Michael.Massing + peer-reviewed   923

Artificial Intelligence Can Detect Alzheimer’s Disease in Brain Scans Six Years Before a Diagnosis | UC San Francisco
Once the algorithm was trained on 1,921 scans, the scientists tested it on two novel datasets to evaluate its performance. The first were 188 images that came from the same ADNI database but had not been presented to the algorithm yet. The second was an entirely novel set of scans from 40 patients who had presented to the UCSF Memory and Aging Center with possible cognitive impairment.

The algorithm performed with flying colors. It correctly identified 92 percent of patients who developed Alzheimer’s disease in the first test set and 98 percent in the second test set. What’s more, it made these correct predictions on average 75.8 months – a little more than six years – before the patient received their final diagnosis.

Sohn says the next step is to test and calibrate the algorithm on larger, more diverse datasets from different hospitals and countries.

“I believe this algorithm has the strong potential to be clinically relevant,” he says. “However, before we can do that, we need to validate and calibrate the algorithm in a larger and more diverse patient cohort, ideally from different continents and various different types of settings.”
Alzheimer's  diabetes  brain  glucose  retrospective  human  in  vivo  prognostic  PET  scan  imaging  correlation  peer-reviewed  research 
7 weeks ago by Michael.Massing
Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study | The BMJ
After adjusting for sociodemographic and lifestyle confounders, fish eaters and vegetarians had 13% (hazard ratio 0.87, 95% confidence interval 0.77 to 0.99) and 22% (0.78, 0.70 to 0.87) lower rates of ischaemic heart disease than meat eaters, respectively (P<0.001 for heterogeneity). This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years. The associations for ischaemic heart disease were partly attenuated after adjustment for self reported high blood cholesterol, high blood pressure, diabetes, and body mass index (hazard ratio 0.90, 95% confidence interval 0.81 to 1.00 in vegetarians with all adjustments). By contrast, vegetarians had 20% higher rates of total stroke (hazard ratio 1.20, 95% confidence interval 1.02 to 1.40) than meat eaters, equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke. The associations for stroke did not attenuate after further adjustment of disease risk factors.

Conclusions In this prospective cohort in the UK, fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters, although vegetarians had higher rates of haemorrhagic and total stroke.
peer-reviewed  research  EPIC  UK  vegetarian  meat  fish  diet  risk  stroke 
september 2019 by Michael.Massing
The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized Trial | Annals of Internal Medicine | American College of Physicians
Fifty-three percent of participants (n = 1711) had the metabolic syndrome at baseline; incidence did not vary substantially by age. However, low levels of high-density lipoprotein cholesterol predominated in younger participants (age 25 to 44 years), and high blood pressure predominated in older participants (age 60 to 82 years). In life-table analyses (log-rank test), incidence of the metabolic syndrome was reduced by 41% in the lifestyle group (P < 0.001) and by 17% in the metformin group (P = 0.03) compared with placebo. Three-year cumulative incidences were 51%, 45%, and 34% in the placebo, metformin, and lifestyle groups, respectively. There was no significant heterogeneity by ethnic group.

Limitations:
The study involved a volunteer group with impaired glucose tolerance, which limits generalizability.

Conclusions:
The metabolic syndrome affected approximately half of the participants in the Diabetes Prevention Program at baseline. Both lifestyle intervention and metformin therapy reduced the development of the syndrome in the remaining participants.
metabolic  syndrome  treatment  intervention  behavioral  diet  dietary  drug  comparison  metformin  peer-reviewed  research  in  vivo  human  clinical  trial 
august 2019 by Michael.Massing
Rethinking A1c goals for type 2 diabetes - Harvard Health Blog - Harvard Health Publishing
An A1c goal of between 7% and 8% is reasonable and beneficial for most patients with type 2 diabetes…

…though if lifestyle changes can get that number lower, then go for it. For patients who want to live a long and healthy life and try to avoid the complications of diabetes, they will need to keep their blood sugars as normal as possible — that means an A1c under 6.5%. However, studies show that using medications to achieve that goal significantly increases the risk of harmful side effects like hypoglycemia and weight gain. To live longer and healthier and avoid both the complications of diabetes as well as the risks of medications, there’s this amazing thing called lifestyle change. This involves exercise, healthy diet, weight loss, and not smoking. It is very effective. Lifestyle change also can help achieve healthy blood pressure and cholesterol levels, which in turn reduce the risk for heart disease. And heart disease is a serious and common complication of diabetes.

Lifestyle change should be the cornerstone of treatment for type 2 diabetes. The recommendations go on to say that for patients who achieve an A1c below 6.5% with medications, we should decrease or even discontinue those drugs. Doing so requires careful monitoring to ensure that the person stays at the goal set with his or her doctor, which should be no lower than 7%, for the reasons stated above.

We don’t even need to follow the A1c for some patients

Elderly patients, and those with serious medical conditions, will benefit from simply controlling the symptoms they have from high blood sugars, like frequent urination and incontinence, rather than aiming for any particular A1c level. Who would be included in this group? People with a life expectancy of less than 10 years, or those who have advanced forms of dementia, emphysema, or cancer; or end-stage kidney, liver, or heart failure. There is little to no evidence for any meaningful benefit of intervening to achieve a target A1c in these populations; there is plenty of evidence for harm. In particular, diabetes medications can cause low blood sugars, leading to weakness, dizziness, and falls. There is the added consideration that elderly and sick patients often end up on a long list of medications that can (and do) interact, causing even more side effects.

The bottom line

There is no question that type 2 diabetes needs to be taken seriously and treated. But common sense should rule the day. Lifestyle changes are very effective, and the side effects of eating more healthfully and staying more active are positive ones. Every person with type 2 diabetes is an individual. No single goal is right for everyone, and each patient should have a say in how to manage their blood sugars and manage risk. That means an informed discussion, and thoughtful consideration to the number.

Sources

Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: A guidance statement update from the American College of Physicians. Annals of Internal Medicine, March 2018.
guidelines  standards  A1c  diabetes  management  self  behavioral  research  peer-reviewed 
august 2019 by Michael.Massing
Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. - PubMed - NCBI
We searched PubMed, the Cochrane Library, EMBASE, and clinical trials registries for published and unpublished studies up until 1 March, 2019. We included 54 randomized controlled trials in adults or children with impaired glucose tolerance, type 1 diabetes, or type 2 diabetes. Continuous data were synthesized using a random effects, inverse variance model, and presented as standardized mean differences with 95% CIs.

RESULTS:
Low-GI diets were effective at reducing glycated hemoglobin (HbA1c), fasting glucose, BMI, total cholesterol, and LDL, but had no effect on fasting insulin, HOMA-IR, HDL, triglycerides, or insulin requirements. The reduction in fasting glucose and HbA1c was inversely correlated with body weight. The greatest reduction in fasting blood glucose was seen in the studies of the longest duration.

CONCLUSIONS:
Low-GI diets may be useful for glycemic control and may reduce body weight in people with prediabetes or diabetes.
foods  low  GI  glycemic  index  diet  food  weight  loss  maintenance  body  fat  clinical  trial  meta-analysis  RCT  peer-reviewed  research  human  in  vivo  systematic  review  HbA1c  biomarkers  treatment  improvement  intervention  fasting  glucose  BMI  total  cholesterol  LDL 
august 2019 by Michael.Massing
Comparison of High-Fiber and AHA Diets | Annals of Internal Medicine | American College of Physicians
At 12 months, mean change in weight was −2.1 kg (95% CI, −2.9 to −1.3 kg) in the high-fiber diet group versus −2.7 kg (CI, −3.5 to −2.0 kg) in the AHA diet group. The mean between-group difference was 0.6 kg (CI, −0.5 to 1.7 kg). During the trial, 12 (9.9%) and 15 (12.6%) participants dropped out of the high-fiber and AHA diet groups, respectively (P = 0.55). Eight participants developed diabetes (hemoglobin A1c level ≥6.5%) during the trial: 7 in the high-fiber diet group and 1 in the AHA diet group (P = 0.066).

Limitations:
Generalizability is unknown. Maintenance of weight loss after cessation of group sessions at 12 months was not assessed. Definitive conclusions cannot be made about dietary equivalence because the study was powered for superiority.

Conclusion:
The more complex AHA diet may result in up to 1.7 kg more weight loss; however, a simplified approach to weight reduction emphasizing only increased fiber intake may be a reasonable alternative for persons with difficulty adhering to more complicated diet regimens.
fat  loss  weight  maintenance  body  fiber  diet  food  treatment  intervention  clinical  trial  human  in  vivo  research  peer-reviewed  comparison 
august 2019 by Michael.Massing
The Effect of Diet and Exercise or Metformin on the Metabolic Syndrome | Annals of Internal Medicine | American College of Physicians
Over half of the patients had the metabolic syndrome at the start of the study. Diet and exercise or metformin each prevented the development of the metabolic syndrome in patients who did not have it at the start of the study. Patients who had the syndrome at the start of the study were more likely to be free of it at the end if they received a diet and exercise intervention or metformin than if they received neither. The benefit of the diet and exercise program was larger than the benefit of metformin.

What were the limitations of the study?

The study included only people with impaired glucose tolerance, so it might not apply to people with normal blood sugar. The study was also too short to see whether the reduction in the metabolic syndrome led to fewer cardiovascular events.

What are the implications of the study?

Diet and exercise or metformin can reduce the metabolic syndrome in people with high blood sugar.
metformin  treatment  self  drug  behavioral  exercise  diet  clinical  trial  metabolic  syndrome  care  improvement  prevention  symptom  comparison  peer-reviewed  research  impaired  glucose  tolerance  dysglycemia  hyperglycemia 
august 2019 by Michael.Massing
Twitter
Diagnosis, treatment, morbidity, mortality, and health disparity effects of Medicaid obstructionism have been speci…
Medicaid  expansion  morbidity  mortality  risk  obstructionism  diagnosis  treatment  health  disparities  cost  benefit  poverty  SDH  social  determinants  of  epidemiology  correlation  chronic  research  peer-reviewed  population  studies  obstruction  public  disease  burden  data  access  care  healthcare  from twitter
july 2019 by Michael.Massing
Health Coverage and Access to Care for Hispanics in "New Growth Communities" and "Major Hispanic Centers" - IssueLab
Health Coverage and Access to Care for Hispanics in "New Growth Communities" and "Major Hispanic Centers"

by Jennifer Tolbert; Michelle Banker; Peter J. Cunningham; Samantha Artiga
peer-reviewed  research 
july 2019 by Michael.Massing
Complication Rates Ramp up in Kids with T2D | Medpage Today
Paired with other trials such as RISE and SEARCH, TODAY demonstrated that about half of kids with type 2 diabetes have rapidly progressing disease, and are already experiencing early mortality
morbidity  mortality  risk  T2D  children  youth  type  2  diabetes  peer-reviewed  clinical  research  human  in  vivo  situ 
july 2019 by Michael.Massing
Twitter
Obamacare Cut Racial Disparities in Cancer Care [a.k.a. Obstruction of Medicaid expansion effectively targets black…
Medicaid  morbidity  mortality  cost  benefit  expansion  risk  obstructionism  diagnosis  treatment  health  disparities  poverty  SDH  social  determinants  of  epidemiology  correlation  chronic  research  peer-reviewed  population  studies  obstruction  public  disease  burden  data  access  care  healthcare  from twitter
june 2019 by Michael.Massing
Twitter
Diabetes. HIV. Now two cancers. Obstructing Medicaid expansion means underdiagnosis and consequent missed treatment…
Medicaid  morbidity  mortality  cost  benefit  expansion  risk  obstructionism  diagnosis  treatment  health  disparities  poverty  SDH  social  determinants  of  epidemiology  correlation  chronic  research  peer-reviewed  population  studies  etiology  diabetes  cause  factor  obstruction  public  disease  burden  data  access  care  healthcare  T2D  socioeconomic  geography  environment  type  2  politics  political  ACA  from twitter
may 2019 by Michael.Massing
Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments | The American Journal of Clinical Nutrition | Oxford Academic
Glycated hemoglobin declined more in people who consumed low-carbohydrate food than in those who consumed low-fat food in the short term (MD: –1.38%; 95% CI: –2.64%, –0.11%; very-low-certainty evidence). At 1 y, the MD was reduced to –0.36% (95% CI: –0.58%, –0.14%; low-certainty evidence); at 2 y, the difference had disappeared. There is low to high (majority moderate) certainty for small improvements of unclear clinical importance in plasma glucose, triglycerides, and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points. There was little to no difference in LDL concentration or any of the secondary outcomes (body weight, waist circumference, blood pressure, quality of life) in response to either of the diets (very-low- to high-certainty evidence).
Conclusions
Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40% yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30% in people with T2D.
triglycerides  fat  low  diet  diabetes  T2D  type  2  blood  pressure  carbohydrates  carb  fasting  quality  of  life  glucose  carbohydrate  waist  circumference  biomarkers  peer-reviewed  research  human  in  vivo  correlation  effects  benefit  nutrition  clinical  trial  review  systematic 
may 2019 by Michael.Massing
Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis - The Lancet Public Health
We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake (<600 kcal or >4200 kcal per day for men and <500 kcal or >3600 kcal per day for women). The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality.

Findings

....In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption (<40%) and high carbohydrate consumption (>70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).

Interpretation

Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

Funding: National Institutes of Health.
whole  grain  carb  carbohydrates  low  fat  loss  guidelines  nutrition  food  foods  protein  macronutrients  proportion  ratio  ketogenic  diet  ketosis  risk  benefit  peer-reviewed  research  human  in  vivo  correlation  mortality  morbidity  all-cause  meta-analysis  animal  meat  plant-based  prospective  large  cohort 
may 2019 by Michael.Massing
What Foods Have No Carbs? | POPSUGAR Fitness
Kind of a clickbaity headline, but some good info with sources about the risks of extreme/prolonged ketogenic eating and the benefits of the right carbs for health and longevity.
whole  grain  carb  carbohydrates  low  fat  loss  guidelines  nutrition  food  foods  protein  macronutrients  proportion  ratio  ketogenic  diet  ketosis  risk  benefit  peer-reviewed  research  human  in  vivo 
may 2019 by Michael.Massing
Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults | Annals of Internal Medicine | American College of Physicians
During a median follow-up of 6.1 years, 3613 deaths occurred, including 945 CVD deaths and 805 cancer deaths. Ever-use of dietary supplements was not associated with mortality outcomes. Adequate intake (at or above the Estimated Average Requirement or the Adequate Intake level) of vitamin A, vitamin K, magnesium, zinc, and copper was associated with reduced all-cause or CVD mortality, but the associations were restricted to nutrient intake from foods. Excess intake of calcium was associated with increased risk for cancer death (above vs. at or below the Tolerable Upper Intake Level: multivariable-adjusted rate ratio, 1.62 [95% CI, 1.07 to 2.45]; multivariable-adjusted rate difference, 1.7 [CI, −0.1 to 3.5] deaths per 1000 person-years), and the association seemed to be related to calcium intake from supplements (≥1000 mg/d vs. no use: multivariable-adjusted rate ratio, 1.53 [CI, 1.04 to 2.25]; multivariable-adjusted rate difference, 1.5 [CI, −0.1 to 3.1] deaths per 1000 person-years) rather than foods.
supplement  risk  variables  vitamins  minerals  metals  dietary  food  benefit  peer-reviewed  research  human  cohort  study  mortality 
april 2019 by Michael.Massing
Twitter
Rising HIV rates and falling intervention map to political obstruction of Medicaid expansion. [Diabetes also goes u…
diabetes  HIV  Medicaid  political  obstructionism  poverty  health  disparities  treatment  diagnosis  chronic  disease  morbidity  mortality  cost  benefit  risk  expansion  SDH  social  determinants  of  epidemiology  correlation  research  peer-reviewed  population  studies  etiology  cause  factor  obstruction  public  burden  data  access  care  healthcare  socioeconomic  geography  environment  T2D  type  2  politics  ACA  from twitter
april 2019 by Michael.Massing
Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. - PubMed - NCBI
Psychological distress is linked with impaired glycemic control among diabetics.

OBJECTIVE:
Estimate changes in glycemic control, weight, blood pressure, and stress-related psychological symptoms in patients with type 2 diabetes participating in a standard Mindfulness Based Stress Reduction (MBSR) program.

DESIGN:
Prospective, observational study.

SETTING:
Academic health center.

PATIENTS:
Adult patients with type 2 diabetes mellitus.

INTERVENTIONS:
Participation in MBSR program for heterogeneous patient population. Diet and exercise regimens held constant.

MAIN OUTCOME MEASURES:
Glycosylated hemoglobin A1c (HA1c), blood pressure, body weight, and Symptom Checklist 90-Revised (anxiety, depression, somatization, and general psychological distress scores).

RESULTS:
Eleven of 14 patients completed the intervention. At 1 month follow-up, HA1c was reduced by 0.48% (P = .03), and mean arterial pressure was reduced by 6 mmHg (P = .009). Body weight did not change. A decrease in measures of depression, anxiety, and general psychological distress was observed.
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  care  correlation  peer-reviewed  research  stress  distress  reduction  mindfulness  based 
april 2019 by Michael.Massing
Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis. - PubMed - NCBI
SMBG was associated with a reduction of HbA1c at 12 weeks (-0.31%; 95% CI: -0.57 to -0.05) and 24 weeks (-0.34%; 95%CI: -0.52 to -0.17), but no difference was found for 1 year. Subgroup analysis including studies with baseline HbA1c greater than 8% showed a higher reduction of HbA1c: -0.83% (95% CI: -1.55 to -0.11) at 12 weeks, and -0.48% (95% CI: -0.77 to -0.19) at 24 weeks, with no difference for 1 year nor for the stratification for number the tests.
CONCLUSION:
SMBG seems to lead to a slightly better glycemic control in the short term in patients with T2D. Patients decompensated at baseline appear to have the greatest benefit.
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  monitoring  correlation  peer-reviewed  research  tight  frequency 
april 2019 by Michael.Massing
Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. - PubMed - NCBI
SMBG was effective in reducing HbA(1c) in non-insulin-treated type 2 diabetes (pooled mean difference, -0.24%; 95% confidence interval, -0.34% to -0.14%; P < 0.00001). Glycemic control significantly improved among the subgroup of patients whose baseline HbA(1c) was >or=8%. In contrast, no significant effect of SMBG was detected in patients who had HbA(1c) <8%.
CONCLUSIONS:
The available evidence suggests the usefulness of SMBG in improving glycemic control in non-insulin-treated type 2 diabetes as demonstrated by the reduction of HbA(1c) levels. In particular, SMBG proved to be useful in the subgroup of patients whose baseline HbA(1c) was >or=8%.
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  monitoring  correlation  peer-reviewed  research  tight  frequency 
april 2019 by Michael.Massing
Using the Common Sense Model of Self-regulation to review the effects of self-monitoring of blood glucose on glycemic control for non-insulin-treat... - PubMed - NCBI
Results from the longitudinal studies and randomized control trials suggested that SMBG may improve glycemic control. The few studies investigating mediators or moderators reported mixed results. Few studies effectively measured the CSM.
CONCLUSION:
Data suggested that SMBG may help improve glycemic control. Future trials must be designed to test hypotheses and improve our understanding of when, how, and for whom SMBG can enhance glycemic control. Rigorously controlled repetitions of current 2-arm trials will yield little new knowledge of theoretical or practical value.
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  monitoring  correlation  peer-reviewed  research  tight  frequency 
april 2019 by Michael.Massing
Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in V... - PubMed - NCBI
A total of 201 subjects completed the monitoring period. The baseline HbA(1c) (8.10 +/- 1.67%) decreased during the monitoring period by 0.30 +/- 0.68% (P < 0.001) at 4 weeks and by 0.36 +/- 0.88% (P < 0.001) at 8 weeks. Although entry HbA(1c) and compliance independently predicted the week 8 HbA(1c) (r = 0.862, P < 0.001), standardized regression analysis found that compliance with the SMBG protocol influenced the week 8 HbA(1c) more than age, sex, BMI, exercise level, carbohydrate consumption, or treatment intensity at baseline. However, SMBG benefited only subjects whose testing compliance exceeded 75% or with an entry HbA(1c) >8.0%. Decreases in HbA(1c) (-0.31 +/- 1.17%, P = 0.001) persisted in the 159 subjects followed for 52 weeks.
CONCLUSIONS:
Intensified blood glucose monitoring improved glycemic control in a large cohort of stable, insulin-treated veterans with type 2 diabetes. SMBG provided a strong stimulus for improved self-care resulting in clinically important and sustained reductions in HbA(1c).
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  monitoring  correlation  peer-reviewed  research  insurance  tight  frequency 
april 2019 by Michael.Massing
Effects of health maintenance organization coverage of self-monitoring devices on diabetes self-care and glycemic control. - PubMed - NCBI
est strip consumption increased during the first 6 months after the policy by 17.9 strips per cohort member (75% relative increase by 6 months; 95% CI, 50% to 101%). Compared with noninitiators of SMBG, initiators (n = 593) showed sudden, significant improvements in regularity of medication use by 6 months after initiation (-19.5 days between dispensings among those with low refill regularity [95% CI, -27.7 to -11.3]; -9.7 days among those with moderate regularity [95% CI, -12.3 to -7.1]), and in glucose control (-0.63% mean HbA(1c) level [as percentage of total hemoglobin] among those with poor baseline glycemic control [HbA(1c) >10%; 95% CI, -1.14% to -0.12%]).
CONCLUSIONS:
Providing free glucose monitors improved rates of self-monitoring in this health maintenance organization population, possibly by offering an initial incentive for patients to engage in more desirable patterns of care. Initiating SMBG was associated with increased regularity of medication use and a reduction in high blood glucose levels.
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  monitoring  correlation  peer-reviewed  research  insurance  tight  frequency 
april 2019 by Michael.Massing
Lack of insurance coverage for testing supplies is associated with poorer glycemic control in patients with type 2 diabetes
Patients with insurance had significantly lower hemoglobin A1c concentrations than those without insurance coverage (7.1% v. 7.4%, p = 0.03). Patients with insurance were younger, had a higher income, were less likely to have a high school education and were less likely to be married or living with a partner. In multivariate analyses that controlled for these and other potential confounders, lack of insurance coverage for self-monitoring testing supplies was still significantly associated with higher hemoglobin A1c concentrations (adjusted difference 0.5%, p = 0.006).

Interpretation

Patients without insurance for self-monitoring test strips had poorer glycemic control.
SMBG  diabetes  type  2  T2D  glycemic  control  glucose  management  blood  self  monitoring  correlation  peer-reviewed  research  insurance  tight  frequency 
april 2019 by Michael.Massing
Protein – Which is Best?
Traditionally, sources of dietary protein are seen as either being of animal or vegetable origin. Animal sources provide a complete source of protein (i.e. containing all essential amino acids), whereas vegetable sources generally lack one or more of the essential amino acids. Animal sources of dietary protein, despite providing a complete protein and numerous vitamins and minerals, have some health professionals concerned about the amount of saturated fat common in these foods compared to vegetable sources. The advent of processing techniques has shifted some of this attention and ignited the sports supplement marketplace with derivative products such as whey, casein and soy. Individually, these products vary in quality and applicability to certain populations. The benefits that these particular proteins possess are discussed. In addition, the impact that elevated protein consumption has on health and safety issues (i.e. bone health, renal function) are also reviewed.

Key Points

Higher protein needs are seen in athletic populations.

Animal proteins is an important source of protein, however potential health concerns do exist from a diet of protein consumed from primarily animal sources.

With a proper combination of sources, vegetable proteins may provide similar benefits as protein from animal sources.

Casein protein supplementation may provide the greatest benefit for increases in protein synthesis for a prolonged duration.
protein  supplements  animal  plant  peer-reviewed  research  comparison  whey  casein 
april 2019 by Michael.Massing
Sudden Infant Death Syndrome and Unclassified Sudden Infant Deaths: A Definitional and Diagnostic Approach | Special Articles | Pediatrics
The definition of sudden infant death syndrome (SIDS) originally appeared in 1969 and was modified 2 decades later. During the following 15 years, an enormous amount of additional information has emerged, justifying additional refinement of the definition of SIDS to incorporate epidemiologic features, risk factors, pathologic features, and ancillary test findings. An expert panel of pediatric and forensic pathologists and pediatricians considered these issues and developed a new general definition of SIDS for administrative and vital statistics purposes. The new definition was then stratified to facilitate research into sudden infant death. Another category, defined as unclassified sudden infant deaths, was introduced for cases that do not meet the criteria for a diagnosis of SIDS and for which alternative diagnoses of natural or unnatural conditions were equivocal. It is anticipated that these new definitions will be modified in the future to accommodate new understanding of SIDS and sudden infant death
SIDS  SUID  mortality  infant  cause  of  death  classification  definition  revision  AAP  American  Academy  Pediatrics  peer-reviewed  research  co-sleeping  citation  history  data  evidence  post-mortem  investigation  human 
february 2019 by Michael.Massing
Research and sudden infant death syndrome: definitions, diagnostic difficulties and discrepancies. - PubMed - NCBI
The diagnosis of causes of sudden infant death is an often complex and difficult process. Variable standards of autopsy practice and the use of different definitions for entities such as sudden infant death syndrome (SIDS) have also contributed to confusion and discrepancies. For example, the term SIDS has been used when the requirements of standard definitions have not been fulfilled. In an attempt to correct this situation recent initiatives have been undertaken to stratify cases of unexpected infant death and to institute protocols that provide frameworks for investigations. However, if research is to be meaningful, researchers must be scrupulous in assessing how extensively cases have been investigated and how closely cases fit with internationally recognized definitions and standards. Unless this approach is adopted, evaluation of research findings in SIDS will be difficult and the literature will continue to be beset by contradictions and unsubstantiated conclusions
SIDS  SUID  mortality  infant  cause  of  death  classification  definition  methodology  criticism  peer-reviewed  research  co-sleeping  citation  data  evidence  post-mortem  investigation  human 
february 2019 by Michael.Massing
Sudden Infant Death Syndrome and Unclassified Sudden Infant Deaths: A Definitional and Diagnostic Approach | Special Articles | Pediatrics
The definition of sudden infant death syndrome (SIDS) originally appeared in 1969 and was modified 2 decades later. During the following 15 years, an enormous amount of additional information has emerged, justifying additional refinement of the definition of SIDS to incorporate epidemiologic features, risk factors, pathologic features, and ancillary test findings. An expert panel of pediatric and forensic pathologists and pediatricians considered these issues and developed a new general definition of SIDS for administrative and vital statistics purposes. The new definition was then stratified to facilitate research into sudden infant death. Another category, defined as unclassified sudden infant deaths, was introduced for cases that do not meet the criteria for a diagnosis of SIDS and for which alternative diagnoses of natural or unnatural conditions were equivocal. It is anticipated that these new definitions will be modified in the future to accommodate new understanding of SIDS and sudden infant death.
SIDS  SUID  mortality  infant  cause  of  death  classification  definition  revision  AAP  American  Academy  Pediatrics  peer-reviewed  research  co-sleeping  citation  history  data  evidence  post-mortem  investigation  human 
february 2019 by Michael.Massing
Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK. - PubMed - NCBI
Night-time infant care therefore differed significantly between South Asian and White British families. South Asian infant care practices were more likely to protect infants from the most important SIDS risks such as smoking, alcohol consumption, sofa-sharing and solitary sleep. These differences may explain the lower rate of SIDS in this population.
SIDS  peer-reviewed  research  correlation  ethnicity  Asian  immigrants  culture  protective  factors  Hispanic  co-sleeping  Pakistan  South  SUID  infant  mortality  evidence  human 
february 2019 by Michael.Massing
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