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Are We Ready to Treat Our Diabetes Patients Using Social Media? Yes, We Are - Goran Petrovski, Marija Zivkovic, 2018
Each patient from the Facebook group had 1.5 ± 3.5 posts per day. Hba1c was significantly lower in patients from the Internet group (7.1 ± 3.2%; 54 ± 35 mmol/mol) compared to patients from the non-Internet group (7.6 ± 2.8%; 60 ± 31 mmol/mol).

Social media like Facebook and Viber can be additional communication tool in adolescents and young people with T1D and can significantly lower HbA1c compared to patients without social media use. CSII patients are more likely to use both social media (Facebook and Viber) compared with MDI patients (Facebook only).
diabetes  type  1  T1D  social  media  peer  support  peer-reviewed  research  benefit  self  care 
september 2018 by Michael.Massing
Glycemic control and vascular complications in type 2 diabetes mellitus - UpToDate
[tl;dr: Glycemic control improves microvascular outcomes in type 2 diabetes, including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation; and showed a beneficial effect of intensive therapy on the development of more advanced clinical outcomes in renal disease and its precursors in the one study with long-enough follow up to assess effect. Cardiovascular risk benefit "has not been established as clearly" for type 2 as for type 1.]

Although the role of glycemic control on microvascular disease in type 2 diabetes was documented in the United Kingdom Prospective Diabetes Study (UKPDS), its role in reducing cardiovascular risk has not been established as clearly for type 2 diabetes....

improving glycemic control improves microvascular outcomes, as illustrated by the findings of a meta-analysis of randomized trials (34,912 participants) [5]. There was a reduction in the risk of microvascular complications (a composite outcome including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation) in the intensive compared with standard glycemic control group (relative risk [RR] 0.88, 95% CI 0.82-0.95). There were significant reductions in risk for each of the individual components.

In other meta-analyses of trials (over 28,000 adults) evaluating the benefits of intensive versus conventional glycemic control specifically on renal outcomes, there was a statistically significant reduction in the risk of microalbuminuria and macroalbuminuria in patients randomly assigned to intensive glycemic control (risk ratios of 0.86 and 0.74, respectively) [6,7]. The reduction in risk of end-stage renal disease did not reach statistical significance (RR 0.69, 95% CI 0.46-1.05). There was no reduction in the risk of doubling of the serum creatinine level or death from renal disease (RRs 1.06 and 0.99, respectively) [6]. Of note, the majority of the trials in the meta-analyses were not of long enough duration to show a beneficial effect of glycemic control on end-stage renal disease, which typically manifests after 10 to 20 years of diabetes duration [8]. In the trials included in the meta-analyses, the absolute rates of severe renal outcomes were low in both the intensive- and conventional-therapy groups, reducing the ability of the analysis to demonstrate a benefit, if one exists. In the one trial with longer-term follow-up (United Kingdom Prospective Diabetes Study [UKPDS] cohort followed for 22 years), there was a beneficial effect of intensive therapy on the development of more advanced clinical outcomes, including renal disease
type  2  T2D  diabetes  risk  tight  management  glucose  control  blood  benefit  morbidity  mortality  microvascular  complications  kidneys  eyes  retinopathy  nephropathy  renal  disease  cardiovascular  peer-reviewed  research  review  meta-analysis  overview  in  vivo  situ  human  clinical  trial  symptoms  comorbidities  self  treatment  care 
september 2018 by Michael.Massing
Psychological morbidity and general health among family caregivers during end-of-life cancer care: A retrospective census survey - Gunn Grande, Christine Rowland, Bernard van den Berg, Barbara Hanratty, 2018
National 4-month post-bereavement postal census survey of family carers of people who died from cancer, retrospectively measuring carers’ psychological health (General Health Questionnaire-12) and general health (EuroQoL EQ-Visual Analogue Scale) during the patient’s last 3 months of life.

N = 1504 (28.5%) of all 5271 people who registered the death of a relative from cancer in England during 2 weeks in 2015 compared with data from the Health Survey for England 2014 (N = 6477–6790).

Psychological morbidity at clinically significant levels (General Health Questionnaire-12 ⩾4) was substantially higher among carers than the general population (83% vs 15%), with prevalence five to seven times higher across all age groups. Overall, carers’ general health scores were lower than population scores, median 75 (interquartile range, 50–80) versus 80 (interquartile range, 70–90), but differences were more marked at younger ages. Female carers had worse psychological morbidity and general health than male carers.

Levels of psychological morbidity among family carers during end-of-life caregiving are far higher than indicated by previous research, indicating a substantial public health problem. Consistent assessment and support for carers to prevent breakdown in caregiving may produce cost savings in long term.
caring  caregiving  end-of-life  terminal  cancer  patients  family  members  depression  correlation  anxiety  stress  toll  peer-reviewed  research  human  in  vivo  situ  general  health 
september 2018 by Michael.Massing
Largest brain study of 62,454 scans identifies drivers of brain aging: Schizophrenia, cannabis use, and alcohol abuse are just several disorders that are related to accelerated brain aging -- ScienceDaily
Researchers studied 128 brain regions to predict the chronological age of the patient. Older age predicted from the scan compared to the actual chronological age was interpreted as accelerated aging. The study found that a number of brain disorders and behaviors predicted accelerated aging, especially schizophrenia, which showed an average of 4 years of premature aging, cannabis abuse (2.8 years of accelerated aging), bipolar disorder (1.6 years accelerated aging), ADHD (1.4 years accelerated aging) and alcohol abuse (0.6 years accelerated aging). Interestingly, the researchers did not observe accelerated aging in depression and aging, which they hypothesize may be due to different types of brain patterns for these disorders.
brain  aging  rate  accelerated  imaging  in  vivo  human  correlation  peer-reviewed  research  population  depression 
september 2018 by Michael.Massing
Long-Chain Omega-3 Fatty Acid Supplements in Depressed Heart Failure Patients: Results of the OCEAN Trial - ScienceDirect
Patients with CHF and depression had low blood omega-3 concentrations that were associated with an elevated risk of mortality.


This study was a randomized, double-blind, placebo-controlled pilot clinical trial using a 400/200 eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) fish oil at 2 g and an almost pure EPA at 2 g, compared with a matched placebo, daily for 12 weeks for patients with CHF and major depressive disorder. Statistical analyses included the intention-to-treat population and “completers” (defined as participants consuming ≥70% of the capsules and completing the final endpoint evaluation between 10 and 14 weeks).


A total of 108 patients with CHF and major depressive disorder and a score ≥18 on the Hamilton Depression Scale who were randomized at 1:1:1 to the 3 interventions at 3 enrolling centers from June 12, 2014, to May 19, 2016; 80 (74.1%) qualified as completers. Intention-to-treat analyses revealed that the levels of all omega-3 variables were significantly elevated in the omega-3 groups, whereas the placebo group showed little change; there were no between-group differences with overall depression measurements. Per-protocol exploratory analyses showed that scores on the social functioning measurement of the 36-item Short Form Health Survey improved notably in the 400/200 EPA/DHA (p = 0.040) and EPA (p = 0.10) groups compared with the placebo group. Spearman correlation analysis indicated that increased omega-3 indices were associated with improved cognitive depressive symptoms.


Omega-3 supplementation resulted in significant increases in omega-3 levels in red blood cell counts, corresponding to a particular compound of omega-3. Changes in cognitive depressive symptoms and social function were in favor of the omega-3 supplementation. Further studies with larger sample sizes are necessary to confirm the benefits of omega-3 supplementation on modifying psychosocial factors for patients with CHF. (Omega-3 Supplementation for Co-Morbid Depression and Heart Failure Treatment [OCEAN]; NCT02057406)
depression  CHF  major  depressive  disorder  peer-reviewed  research  human  clinical  trial  in  vivo  situ  cognition  functional  improvement  treatment  cognitive  comorbidity  mortality  risk  benefit  supplements  omega-3  DHA  EPA  RCT 
september 2018 by Michael.Massing
Metabolic Flexibility as an Adaptation to Energy Resources and Requirements in Health and Disease | Endocrine Reviews | Oxford Academic
metabolic flexibility can be placed in the broad context of health and disease and a deeper understanding of its intricacies will significantly affect health care. As a final note, the situation portrayed here does not necessarily reflect that of each individual. Because of the genetic and epigenetic disparity of humans and the enormous varieties in lifestyle, it is not unthinkable that each person fashions a unique way to maintain energy homeostasis. In light of the rapid developments in the field of nutrigenomics and personalized medicine, future research will likely focus on the union between metabolic flexibility and personalized medicine.
metabolic  metabolism  flexibility  evolution  genetics  epigenetics  individual  variation  endocrine  neurotransmitter  hormone  insulin  peer-reviewed  research  pathophysiology  risk  genetic  factor  energy  homeostasis 
august 2018 by Michael.Massing
How Much Protein Should I Eat Each Day?
That said, many experts believe that to maintain muscle mass and proper functioning, older adults need to eat double the amount of protein they needed in their younger years, says Abby Sauer, M.P.H., R.D., a dietitian specializing in adult and geriatric nutrition. That’s right, double!

In one American Journal of Physiology—Endocrinology and Metabolism study, adults ages 52 to 75 improved their muscle health by following a diet containing 1.5 grams of protein per kilogram of bodyweight per day. That’s roughly twice the current RDA.

If that seems like a lofty goal, take it one meal at a time: Aim to eat 25 to 30 grams of protein at breakfast, lunch, and dinner.
protein  diet  foods  aging  muscle  maintenance  health  peer-reviewed  research  in  vivo  human  satiety 
august 2018 by Michael.Massing
Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia | Cardiology | JAMA | JAMA Network
These findings may support the promotion of cardiovascular health to prevent development of risk factors associated with dementia.
cardiovascular  heart  brain  risk  health  dementia  benefit  correlation  peer-reviewed  research  human  in  situ  cohort  vivo 
august 2018 by Michael.Massing
Air Pollution Linked to Infant Deaths | Global Health | JAMA | JAMA Network
Poor air quality is responsible for 1 in 5 infant deaths in sub-Saharan Africa, according to a study published in Nature.

To quantify the effect of breathable air pollutants on premature deaths among infants in Africa, the investigators examined recent satellite-based estimates of air pollutant particles (ambient respirable particulate matter with an aerodynamic diameter less than 2.5 μm [PM2.5]). They combined the air quality data with results from 65 household surveys across 30 sub-Saharan African countries on the timing and location of almost 1 million infant births—and any subsequent deaths in the first year of life—between 2001 and 2015. They then matched the location and timing of each birth to satellite-based estimates of PM2.5 exposure from 9 months before birth to 12 months after.

The investigators found a strong linear association of infant mortality with increases in PM2.5 exposure. Specifically, with every 10 μg per cubic meter increase in the concentration of breathable particulate matter in the first 12 months of life, there was about a 9% increase in infant mortality. This association was consistent over the study’s 15 years and was independent of household wealth.

Concentrations of PM2.5 higher than minimum exposure levels were responsible for 22% of infant deaths in 30 countries and led to 449 000 additional infant deaths in 2015. This estimate is more than 3 times higher than earlier data, suggesting poor air quality is an even bigger problem than previously appreciated.
air  pollution  environmental  factors  environment  infant  mortality  Africa  particulate  matter  risk  peer-reviewed  research  correlation  human  in  vivo  population  situ 
august 2018 by Michael.Massing
Can a Sauna Session Count as a Workout?
Those who sweated it out two to three times per week were 23 percent less likely to suffer from coronary heart disease or cardiovascular disease. People who sauna-bathed four to seven times per week were 48 percent less likely to die of those heart diseases — and 40 percent less likely to die of any other causes than people who only sauna-bathed once per week. 

The longer people spent in the heat during each sauna session — which ran from two- to 90-minutes(!) long — the greater their risk of survival. Guys who spent more than 19 minutes in the sauna were 52 percent less likely to suffer sudden cardiac death that men who sauna-bathed for less than 11 minutes at a time.
sauna  bathing  risk  benefit  cardiac  cardiovascular  morbidity  mortality  correlation  human  cohort  prospective  in  vivo  situ  peer-reviewed  research  all-cause 
july 2018 by Michael.Massing
Sauna bathing reduces the risk of stroke in Finnish men and women | Neurology
Baseline habits of sauna bathing were assessed in 1,628 adult men and women aged 53–74 years (mean age, 62.7 years) without a known history of stroke in the Finnish Kuopio Ischemic Heart Disease prospective cohort study. Three sauna bathing frequency groups were defined: 1, 2–3, and 4–7 sessions per week. Hazard ratios (HRs) (95% confidence intervals [CIs]) were estimated for incident stroke.

Results During a median follow-up of 14.9 years, 155 incident stroke events were recorded. Compared with participants who had one sauna bathing session per week, the age- and sex-adjusted HR (95% CI) for stroke was 0.39 (0.18–0.83) for participants who had 4–7 sauna sessions per week. After further adjustment for established cardiovascular risk factors and other potential confounders, the corresponding HR (95% CI) was 0.39 (0.18–0.84) and this remained persistent on additional adjustment for physical activity and socioeconomic status at 0.38 (0.18–0.81). The association between frequency of sauna bathing and risk of stroke was not modified by age, sex, or other clinical characteristics (p for interaction > 0.10 for all subgroups). The association was similar for ischemic stroke but modest for hemorrhagic stroke, which could be attributed to the low event rate (n = 34).

Conclusions This long-term follow-up study shows that middle-aged to elderly men and women who take frequent sauna baths have a substantially reduced risk of new-onset stroke.
sauna  risk  reduction  benefit  bathing  peer-reviewed  research  human  in  vivo  situ  prospective  cohort  stroke  ischemic  correlation 
july 2018 by Michael.Massing
Glycemic Control in Nonpregnant Adults With Type 2 Diabetes | Guidelines | JAMA | JAMA Network
[As is so often the case, the discussion of treatment risk vs. benefit in glycemic control/management is distorted by an actually or effectively exclusive focus on drug therapy. —DMM]

In the United States, type 2 diabetes affects 30 million people and is a major cause of morbidity and mortality.1 Glycemic control has been shown to reduce diabetes complications, particularly for microvascular disease.2,3 However, increasing recognition of adverse events due to intensive diabetes treatments has prompted major disagreements about optimal glycemic targets.
glycemic  control  tight  management  glucose  complications  late-stage  symptoms  risk  mitigation  prevention  microvascular  diabetes  type  2  T2D  drug  therapy  treatment  peer-reviewed  research  in  vivo  situ  human  clinical  trial  blood  benefit  comorbidities  morbidity  self  care  behavioral 
july 2018 by Michael.Massing
Frequency and phenotype of type 1 diabetes in the first six decades of life: a cross-sectional, genetically stratified survival analysis from UK Biobank - ScienceDirect

13 250 (3·5%) of 379 511 white European individuals in UK Biobank had developed diabetes in the first six decades of life. 1286 more cases of diabetes were in the half of the population with high genetic susceptibility to type 1 diabetes than in the half of the population with low genetic susceptibility. These genetically defined cases of type 1 diabetes were distributed across all ages of diagnosis; 537 (42%) were in individuals diagnosed when aged 31–60 years, representing 4% (537/12 233) of all diabetes cases diagnosed after age 30 years. The clinical characteristics of the group diagnosed with type 1 diabetes when aged 31–60 years were similar to the clinical characteristics of the group diagnosed with type 1 diabetes when aged 30 years or younger. For individuals diagnosed with diabetes when aged 31–60 years, the clinical characteristics of type 1 diabetes differed from those of type 2 diabetes: they had a lower BMI (27·4 kg/m2 [95% CI 26·7–28·0] vs 32·4 kg/m2 [32·2–32·5]; p<0·0001), were more likely to use insulin in the first year after diagnosis (89% [476/537] vs 6% [648/11 696]; p<0·0001), and were more likely to have diabetic ketoacidosis (11% [61/537] vs 0·3% [30/11 696]; p<0·0001).


Genetic susceptibility to type 1 diabetes results in non-obesity-related, insulin-dependent diabetes, which presents throughout the first six decades of life. Our results highlight the difficulty of identifying type 1 diabetes after age 30 years because of the increasing background prevalence of type 2 diabetes. Failure to diagnose late-onset type 1 diabetes can have serious consequences because these patients rapidly develop insulin dependency.
diabetes  type  1  age  incidence  prevalence  diagnosis  peer-reviewed  research  genetics  risk  adult  onset  T!D  demographics  presentation  UK  Europe  genetic 
june 2018 by Michael.Massing

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