Beat it

Beat it

Diabetes takes disproportionate toll on blacks, Hispanics


Magaly Olivero, Conn. Health I-Team Writer

Connecticut's diabetes rate ranks lower than the national average, but Hispanics and blacks are more than twice as likely to have the disease compared with their white neighbors and are at greater risk of dying from diabetes-related causes.
About 250,000 Connecticut adults (8 percent) have been diagnosed with Type 2 diabetes and an estimated 83,000 state residents don't realize they have the disease, according to 2011-13 data from the U.S. Centers for Disease Control and Prevention.
Nationally, 29.1 million people (9.3 percent) have diabetes and 8.1 million people don't know they have the disease, the CDC reports.
Connecticut's Hispanics (14.6 percent) and blacks (14.1 percent) have significantly higher rates of diabetes than whites (6.7 percent).
In addition, adults with annual household incomes below $25,000 are 2.3 times more likely to have diagnosed diabetes compared with adults with household incomes over $75,000, according to the CDC.
Health experts cite multiple barriers to comprehensive diabetes care, including inadequate prescription coverage for costly medications and testing supplies; a shortage of Spanish-speaking medical specialists and community health workers; insensitivity among health care providers to cultural food preferences; a lack of neighborhood markets offering healthy foods; and a dearth of safe recreational opportunities.
"We need a more comprehensive set of solutions that happen at the neighborhood level to get at the root causes of diabetes," said Dr. Mehul Dalal, chronic disease director for the state Department of Public Health. He said the data show "shocking disparities."
The `Silent Killer'
Diabetes occurs when blood sugar (also known as glucose) levels remain abnormally high because the body doesn't produce insulin (Type 1 diabetes) or doesn't use insulin properly (Type 2 diabetes). About 95 percent of people with the disease have Type 2 diabetes, the American Diabetes Association reports.
Health experts often call diabetes the "silent killer" because people do not experience symptoms during the early years of the disease. But the long-term complications of diabetes can be deadly and costly. Diabetes can lead to serious health issues such as blindness, kidney failure, lower-extremity amputations, stroke and heart disease. One report estimates the total cost of diabetes in Connecticut at $2.43 billion annually, the ADA reports.
Research shows some ethnic and racial groups are genetically predisposed to developing diabetes, including Hispanics, blacks, Asians and Native Americans.
In Connecticut, blacks and Hispanics are more likely to die from diabetes and experience higher rates of diabetes-related hospitalizations and amputations than whites, according to data from the DPH.
Black adults had 4.2 times the rate of hospitalizations for diabetes and four times the rate of diabetes-related lower-extremity amputations, compared with white adults.
Hispanic adults had 2.2 times the rate of hospitalizations for diabetes and nearly twice the rate of diabetes-related lower-extremity amputations, compared with white adults.
Black adults had the highest diabetes and diabetes-related mortality rates, followed by Hispanic residents.
"Diabetes is one of the most serious health problems that African-Americans and Hispanics face today," said Lindsay Scheinblum, manager for fundraising and special events with the Connecticut chapter of the American Diabetes Association. The ADA offers outreach programs to increase awareness among Hispanics and blacks.
While genetics plays a role in the onset of diabetes, lifestyle issues such as obesity and physical inactivity are the main culprits behind the increased prevalence of Type 2 diabetes among people of all ages, said Dr. Raul Arguello, chairman of the Pediatric Department at Danbury Hospital and chief of the Pediatric Endocrine and Diabetes Program.
"There has been an explosion of Type 2 diabetes in teenagers nationwide," said Arguello, a pediatric endocrinologist who noted that diabetes in children was "practically nonexistent" two decades ago. "Now it is a fact of life for many families."
Expensive medications
Dr. Bismruta Misra, an endocrinologist at Stamford Hospital, sees some "positive trends" in her medical practice, where up to 60 percent of all patients have diabetes.
More people are seeking medical care after gaining health insurance with passage of the Affordable Care Act. Primary care physicians are actively working to identify patients with pre-diabetes -- those with high blood sugar levels at risk of becoming diabetic.
But many patients can't afford the expensive medications and blood sugar testing supplies that are crucial for managing the disease. People with diabetes spend an estimated $7,900 a year on medication and supplies, the ADA reports.
"People living on a fixed income may have to choose between paying for their insulin or paying their rent," Misra said. "They have health insurance to see a doctor. But their prescription coverage is terrible or they don't have any at all."
Other challenges include "structural barriers" that make it difficult for urban and rural residents to manage diabetes, Dalal said. These hurdles include a shortage of neighborhood markets that carry fresh produce and few recreational options in communities that lack sidewalks or aren't safe.
Cultural barriers
A shortage of medical providers who understand the cultural and language preferences of their patients can create barriers to care, said Arguello, a native of El Salvador who speaks English with his pediatric patients and Spanish with their parents. "People feel more comfortable when they can communicate in their own language," he said.
Understanding cultural food preferences is also key. For example, white rice -- which the body metabolizes as sugar -- is the basis of many meals for Hispanics and Asians. Fried foods enjoyed by blacks and other ethnic groups increase the risk for obesity. Even Sunday dinners that bring Italian families together can pose a health threat because pasta is a carbohydrate that acts like sugar in the body.
Home-based interventions
Home-based interventions with specially trained bilingual community health workers can help low-income residents achieve their Type 2 diabetes goals, said Sofia Segura-Perez, associate director of the Center for Community Nutrition at the Hispanic Health Council in Hartford.
In a recent study, patients who were linked to community health workers successfully attained better blood-glucose control. The workers provided education about nutrition, grocery shopping, medications, exercise and diabetes medical management, in addition to assisting with translation services and transportation to doctor visits. The HHC study was conducted in conjunction with the University of Connecticut and Hartford Hospital.
"Community workers can identify things at home that make it difficult for people to adhere to a regimen," said Segura-Perez. These include "social stressors" such as lacking money to buy food, worrying about eviction, or raising grandchildren because the parents are absent.
Other studies show Hispanics who immigrated to the United States are at a greater risk of developing diabetes the longer they live in America.
Looking ahead
Experts point to prevention and self-management initiatives underway to help stem the prevalence of diabetes. State health officials are working with the state Department on Aging to increase the use of diabetes self-management programs in community settings and to offer programs in Spanish and English. Local organizations, such as YMCAs, are offering evidence-based intervention programs to reach at-risk residents. More health care systems are using health information technology to identify and track patients who would benefit from diabetes prevention and self-management education programs.
Segura-Perez looks forward to a time when insurers cover home-based strategies that help diabetics avoid more costly complications such as hospitalizations and amputations.

"My hope is that people will recognize the value of home-based interventions to the individual and society," she said. 

Low-Carb Diets That Affect Your Health

Written by: Padmapreetham Mahalingam

Mail Is low-carb diet healthy? Most people who are planning to lose weight generally try to cut down on the intake of carbohydrates to get lean faster. A low-carb diet is known for enabling quick weight loss, yet many are not aware that fast fat loss always comes with a price. According to some nutritional experts, a low-carb diet doesn’t work in the long run. Nutrition professionals also believe that every person should eat a well-balanced diet and try to enjoy everything in moderation rather than opting for a low-carb diet. Experts believe that most people crave for carbohydrates and cutting them out from your diet can only lead to more craving. Most dietitians believe that a low-carb diet is bad for health or difficult to stick to
Yet, there are studies to show that many shed weight quicker because low-carb diet offers a better advantage when it comes to effortless weight loss and loss of fat mass than a normal protein diet.
Low-carb diet can be healthy to prevent serious health conditions such as metabolic syndrome, diabetes, high blood pressure and cardiovascular disease. However, it is common knowledge that any diet that helps in shedding excess weight can have serious repercussions or risk factors such as cardiovascular disease and diabetes. Here are a few things about the risk factors of low-carb diet that you aren’t aware of. Take a look.Sad and stressedIt is found that people who deprive themselves of carb will be in a foul mood most of the time. When you say foul mood, it means that you have temper issues and would be snapping at people such as your husband, colleagues or children. Carb eaters feel calmer, composed and happier compared to people who consume less carbs. Carbs definitely boost your mood and reduce stress. On the other hand, low-carb diet can make you feel sad and grouchy. This clearly shows that low-carb diet isn’t healthy and can lead to feelings of deprivation.FatterCutting down carbs will certainly spoil the best efforts to stay slim. Opting for low-carb diet can eventually lead to stress and depression. Moreover, too much of stress can produce high levels of hormones such as cortisol. It would eventually stimulate your appetite and lead to intense cravings and over eating or binge eating behaviour. What’s more, low-carb diet is bad for health as it leads to high risk of binging on carbs.KetosisIf you are trying to restrict carbs to less than 20 grams a day, it will result in a process called Ketosis. Ketosis happens mostly due to low carbs especially when you are limiting yourself to under 50 grams of carbs per day. Ketosis occurs when your body doesn’t have enough glucose (sugar) for energy, so it breaks down the stored fat. Thus, this allows ketones to generate in the body. It clearly proves low carbs isn’t healthy.Belly bloatDo you think low carbs can make your belly bloat? Belly bloat is the main symptom of constipation. Fibre is one of the carbs and in reality, if you limit carbs, then the result is constipation. Meanwhile, some experts believe that if you try to consume large amount of proteins or fat from animal sources, there are chances that you might end up with heart disease or cancer.Mineral deficiencies Low-carb diet lacks essential nutrients. The other problem is that low-carbohydrate diet would boost saturated fat. So when your body catches on to low-carb diet, it would increase the risk of cancer. Unfortunately, diets that contain high protein and fat are always associated with obesity related disorders such as heart disease and diabetics. Low-carb diet is definitely bad for health.




Exercise Timing in Patients with Diabetes: Maximizing Metabolic Benefit


By Jeannette Y. Wick, RPh, MBA, FASCP

The promise of personalized medicine has led growing interest among researchers in innovative ways to maximize treatment effectiveness. Researchers at the University of Missouri and the National Research Council in Padova, Italy, recently investigated the role that timing of resistance exercise plays in lowering cardiovascular risk. They wondered if the time of day when diabetics exercise could explain the lower-than-expected exercise-derived benefits seen in some diabetics.

Previous studies have examined the benefit of aerobic exercise, but the researchers observed that aerobic exercise (especially after a meal) is impractical for many obese diabetics. Resistance exercise, consisting of short work periods with longer breaks, was suggested as a more practical alternative.

Abnormal post-prandial glucose or triacylglycerol (TAG) elevations have been shown to be a significant cardiovascular risk factor in type 2 diabetes. These researchers designed a small trial (N=13) and evaluated post-prandial glucose and TAG levels when diabetics performed resistance exercise before a meal, after a meal, or not at all.

Participants were obese, physician-diagnosed type 2 diabetics who did not use insulin but continued their current medication regimens. The researchers noted gastric emptying, endocrine responses, free fatty acids, and beta-cell function (via mathematical modeling).

Study participants completed a three-day program of controlled diet and exercise routines. The resistance exercises included leg presses, seated calf raises, seated chest flyes, seated back flyes, back extensions, shoulder raises, leg curls, and abdominal crunches. The researchers recorded clinical outcomes during each phase and then conducted statistical analyses to demonstrate the significance of their findings.

The study concluded that resistance exercise engenders a beneficial reduction in post-prandial glucose levels. Exercise after a meal was shown to produce a more effective reduction than exercise before a meal, however. Additionally, the authors noted that, for the first time, TAG levels were shown to be unaffected by resistance exercise before a meal.

The researchers suggested that resistance exercise is most effectively timed after a meal, although they acknowledged the benefits were modest. They suggested, unsurprisingly, that appropriate exercise of any sort, regardless of timing, offers important metabolic benefits for type 2 diabetics. This study appears ahead of print in the Journal of Applied Physiology.



Should Diabetics Avoid Sugar Completely?



Eating sugar does not give you diabetes. But if you eat too much of sweet after being diagnosed of diabetes, it can surely harm you. As a diabetic, you have to live with certain restrictions. But these restrictions need not be very rigid. So, should diabetics avoid sugar completely?
Avoiding sugar for diabetes completely is also not safe. Absolute abstinence would mean that the body is being devoid of sugar. It can lead to deficiency and further complications. The idea is to eat a well-balanced diet in the specific quantity and at the right
Being diagnosed with a certain disease does not bring life to a halt. With minor changes in lifestyle and habits, you can bounce back to life and live with health and happiness. Keep these things in mind concerning a diabetic diet.

IS CHOCOLATE GOOD FOR DIABETICS?

Never go hungry: As a diabetic, never go hungry. This could lead to a drop in your sugar levels and possibly, some serious complications. If the need be, carry some eatables at all times. Make a timetable in which you can include all your three meals of the day interspersed with snacks in between.
Eat at regular intervals: As you should not go hungry, you should make it a point to eat at regular intervals. Eat small meals and have them frequently. There is no hard and fast rule as to what you should eat and what you should not. It is the portion that has to be controlled.Have more proteins: In order to have a healthy body, it is important to have adequate amount of proteins. This certainly holds good for all but it is increasingly important for diabetics.
Have high fibre foods: Fibre-rich whole grains are packed with nutrition. They keep you feeling full for a longer time as the glucose takes longer to break down. They are called complex carbohydrates and stay in the system longer than the refined starches.Carry something sweet: There may be times when your sugar levels dip to an unwanted low. As a precautionary measure, always carry a small candy or a sweet cookie with you all the time. If you feel giddy or uncomfortable, it could be due to the dipping sugar levels in the body. Should diabetics avoid sugar completely? Well, not really.Do not negate sweet: You cannot negate sugar from your meals. Sugar travels into our system from sources other than raw sugar. Foods high in starch too contain glucose. The aim should not be to avoid sugar for diabetes completely.What is needed is to monitor the types of sugars. On a daily basis, it is absolutely fine to have a good meal that contains sources of starch such as whole grain wheat and brown rice. These foods too contain sugars but of the good kind.
Exercise regularly: Eat well and exercise even harder. In order to maintain good health, it is important to exercise on a regular basis. Exercising helps burn off the excess fat and glucose. It helps in keeping the glucose level under control.



Sample diet plan for diabetics by nutritionist Prema Kodical


Tania Tarafdar Jan 19, 2015 at 01:31 pm

Maintaining a healthy diet and monitoring blood sugar levels is vital for any diabetic. A healthy diet will have a positive effect on your glucose levels and will help you deal with diabetes. Well-known nutritionist Prema Kodical tells you which foods you should eat as well as steer clear off from your diet if you are suffering from diabetes. You may also read expert diet and exercise tips to manage diabetes.

Foods to be avoided by a diabetic                               
•           Avoid refined and processed food like flour or maida and rawa as they have a high glycemic index that can cause a spike in your blood sugar levels.
•           Refrain from fruits with higher glucose than fructose content like mangoes, grapes, jackfruit and bananas.
•           Foods containing trans fats like bread and bakery products can also fluctuate your blood sugar levels.
•           Avoid foods with saturated fats like butter, ghee, deep fried foods, sweets and starchy vegetables like yam, potatoes and raw bananas.
•           Foods with high salt content like canned and dried fish sauces, papads, pickles and chutneys, and sausages should also be avoided by a diabetic.
Why is it important to avoid fats?
Unhealthy fats like trans fat and saturated fat have entered our diets in a big way through commercially available snacks, biscuits, cookies, fried foods and refined oils. The high intake of these fats is associated with insulin resistance. Consumption of fats increases bad cholesterol in the body, leading to heart diseases like arteriosclerosis and atherosclerosis, thus, increasing the risk of heart attack or stroke.
Why should a diabetic cut down on sodium?
Diabetics are at a higher risk of developing high blood pressure, a leading cause of heart disease. High sugar damages the inner lining of blood vessels, making it difficult for the vessels to constrict and expand smoothly, increasing the risk of high blood pressure. A diabetic should therefore, reduce intake of salt to prevent or control blood pressure. According to Prema, the daily recommended value of salt intake per day is 1,500 mg.
Cooking tips to cut down on sodium by Prema Kodical
•           Use homemade or unsalted butter.
•           Use less cheese in your recipes.
•           Make use of herbs, garlic, seasonings and spices instead of salt.
•           Avoid adding too many sauces to your dishes.
•           Avoid eating dried fish, pickles and chutneys.
•           Avoid processed and packaged foods. The more processing a food undergoes, the more fibre it loses and more sodium it gains.


Foods a diabetic should eat
Fibre-rich foods
Fibre-rich foods have a low glycemic index that do not cause any spike in blood sugar levels. Include fibre-rich fruits like apple, pear, papaya, orange and muskmelon, green leafy vegetables and other vegetables like karela, lady’s finger and cabbage in your diet. Also eat more of whole grains like oats, brown rice, bajra, jowar and barley. Here’s another reason for consuming fibre-rich foods, keeps you off heart disease.
Antioxidant-rich foods
Foods rich in antioxidants can protect the body from oxidative properties of high blood sugar. Antioxidants can also assist in proper absorption of insulin leading to a drop in blood sugar in diabetics. In order to maximise your antioxidant intake, eat five to six servings of fruits and vegetables in a day. This roughly translates into one serving of a salad, two servings of cooked vegetables and at least two fruits in a day. Another very good source of antioxidant is soybean. Here’s a healthy breakfast recipe, soya dosa.
Sample diet plan for diabetics by nutritionist Prema Kodical
Breakfast
1 wholewheat paratha or 1 medium bowl oats porridge topped with 1 tsp each of cut walnut and almond
Mid morning snack
1 medium size apple/pear/orange
 Lunch
1 medium bowl salad with a dash of vinegar or lime juice
2 phulkas/1 cup brown rice
1 medium bowl dal
1 bowl sabzi
1 bowl of low-fat curd/2 pcs grilled chicken or curry
Evening snack
1 moong chilla /1 bowl roasted chana with few peanuts/ 2 egg white omelette and phulka roll
Dinner
1 mug vegetable soup (homemade)
1 jowar bhakri /1 cup daliya and moong khichdi
1 bowl sabzi
1 bowl of low-fat paneer/1 slice grilled fish or curry
Water - 8 to 10 glasses (Read: Another healthy diet plan for diabetics)



A 'tattoo' may end fingerpricks for diabetics


Robert Ferris |
Researchers have developed an ultra-thin sensor that sits on the skin like a "rub-on tattoo" and can help patients monitor blood sugar levels without the painful prick of the finger that currently available devices require, according to research published this week.
About 80,000 children are diagnosed with Type 1 diabetes around the world every year, according to the American Diabetes Association. Several times a day, many of those patients punch a small hole in their fingers and release a drop of blood onto a device that checks their blood glucose levels. The results will tell them whether or not they need to pump themselves with insulin. The pinprick may be necessary, but it can hurt and annoy patients.
Scientists at the University of California, San Diego, developed a thin and flexible patch resembling a temporary tattoo that they say can continuously monitor glucose levels in the blood without puncturing or irritating the skin. The sensor is a clear patch affixed with two small electrodes and an enzyme that reacts with glucose. The researchers ran a mild electrical current through the electrodes to drive glucose to the surface of the skin where it reacted with the enzyme on the patch. Measuring the reaction allowed the scientists to accurately take blood glucose measurements in seven healthy volunteers. They published their findings Monday in the journal Analytical Chemistry.
Read MoreMarkets will see gains in 2015: Analyst
The team is part of the Center for Wearable Sensors at UCSD and is now working with other engineers to develop the other half of the device: a wearable wristband or other similar device that would provide the electrical current and the glucose readouts. The tool could be available in a few years and could have appeal not just to Type 1 diabetics, said Amay Bandodkar, one of the researchers on the team.
"Carbohydrate-rich diets and the related insulin spike is one of the major reasons for several of the modern lifestyle diseases faced by humans, especially in developed countries like the USA," Bandodkar told CNBC. A noninvasive glucose monitor might appeal to a broad swath of the population suffering from Type 2 diabetes as well, which does not require insulin injections, or other diet-related diseases. Bandodkar thinks information about glucose levels could be collected in databases and help scientists understand broad health trends, and the "corrective steps needed to be taken to control the spread of modern lifestyle diseases," he said.
A non-invasive glucose monitor could also be useful in treating conditions such as kidney disease, or appeal to athletes tracking their nutrition or physiological changes. The researchers also noted in their study that this technology could pave the way for other sensors that monitor different chemicals in human bodies, or could even lead to new ways of delivering drugs through the skin.
Non-invasive glucose monitoring has become something of a hot area. A medical device company called Cygnus had previously brought wristband-based glucose monitor to market, but wearers complained of skin irritation, according to the UCSD researchers.
As recently as last summer, Apple, Google and Samsung were reported to be trying to add glucose monitoring to their wearable devices, according to Reuters.
Read MoreWhich religion holds the largest share of wealth?
Google also partnered with Novartis in 2014 to develop a contact lens that can monitor glucose through fluids in the eye. Monitor maker DexCom showed a simulation of what its glucose monitoring app would look like on an Apple Watch at CES this past week, fueling further speculation about the capabilities of the device.


7 super foods for people with diabetes


By Wasatch Clinical Research

Everyone wants to know how to eat more healthily, but for diabetics, meal planning isn't always simple. Carbs become a much bigger deal and with each ingredient, you'll be keeping a running tally of glucose index scores in your head.
But being diabetic doesn't have to mean your diet is bland, boring or downright unpleasant. Take a look at some of these tasty super foods every diabetic could include in his or her diet and start incorporating them into your own dishes.
Non-starchy vegetables
Not all vegetables were made equally, though they all have healthy properties. Diabetics looking to pack their diet with super foods, however, should focus on non-starchy veggies like broccoli, artichokes, asparagus and beets.
When it comes to satisfying your appetite for a small number of calories, you can't go wrong with these options, so keep a variety on hand for when a snack craving hits you.
In 2011, a small study conducted by scientists at Newcastle University took this advice a step further: The participants in their trial ate nothing but non-starchy vegetables and liquid diet drinks for eight weeks.
By the end of the study, their type 2 diabetes was in remission and they'd lost an average of 30 pounds. A second study is underway to try and reproduce the initial trial's results.
Beans
On a list of healthy foods for diabetics, you might be surprised to see beans make the cut. While not especially sugary, their other nutritional properties aren't generally known.
However, diabetes.org says they are "very high in fiber, giving you about a third of your daily requirement in just a half cup." While they do fall under the category of starchy vegetables, they provide a healthy replacement for meat, with lots of protein but no saturated fat.
Dark chocolate
Being diabetic doesn't mean you have to give up all sweet things. In fact, though you'll still want to eat it sparingly, your doctor might even encourage you to add a serving of dark chocolate to your diet. Dark chocolate has been proven to improve insulin sensitivity and hold you over between meals.
Plus, Reader's Digest online reported that researchers from the University of Copenhagen found that "people who ate dark chocolate reported that they felt less like eating sweet, salty or fatty foods compared to volunteers given milk chocolate. ... Dark chocolate also cut the amount of pizza that volunteers consumed later in the same day by 15 percent." Maybe you could work it in as an aperitif to your dinner.
Tomatoes
Whether you believe it's a fruit or a vegetable, you eat it raw or in a sauce, the tomato is a powerhouse food that benefits everyone who eats it. The secret to its success seems to be lycopene, a substance healthline.com reports has been found to "reduce the risk of cancer (especially prostate cancer), heart disease, and macular degeneration, an eye disease that causes blurred vision."
Add tomatoes to your leafy, non-starchy salad, stir them into pasta, or make your own sauce (to cut down on sodium) to take full advantage of this deliciously healthy food.
Low-fat dairy products
Other healthy foods with extra benefits for diabetics are low- or non-fat milk and yogurt. These products are packed with vitamin D, a nutrient especially necessary for diabetics, and they have low GI scores.
A Harvard group interested in exploring the effects of diet and lifestyle factors on diabetes followed 1,243 patients for 12 years. After adjusting for other factors, including initial body mass index, the researchers found that men who had a higher intake of low-fat dairy products were less likely to develop type 2 diabetes. So go ahead, pour yourself another glass of milk to celebrate.
Wild salmon
You might replace some of your meat intake with beans, but make an exception for wild salmon if you have access to some. Surprisingly enough, it's another good source of vitamin D and filled with omega-3 fatty acids (that's the good kind of fat, the kind that lowers your risk of heart disease).
Diabetes.org added a small quip about salmon, however: "Stay away from the breaded and deep fat fried variety. ...They don't count in your goal of six to nine ounces of fish per week."
Blueberries
As always, diabetics will appreciate food with a low GI score. Unlike many fruits, blueberries have a relatively low score and are known for having the highest antioxidant levels of any known fruit or vegetable.
Also on their resume is their ability to possibly lower your risk of heart disease and cancer. In fact, most fruits of the "berry" variety, including raspberries and strawberries, have similar properties. So bring on the fruit salad!
It is possible to stay healthy and be a diabetic. To help you out, you may benefit from participating in clinical studies. To find out more information, visit wasatchcrc.com.



The U.S. Might Be Overtreating Diabetes


By John Tozzi
American doctors may be giving drugs to a lot of older diabetic patients who are unlikely to benefit and might even be harmed, a new study in JAMA Internal Medicine suggests. Older, sicker patients are treated as aggressively to get their blood sugar under control as healthier patients are, according to an analysis of a nationally representative survey of Americans 65 and older. That's despite what researchers say is greater risk that they'll suffer from dangerously low blood sugar, known as hypoglycemia, and little evidence that they benefit from intense diabetes management.
About 21 million Americans have been diagnosed with diabetes, and another 8 million are undiagnosed, according to the Centers for Disease Control (CDC). The prevailing approach to treating diabetes is to get a measure of patients' average blood sugar over several months, known as hemoglobin A1C, to below 7 percent, says Kasia Lipska, an endocrinologist at the Yale School of Medicine and lead author of the study. But in people with poor health, especially, the benefits of reaching that blood sugar level need to be weighed against the risks of treatment, including hypoglycemia, which can lead to confusion, accidents, falls, comas, or even death. "It’s clearly recognized by guidelines and by some prior research that these strategies are unlikely to result in benefit in people with poor health, and more likely to increase the risk of harm," Lipska says.
Yet treatment of older adults with medication such as insulin or sulfonylurea to control blood sugar didn't vary significantly with patients' health status—meaning sick people at risk of harm from the medications were being treated about as aggressively as healthier patients who were more likely to benefit. The data included 1,288 older Americans with diabetes who were treated between 2001 and 2010.
The research doesn't actually show that these people are being overtreated or that they're experiencing adverse effects, cautions S. Sethu Reddy, chief of adult diabetes at the Joslin Diabetes Center in Boston. The survey that researchers analyzed doesn't have data on patients' outcomes. It also likely includes patients whose blood sugar level is relatively low because they were recently diagnosed with diabetes, not because they were aggressively treated, Reddy says. In general, though, doctors and patients need to weigh the risks and benefits of treatment: "One needs to individualize therapy, and you shouldn’t have the same target for everybody."
Lipska says her findings reflect a broader problem in American medicine: It's much easier for doctors to prescribe treatment to try to get patients to reach a certain measurement than to tailor treatment to the individual. "When the goals are not the same for everyone, it requires a longer discussion, a more complicated risk-benefit analysis," she says. "It’s more complicated but I think it’s better care."




Night Shift May Boost Black Women's Diabetes Risk


Odds are highest for younger women and those doing shift work for many years

WebMD News from HealthDay
By Robert Preidt
HealthDay Reporter
MONDAY, Jan. 12, 2015 (HealthDay News) Night shift work significantly increases the risk of diabetes in black women, according to a new study.
"In view of the high prevalence of shift work among workers in the U.S.A. -- 35 percent among non-Hispanic blacks and 28 percent in non-Hispanic whites -- an increased diabetes risk among this group has important public health implications," wrote the study authors from Slone Epidemiology Center at Boston University.
It's important to note, however, that the study wasn't designed to prove that working the night shift can cause diabetes, only that there is an association between the two.
The new research included more than 28,000 black women in the United States who were diabetes-free in 2005. Of those women, 37 percent said they had worked night shifts. Five percent said they had worked night shifts for at least 10 years, the researchers noted.
Over eight years of follow-up, nearly 1,800 cases of diabetes were diagnosed among the women.
Compared to never working night shifts, the risk of diabetes was 17 percent higher for one to two years of night shifts. After three to nine years of night shift work, the risk of diabetes jumped to 23 percent. The risk was 42 percent higher for 10 or more years of night work, according to the study.
After adjusting for body mass index (BMI -- an estimate of body fat based on height and weight) and lifestyle factors such as diet and smoking, the researchers found that black women who worked night shifts for 10 or more years still had a 23 percent increased risk of developing diabetes. And those who had ever worked the night shift had a 12 percent increased risk.
The link between night shift and diabetes was stronger in younger women than in older women. Compared to never working the night shift, working night shifts for 10 or more years increased the risk of diabetes by 39 percent among women younger than 50 and by 17 percent among those 50 and older.


Study: Diabetes drug affecting fish in Lake Michigan


By Keith Matheny, 

Detroit Free Press

Wastewater treatment processes aren't filtering out all the Metformin, which could alter how fish reproduce

Researchers have found that pharmaceuticals and personal-care byproducts persist at low levels miles from sewage discharge pipes in Lake Michigan. And a study from the University of Wisconsin-Milwaukee shows that the most prevalent drug in the lake — the Type 2 diabetes medication Metformin — changes the hormonal system of fish exposed to it.
But what long-term effects it may have on fish and their ability to reproduce are unknown.
In the research group's latest study, fathead minnows were exposed to Metformin at the levels found in Lake Michigan for four weeks. Male minnows showed disruption of their endocrine systems, producing a chemical messenger usually associated with females' egg production, said Rebecca Klaper, a professor and research scientist at the university's School of Freshwater Sciences.
She coauthored a 2013 paper that found that Metformin and other products persist in Lake Michigan, including the birth-control pill hormone progesterone and sulfamethoxazole, an antibiotic used to treat urinary tract and ear infections.
The drugs are not completely broken down by people's bodies after ingestion, are excreted and then are not fully removed by wastewater treatment processes. The flushing of old pharmaceuticals down the toilet contributes to the problem.
"It's enough to raise an alarm bell that this might be something that causes changes in reproduction of fish," she said. "It's something that definitely warrants further study."
The levels of the products are relatively minuscule — micrograms and nanograms per liter of water, Klaper said. A microgram is one-millionth of a gram; a nanogram is one billionth of a gram. What, if any, effects they have — individually or mixed together in the lake — are not well understood, she said.
Of all the drugs researchers tested for in Lake Michigan, Metformin is found at the highest concentrations, at up to 40 parts per billion. More than 60 million Metformin prescriptions were dispensed in the U.S. in 2013, according to drug market research firm IMS Health.
"It wasn't something we had really thought about before," Klaper said. "But there are a lot of people with Type 2 diabetes, and it's a very common medication to be prescribed."
The Metformin enters wastewater treatment plants at 40 parts per billion and is found at levels between 100 and 200 parts per trillion 2 miles out in Lake Michigan, Klaper said.
"The sewage treatment plant is taking out a significant amount of the medication, but it's just that it's coming in at such a high concentration, it doesn't remove it all," she said. "A sewage treatment plant wasn't designed to take these medications out."
Doing something about that would be a monumental task. Metformin is the most prescribed treatment for the millions of Americans with Type 2 diabetes. And providing sophisticated-enough filtration systems for wastewater treatment plants to remove the drug and other personal-care products is impractical.
"It's very difficult — wastewater treatment plants aren't designed to treat nanoparticles," said Timothy Lynch, manager of the Benton Harbor-St. Joseph Wastewater Treatment Plant on the shores of Lake Michigan. The plant serves about 60,000 homes and treats about 9 million gallons of waste per day.
"To retrofit with that type of technology would be very expensive, and are the paybacks for what you are accomplishing worth the cost? For most facilities and most governmental units, just maintaining the existing infrastructure is a challenge."
Klaper said future study will look at how fish are affected over a longer term of exposure.
"We also need to explore other compounds," she said. "This was just one of many. What happens when these are in a mixture? Which ones are the ones to focus on and get rid of? Then we've got a starting point."
Keith Matheny



Weight-loss device that tricks brain clears FDA


WASHINGTON -- A first-of-its-kind weight-loss device that uses electrode implants to trick the brain into thinking the stomach is full has won regulatory approval Wednesday in the U.S.
The Food and Drug Administration cleared the Maestro Rechargeable System, the first weight-loss device that targets the pathway between the brain and the stomach that controls feelings of hunger and fullness.
The device is only approved for patients 18 and older who, in the past five years, haven't been able to lose weight in a supervised weight-management program. Eligible patients must have a body mass index of 35 to 45 and at least one other related health condition like type 2 diabetes, high blood pressure or high cholesterol. The system also is the first obesity device approved in the U.S. since 2007, the FDA said in a statement.
EnteroMedics Inc., which has been publicly traded since 2007, soared nearly 19 percent to $1.40 a share in New York trading, bringing its market value to $96.7 million. The shares had declined 50 percent in the past year through Tuesday.
Products to help Americans lose weight have been a hot category in the last few years, though one that has had some trouble producing major revenue. The FDA has approved four weight-loss drugs since 2012, three pills and one injection.
St. Paul, Minnesota-based company's system uses electrodes implanted in the abdomen to send electrical pulses to nerves, the FDA said. Patients use external controllers to charge the device and allow doctors to adjust its settings.
How exactly the system helps people lose weight is unknown, the FDA said.
"Obesity and its related medical conditions are major public health problems," William Maisel, deputy director for science and chief scientist in the FDA's Center for Devices and Radiological Health, said in the statement. "Medical devices can help physicians and patients to develop comprehensiveobesity treatment plans."
Serious adverse reactions included nausea, pain at the neuroregulator site, vomiting and surgical complications. Other side effects included heartburn, problems swallowing, belching and chest pain.
A clinical trial of the Maestro didn't achieve its primary objective of getting patients to lose 10 percent more excess weight than the control group, the FDA said. Still, an agency advisory panel found that data from the trial provided evidence of sustained weight loss and that the device's benefits outweighed its risks for some patients.
Even with the FDA ruling, the Maestro faces a tough road for wide adoption. Many insurers and government health programs have refused to cover weight-loss treatments since Belviq, from Arena Pharmaceuticals Inc. and Eisai Co., and Qsymia, by Vivus Inc., were approved in 2012.
A company executive said the device is already approved in Europe and Australia though it is not yet on sale. EnteroMedics plans to focus on the device's U.S. launch, targeting sales to surgical centers. The company is also pursuing reimbursement from health care insurance providers.
The Associated Press contributed to this report.
-- Bloomberg News


How to spot a weight loss scam



Expert: how to spot a weight loss scam

By Beth Galvin, FOX Medical Team Reporter
When it comes to dieting most of us would love a quick fix, but if that weight loss plan sounds too good to be true... it probably is!
  You're ready. You want it. You're going to finally conquer your weight!
So how can you avoid getting tripped up by a diet plan  that just can't deliver? We asked Meagan Moyer, a registered dietitian with the Emory Bariatrics Center, for her advice.
She says beware of big claims that sound just too good to be true.   Moyer says, “Definitely the first red flag of a diet scam would be "Do this!  Don't change anything about your eating or your exercise habits and you'll lose weight! Just take this pill!" Honestly, true weight loss, true behavior change has to come about with eating better  and becoming more physically active."
 And, if a weight loss plan claims to work  for everyone?  It probably doesn't.   Moyer says, "We all have different metabolisms.  So one-size-fits-all is definitely not the case."    
  Also, steer clear of diets that sound just too easy  or too hard.  That's where a lot of us get tripped up.  Moyer says, “I'd say the worst mistake a person might make is really trying to follow a very restrictive diet.  Like a cleanse, or something like that.  Without medical supervision, or even
with medical supervision, those can actually be very dangerous and really wreak havoc on your body and your health."
 "If you're looking to follow a certain diet plan, definitely do your homework.” Moyer says, “Find out who it is. What are their credentials? Do they actually know about nutrition?  Is it effective ? Do your homework.  It's your health. You want to feel better, not worse."

So, where should we invest  our time and money?  What's tried and true?  Moyer says, “So, what really works is behavior change. We can all do better in eating more healthfully, being more active.  So the best thing you can do is not put yourself on a diet. It's all about true behavior change. Behavior change takes a long time, but it sticks. It lasts, and it's the end of dieting."

PTSD doubles diabetes risk in women



Boston, MA — Women with post-traumatic stress disorder are nearly twice as likely to develop type 2 diabetes compared with women who don’t have PTSD, according to researchers at Harvard T.H. Chan School of Public Health and the Mailman School of Public Health at Columbia University.
The longitudinal cohort study provides the strongest evidence to date of a causal relationship between PTSD and type 2 diabetes. Results were published online January 7, 2015 in JAMA Psychiatry.
The researchers analyzed survey data collected between 1989 and 2011 from 49,739 women enrolled in the Nurses’ Health Study II and found a dose-response relationship: the greater the number and severity of PTSD symptoms, the greater a woman’s risk of type 2 diabetes. Four percent of the nurses reported the highest number of PTSD symptoms By age 60, nearly 12 percent of women with the highest number of PTSD symptoms had developed type 2 diabetes, whereas fewer than 7 percent of women with no trauma exposure had diabetes.
Antidepressant use and elevated body mass index accounted for nearly half of the increased risk of type 2 diabetes, or 34 and 14 percent, respectively. On the other hand, smoking, diet quality, alcohol intake, and physical activity did not explain the association.
One in nine women will have PTSD at sometime over the course of her lifetime—twice the rate of men. Women are also more likely to experience extreme traumatic events like rape that carry a high risk for the disorder.
“Not only is PTSD devastating to mental health, but it affects physical health too, raising risk for cardiovascular disease, diabetes, and obesity,” said senior author Karestan Koenen, professor in the Department of Epidemiology at the Mailman School and adjunct associate professor of social and behavioral sciences at Harvard Chan School.
“Women with PTSD and the health professionals who care for them should be aware that these women are at greater risk for diabetes,” said first author Andrea Roberts,  research associate in the Department of Social and Behavioral Sciences at Harvard Chan School. “As fewer than half of Americans with PTSD receive treatment, our study adds urgency to the effort to improve access to mental health care to address factors that contribute to diabetes and other chronic diseases.”
To assess type 2 diabetes, the researchers used a validated survey method that first asked women whether they had been diagnosed by a doctor, then confirmed diagnosis with information about test results, symptoms, and medications. PTSD was assessed using the Short Screening Scale. The nurses reported a range of trauma, including sexual assault, domestic violence, car accidents, and unexpected death of a loved one.
The study builds on past findings by the researchers, including a 2013 study that reported a link between PTSD and obesity. Other research has shown a link between mental health issues like anxiety, social phobia, and agoraphobia and type 2 diabetes.
Further research is needed to identify the biochemical and possible additional behavioral changes, such as sleep disturbance, that mediate the relationship between PTSD and type 2 diabetes.
Co-authors include Jessica C. Agnew-Blais, Donna Spiegelman, Susan M. Mason, Laura Kubzansky, and Frank Hu of Harvard Chan School; Sandro Galea of the Mailman School; and Janet Rich-Edwards of Brigham and Women’s Hospital, Boston, and Harvard Chan School.
The study was supported by National Institutes of Health grants to Roberts (MH078928 and MH093612); Agnew-Blais (T32MH017119); Galea (MH095718, MH082598, MH 082729, DA013336, and DA034244); Koenen (MH078928, MH093612). The Nurses’ Health Study II is funded in part by NIH CA50385. Galea supported by Department of Defense grant W81XWH-07-1-0409.
Visit the Harvard T.H. Chan website for the latest news, press releases and multimedia offerings.