressure have long aimed for 140, howeverrecent research found more aggressive treatment -- setting a goal for systolic pressure of 120 -- can significantly lower the risk of cardiovascular events and death.
Health benefits have been seen when aiming for an even lower blood pressure, but diabetic patients face other health concerns that complicate such strong treatment goals.
"In practice, it is important to remember that undertreatment of high blood pressure is a bigger problem than overtreatment," Mattias Brunström, a doctoral student at Umeå University, said in a press release. "Many treatment guidelines, both Swedish and international, will be redrawn in the next few years. It has been discussed to recommend even lower blood pressure levels for people with diabetes -- maybe as low as 130. We are hoping that our study, which shows potential risks of such aggressive blood pressure lowering treatment, will come to influence these guidelines."
For the study, published in the British Medical Journal, researchers reviewed 49 trials including 73,738 participants, most of whom had type 2 diabetes, to find the effects of varying levels of blood pressure treatment.
For patients with systolic pressure above 150, aggressive blood pressure treatment lowered the risk of any type of death, death from a cardiovascular event, heart attack, and kidney discharge. With a baseline systolic pressure between 140 and 150, treatment also was seen to reduce death, heart attack, and heart failure.
Patients with systolic pressure lower than 140, however, saw an increased risk of heart attack, a cardiovascular event leading to death, or any cause of death.
"Our study shows that intensive blood pressure lowering treatment using antihypertensive drugs may be harmful for people with diabetes and a systolic blood pressure less than 140 mm Hg," Brunström said. "At the same time, it is important to remember that blood pressure lowering treatment is crucial for the majority of people with diabetes whose blood pressure measures above 140."


Blood pressure drugs may raise heart attack risk for diabetes patients


While patients with systolic pressure above 140 saw health benefits, those with pressure at or below 140 saw potential risks go up.

By Stephen Feller  

Previous studies have shown more aggressive treatment of blood pressure is beneficial for most patients, however a new study from Sweden shows diabetes patients face greater health risk with the tougher approach. Photo by Rido/Shutterstock
UMEA, Sweden, Feb. 25 (UPI) -- Although many with diabetes have high blood pressure, and it is important for these patients to keep blood pressure under control, a new study suggests aggressive treatment may increase risk for heart attack.
Researchers in Sweden found in a large study that diabetic patients with systolic blood pressure lower than 140 before treatment with antihypertensive drugs had a higher chance for heart attack.
More than 70 million people in the United States have high blood pressure, considered a systolic pressure above 140 and diastolic pressure above 90. Recommendations for controlling blood pressure have long aimed for 140, howeverrecent research found more aggressive treatment -- setting a goal for systolic pressure of 120 -- can significantly lower the risk of cardiovascular events and death.
Health benefits have been seen when aiming for an even lower blood pressure, but diabetic patients face other health concerns that complicate such strong treatment goals.
"In practice, it is important to remember that undertreatment of high blood pressure is a bigger problem than overtreatment," Mattias Brunström, a doctoral student at Umeå University, said in a press release. "Many treatment guidelines, both Swedish and international, will be redrawn in the next few years. It has been discussed to recommend even lower blood pressure levels for people with diabetes -- maybe as low as 130. We are hoping that our study, which shows potential risks of such aggressive blood pressure lowering treatment, will come to influence these guidelines."
For the study, published in the British Medical Journal, researchers reviewed 49 trials including 73,738 participants, most of whom had type 2 diabetes, to find the effects of varying levels of blood pressure treatment.
For patients with systolic pressure above 150, aggressive blood pressure treatment lowered the risk of any type of death, death from a cardiovascular event, heart attack, and kidney discharge. With a baseline systolic pressure between 140 and 150, treatment also was seen to reduce death, heart attack, and heart failure.
Patients with systolic pressure lower than 140, however, saw an increased risk of heart attack, a cardiovascular event leading to death, or any cause of death.

"Our study shows that intensive blood pressure lowering treatment using antihypertensive drugs may be harmful for people with diabetes and a systolic blood pressure less than 140 mm Hg," Brunström said. "At the same time, it is important to remember that blood pressure lowering treatment is crucial for the majority of people with diabetes whose blood pressure measures above 140."