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Tag: diabetes

The Co-Occurrence of Diabetes & Heart Disease

The number of people living with diabetes has tripled since 2000, leading to enormous financial ramifications: the global cost of the disease is $850 billion each year. The latest estimates from the International Diabetes Federation indicate that one in 11 adults worldwide have diabetes; most have type 2 diabetes, which is strongly linked to obesity and lack of exercise. There is a strong link between type 2 diabetes and cardiovascular disease, as people with diabetes are more than twice as likely to develop cardiovascular disease and lower life expectancy.

According to a study presented at the American Heart Association’s Scientific Sessions last week, data indicates that children and young adults with diabetes mellitus have a fivefold increased risk of all-cause mortality, and a sevenfold increased risk of sudden cardiac death, compared with age-matched individuals without diabetes. The findings highlight the critical need for continuous cardiovascular risk monitoring and management in young people with DM.

Less than half of those diagnosed with diabetes are aware that the diseases places them at a much higher risk for cardiovascular disease complications; the lack of awareness prevents addressing risks and improving health–often leading to preventable deaths. Ken Thorpe, Chairman of the Partnership to Fight Chronic Disease, urges education and the power of prevention. “We must do better to diagnose, treat, and prevent chronic conditions like diabetes and cardiovascular diseases, and one of the first and most important actions we can take is to raise awareness among patients, providers, and policymakers of the alarming co-existence of these two debilitating conditions, and what can be done to avoid them in the first place.”

The total number of diabetes worldwide is now 451 million, and is expected to reach 693 million by 2045 if current trends continue.

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New ADA/AADE Standards Combine Diabetes Education & Support

New recommendations from the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) combine the concepts of diabetes self-management education and support for the first time.


The document, published in both Diabetes Care and the Diabetes Educator, is an update from 2014, when guidelines for diabetes self-management support and diabetes self-management education had been outlined separately.

Today, the view is that “diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes and those at risk for developing the condition,” write task force co-chairs and certified diabetes educators Joni Beck, PharmD, and Deborah A Greenwood, PhD, RN, and colleagues.

“DSMES is the ongoing process of facilitating the knowledge, skills, and ability necessary for prediabetes and diabetes self-care, as well as activities that assist a person in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis, beyond or outside of formal self-management training,” they explain.

While the standards define evidence-based DSMES services that meet or exceed Medicare’s diabetes self-management training (DSMT) regulations, they don’t actually guarantee reimbursement. “The hope is that payers will view these standards as a tool for reviewing DSMES reimbursement requirements and consider change to align with the way their beneficiaries’ engagement preferences have evolved,” the authors say.

Currently, less than 5% of Medicare beneficiaries use the DSMES benefits that are covered.

The standards apply to diabetes educators in a variety of settings and within new and emerging models of care, such as virtual visits, accountable care organizations, patient-centered medical homes, and value-based payment models.

These same DSMES standards are used both for ADA recognition and AADE accreditation and also can serve as a guide for non-accredited and non-recognized diabetes education providers.

Although there is overlap between DSMES services and those of the National Diabetes Prevention Program (National DPP) lifestyle-change program, the two are tailored to different audiences (diabetes vs prediabetes) and have different goals (diabetes management vs prevention). Recognition of DPP programs is handled by the US Centers for Disease Control and Prevention. Centers providing both types of services have been shown successful, but they need to meet both sets of standards.

The new document details 10 specific standards for DSMES programs: internal structure, stakeholder input, evaluation of population served, quality coordinator overseeing DSMES services, the DSMES team, curriculum, individualization, ongoing support, participant progress, and quality improvement.

While previous standards have used the term “program,” the current terminology is “services,” which “more clearly delineates the need to individualize and identify the elements of DSMES appropriate for an individual. This revision encourages providers of DSMES to embrace a contemporary view of the new complexities of the evolving healthcare landscape,” the authors write.

Expect the next revision sooner than 3 years from now, they say. “Given the rapidly changing healthcare environment and the ever-growing field of technology, the 2017 Standards Revision Task Force recognizes the potential need to review the literature for evidence-driven updates more frequently in the future as advances in healthcare delivery are evolving.”

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Moderate Drinking May Help Prevent Diabetes

A study published in Diabetologia, conducted by researchers from the National Institute of Public Health of the University of Southern Denmark, suggests that people who drink three to four times a week are less likely to develop type 2 diabetes than those who never drink.

The study, which surveyed over 70,000 people on alcohol intake, found that wine was particularly beneficial—as it likely plays a role in helping manage blood sugar. The study does note, however, that drinking frequency has an independent effect from the amount of alcohol taken: the effects are more beneficial when drinking the alcohol in four portions, rather than all at once.

The researchers concluded that moderate drinking three to four times a week reduced a woman’s risk of diabetes by 32%, while it lowered a man’s risk by 27%, compared with people drinking less than one day a week.

The findings further suggest that not all types of alcohol yielded the same effect: while men who drank 1-6 peers per week lowered their diabetes risk by 21%, there was little to no impact on women’s risk. Conversely, a high intake of spirits among women significantly increased their risk of diabetes—yet there was no effect on men.

The team have used a similar survey to research the effect of alcohol on other conditions, finding that drinking moderately a few times a week was linked to a lower risk of cardiovascular disorders including heart attack and stroke.

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Biomarkers Could Predict Best Diets

A new study, published in the American Journal of Clinical Nutrition, has indicated two biomarkers that can predict the efficacy of certain diets for weight loss: specifically, for people with prediabetes or diabetes.

Through an analysis of over 1,200 adults, researchers discovered that a person’s fasting blood glucose levels, fasting insulin levels, or both, could pinpoint which diets would most likely lead to weight loss. These biomarkers were particularly effective in determining which diets were best for people with pre-diabetes and diabetes.

Each year, millions of us go on diets in an attempt to lose weight, but not all of us succeed. A new study has uncovered two biomarkers that could predict how effective certain diets will be for weight loss, particularly for people with prediabetes or diabetes.

Statistics from the American Diabetes Association indicate that approximately 29.1 million people in the Untied States have diabetes; estimates show that around 75 million people have pre-diabetes, yet almost 90% remain unaware. Type 2 diabetes is the most common form of the condition: the body is unable to effectively use the hormone insulin, which causes high blood glucose levels. For people with prediabetes, blood glucose levels remain higher than normal—yet not high enough to lead to a diagnosis of diabetes.

The researchers in the study believe that a person’s fasting blood glucose and insulin levels could be utilized to help identify the most effective diet for weight loss, after analyzing the data of three dietary clinical trials: the Diet, Obesity, and Genes trial, the OPUS Supermarket intervention (SHOPUS), and the Nutrient-gene interactions in human obesity (NUGENOB) trial. The subjects were all overweight; the researchers evaluated and assessed their fasting blood glucose levels, and fasting insulin levels, in order to determine whether the levels were associated with weight loss in response to certain diets.

These results symbolize a kind of breakthrough in personalized nutrition: among adults with prediabetes, the team found that a diet rich in whole grains, vegetables, and fruits was the most effective for weight loss. For example, in the SHOPUS trial, adults with prediabetes who followed a diet high in the aforementioned foods lost more weight than those who followed a controlled diet. For people with type 2 diabetes, the researchers found that a diet rich in plant-based, “healthy” fats, and low in carbohydrates, was most effective for weight loss.

The team reported that adding participants’ fasting insulin levels to the analysis further strengthened the identified correlations between diet and weight loss, confirming the hypothesis that fasting blood glucose and fasting insulin levels may be biomarkers for weight loss.

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Heart Disease Among Chinese Americans: Frequently Overlooked

A new study published by the Centers for Disease Control and Prevention indicates that risk factors for heart disease among Chinese Americans are often overlooked, as the standard generally utilized to determine a healthy weight is commonly not adjusted for Asian populations.

The study, “Obesity and Modifiable Cardiovascular Disease Risk Factors Among Chinese Americans in New York City, 2009—2012” examined the relationship between body mass index (BMI) and risk factors for cardiovascular disease among New York City’s Chinese Americans.

Simona Kwon, lead investigator of the study and director of New York University’s Center for the Study of Asian Health, reported that Asian Americans are often left out of health research analysis, “Because it looks like we’re not experiencing health disparities in cardiovascular disease.”

Kwan reports that there is a well established link between high rates of diabetes and South Asian communities, yet there is a ‘model minority’ of East Asians having less risk of cardiovascular disease. While the World Health Organization defines a ‘normal’ BMI as between 18.5 to 24.9, ‘overweight’ as 25 to 29.9, and ‘obese’ as 30 or higher, people of Asian descent tend to have higher body fat percentages—so BMI measurements must be adjusted.

Measured against standard BMI values, the authors found a low prevalence of Chinese Americans who were overweight and obese, yet when they used the BMI cut points adjusted or the Asian population, the numbers went up. Researchers state that Chinese Americans are disproportionately affected by cardiovascular disease risk factors that are preventable and treatable, like diabetes and high blood pressure.

Because physicians decide whether or not to screen patients for diabetes based on BMI, authors of the article suggest that patients of Asian descent should use lower BMI cut points; traditional cutoffs would miss Chinese Americans at risk of diabetes.

“There’s a need to disaggregate data on Asian Americans and focus on subgroups because when you look at Asian Americans as a whole, a lot of differences get masked,” says Kwan.

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Faculty Spotlight: Anne L. Peters, MD

Currently a professor at the Keck School of Medicine of the University of Southern California and the Director of the USC Clinical Diabetes Programs, Dr. Anne L. Peters has worked in the field of diabetes prevention through extensive involvement with multiple clinical trials, NIH grants, over 100 articles in peer-reviewed medical journals, and speaking engagements across the globe.

While concurrently directing diabetes centers in Beverly Hills and in underserved East Los Angeles, Dr. Peters works with the LA County Department of Health Services on the institution of a county-wide diabetes program. Dr. Peters has previously served as director of the clinical diabetes programs at Cedars-Sinai Medical Center and UCLA before her tenure at USC, after receiving her medical degree from the Pritzker School of Medicine at the University of Chicago, performing an internal medicine residency at Stanford University and Harbor UCLA Medical Center, and a fellowship in endocrinology at Cedars-Sinai.

Dr. Peters has served as a principal investigator on multiple clinical trials focused on diabetes prevention, and is currently involved with three NIH grants aimed at curbing and reducing heart disease and diabetes. Dr. Peters has additionally established the Community Diabetes Initiatives Research Center in collaboration with Children’s Hospital Los Angeles. She has authored three books on diabetes, in addition to articles that have appeared in JAMA, The New England Journal of Medicine, Annals of Internal Medicine, and Diabetes Care.

Dr. Peters serves on the ABIM Endocrine Board, multiple ADA committees, and the EASD/ADA Diabetes Technology Committee. She was the recipient of the ADA Outstanding Physician Clinician Award in 2008, and the 2010 Bernardo Houssay Award from the National Minority Quality Forum for her work with underserved populations. Dr. Peters has of the ADA/EASD Position Statement on “Management of Hyperglycemia in Type 2 Diabetes,” and the ADA Position Statement on “Treatment of Type 1 Diabetes Across the Lifespan.”

Join us in San Diego on May 6th for the CMHC Regional Conference, and hear Dr. Peters and colleagues address “T2DM Updates in Treatment and Cardiovascular Outcomes and Trials” while providing updates on current and emerging therapies, treatment guidelines, and strategies to improve clinical outcomes.

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2017 ADA Standards of Medical Care in Diabetes Emphasize Psychological Health and Personalized Treatment Options

The newly published 2017 Standards of Medical Care in Diabetes by the American Diabetes Association emphasize psychological health, access to care, expanded and personalized treatment options, as well as hypoglycemia tracking in patients with diabetes as critical areas of focus.

In addition to screening, diagnosis, and treatment options, including metabolic surgery, that will provide better outcomes for patients with diabetes and information to improve the prevention/delay of type 2 diabetes, the guidelines also include data from a report that focused on beta-cell dysfunction and describes approaches to clarify specific subtypes of diabetes to facilitate personalized care.

The Standards also specifically include a recommendation to consider the use of empagliflozin in patients with type 2 diabetes and established cardiovascular disease to reduce the risk of cardiovascular death.

References:

ADA: 2017 Standards of Medical Care in Diabetes Released.

2017 Standards of Medical Care in Diabetes.

Boehringer Ingelheim and Lilly welcome new recommendation for Jardiance® (empagliflozin) tablets in updated American Diabetes Association’s 2017 Standards.

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World Diabetes Day

diabetesToday marks World Diabetes Day, a commemoration of the disease that affects over 29 million Americans: 9.3% of the country’s population. November 14th also coincides with the birthday of Frederick Banting, the first physician and scientist to use insulin on human patients—and the youngest Nobel laureate in the area of physiology and medicine.

Diabetes manifests in two major forms; Type 1 is characterized by a lack of insulin production—the cause is unknown, and unpreventable. Type 2 diabetes, which is more common and accounts for approximately 90% of diabetics worldwide, is often preventable: it results from the body’s ineffective use of insulin. Because the pancreas generates little to no insulin, or the cells cannot utilize the insulin efficiently and effectively, glucose cannot enter the cells and builds up in the blood. Read more

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Including Walnuts in Daily Diet Improves Health in Adults at Risk for Diabetes

Researchers randomized 112 participants, 31 men and 81 women, ranging in age from 25 to 75 years with multiple risk factors for diabetes (overweight, high blood sugar, blood pressure, or cholesterol, or excess fat around the midsection) to follow a reduced calorie diet with or without nutrition counseling. Within these groups, half were randomly assigned to add walnuts to their daily diet (about 2 ounces/day) for 6 months. After a 3-month break, researchers then switched the groups. Participants were assessed for diet quality, body composition, and cardiac risk measures.

Study results showed that walnuts, with or without nutrition counseling, significantly improved diet quality as measured by the Healthy Eating Index 2010. Endothelial function and total and LDL-C significantly improved from baseline; other factors such as BMI, percent body fat, visceral fat, fasting glucose, glycated hemoglobin, and blood pressure, did not change significantly.

Read the full study here.

References:
Njike V et al. Walnut ingestion in adults at risk for diabetes: effects of body composition, diet quality, and cardiac risk measures. BMJ Open Diab Res Care. 2015;3:e000115 doi:10.1136/bmjdrc-2015-000115.

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