Michael.Massing + type   397

Early predictors of metabolic syndrome in healthy 7-9 year-olds identified -- ScienceDaily
Markers that may precede the metabolic syndrome and mechanisms that explain these relationships have yet to be identified. These mechanisms may originate in the intrauterine environment, be exacerbated in susceptible populations, such as African Americans and, be further promoted by a genetic predisposition, particularly among African American children. These abnormalities may work synergistically to create a childhood metabolic syndrome phenotype and may originate earlier in youth than previously proposed.

The purpose of the study was to explore potential correlates of insulin sensitivity, fasting insulin, and insulin resistance, and to determine the best model to predict them in young children. The study of more than 100 healthy children, ages 7-9, found that fat in the liver, abdominal fat, and fat oxidation predicted insulin resistance and appear to be early markers for the metabolic syndrome via a mechanism of impaired lipid metabolism and fat oxidation. Impaired metabolic function may be due, in part, to pre-and post natal factors that are modified by current physical activity. Therefore, race, low or high pregnancy weight and/or birth weight, and low physical activity collectively create a phenotype for poor metabolic function leading to increased risk for insulin resistance in young children.

"Although some of the risk factors cannot be changed, pregnancy weight, birth weight, and physical activity can all be modified and are targets for early intervention to prevent or delay insulin resistance and reduce the risk for metabolic syndrome," noted Dr. Sothern, who is the study's principal investigator.
low  birth  weight  risk  metabolic  syndrome  lipids  fats  blood  cholesterol  skeletal  fat  fatty  liver  epigenetic  insulin  resistance  child  development  children  youth  health  disparities  diabetes  teen  diet  body  disorder  etiology  T2D  research  correlation  type  2  factor  public  genetics  genetic  biomarkers  prognosis  diagnosis  screening  in  vivo  human  clinical  trial  prognostic  leg  prenatal  perinatal  breast  feeding  childhood  cause 
9 weeks ago by Michael.Massing
Insulin resistance/poor insulin sensitivity is closely associated with increased total body fat and may precede development of the metabolic syndrome and type 2 diabetes. Indicators of impaired insulin sensitivity have yet to be clearly identified in children prior to puberty.

The LSUHSC researchers found that the child’s current fat weight is the strongest predictor for poor insulin sensitivity which is a risk factor for type 2 diabetes. LDL (bad cholesterol) was also strongly associated with insulin sensitivity in the prediction model. Previously unidentified Metabolic Syndrome markers discovered by Dr. Sothern’s team include:

• Fat in the liver cells and fat in the skeletal (leg) muscle cells also predict poor insulin sensitivity and high insulin resistance (pre-diabetes) along with an impaired fat burning ability in the muscles.

• These relationships were only found after the researchers considered the child's current fat weight, so the strongest predictor is whether or not these young children are currently overweight or obese.

• The fat in the skeletal muscle became less important after Dr. Sothern’s team considered the mother’s weight prior to and during pregnancy, whether the child was breast-fed, and the current physical activity level of these young children.

“This means that if the mother has a healthy weight gain during pregnancy and the child is breast-fed and physically active, the fat may not accumulate in the skeletal muscle and/or liver and the child may not experience an impaired fat burning ability in the muscle. All of these factors are significantly associated with poor insulin sensitivity that may eventually lead to type 2 diabetes in adolescence or young adulthood. We hope to conduct future prospective studies in this cohort of healthy children to confirm this finding,” notes Dr. Melinda Sothern, LSU Health Sciences Center New Orleans Professor of Public Health and study leader.

Collectively, fat oxidation (how well the body is able to utilize fat as a fuel), blood pressure, and lipids (HDL and LDL) were identified as the best physiologic predictors of insulin sensitivity.

Arlette Soros, MD, an LSUHSC Pediatrics fellow who is a member of Dr. Sothern’s research team, is presenting results of the first study to examine why some children become hypoglycemic (low blood sugar) during insulin sensitivity testing. She will report that children who are lean and have less fat in their skeletal muscle are more likely to get hypoglycemia. Also those with the best insulin sensitivity were the most likely to get low blood sugar.

“We are not sure why this is but think they may be more fit and less prone to diabetes,” concludes Dr. Sothern.
American Diabetes Association 2009 Annual Scientific Session Meeting in New Orleans. Dr. Sothern’s group is the first to document previously unknown markers for obesity, heart disease and diabetes, collectively called the Metabolic Syndrome, in children [ages 7–9]. Posters will be presented on Saturday, June 6, 2009, and Brian Bennett, a Research Associate in Dr. Melinda Sothern’s laboratory will make the oral presentation, Early Markers for the Metabolic Syndrome in Youth, on Monday, June 8, 2009.
low  birth  weight  risk  metabolic  syndrome  lipids  fats  blood  cholesterol  skeletal  fat  fatty  liver  epigenetic  insulin  resistance  child  development  children  youth  health  disparities  diabetes  teen  diet  body  disorder  etiology  T2D  research  correlation  type  2  factor  public  genetics  genetic  biomarkers  prognosis  diagnosis  screening  in  vivo  human  clinical  trial  prognostic  leg  prenatal  perinatal  breast  feeding  cause 
10 weeks ago 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
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).
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
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.

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.

Prospective, observational study.

Academic health center.

Adult patients with type 2 diabetes mellitus.

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

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

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.
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%.
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.
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.
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%]).
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).


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
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
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
Found it! And more on adult onset/presentation/diagnosis of type 1 diabetes
T1D  dsma  onset  presentation  incidence  diagnosis  type  1  diabetes  demographics  epidemiology  from twitter
june 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
Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. - PubMed - NCBI
The nature of carbohydrate is of considerable importance when recommending diets intended to reduce the risk of type II diabetes and cardiovascular disease and in the treatment of patients who already have established diseases. Intact fruits, vegetables, legumes and wholegrains are the most appropriate sources of carbohydrate. Most are rich in nonstarch polysaccharides (NSPs) (dietary fibre) and other potentially cardioprotective components. Many of these foods, especially those that are high in dietary fibre, will reduce total and low-density lipoprotein cholesterol and help to improve glycaemic control in those with diabetes. There is no good long-term evidence of benefit when NSPs or other components of wholegrains, fruits, vegetables and legumes are added to functional and manufactured foods. Frequent consumption of low glycaemic index foods has been reported to confer similar benefits, but it is not clear whether such benefits are independent of the dietary fibre content of these foods or the fact that low glycaemic index foods tend to have intact plant cell walls. Furthermore, it is uncertain whether functional and manufactured foods with a low glycaemic index confer the same long-term benefits as low glycaemic index plant-based foods. A wide range of carbohydrate intake is acceptable, provided the nature of carbohydrate is appropriate. Failure to emphasize the need for carbohydrate to be derived principally from wholegrain cereals, fruits, vegetables and legumes may result in increased lipoprotein-mediated risk of cardiovascular disease, especially in overweight and obese individuals who are insulin resistant.
risk  benefit  industrialized  processed  lipids  vegetables  cardiovascular  blood  whole  grain  fruit  carbohydrate  legumes  glucose  peer-reviewed  research  response  insulin  fiber  comparison  overview  correlation  type  2  T2D  effect  diet  epidemiology  etiology  self  care  management  long  term  short  soluble  insoluble  metabolism  prevention  intact  integrity  diabetes  cause  factor 
september 2017 by Michael.Massing
Cereal grains, legumes and diabetes. - PubMed - NCBI
Epidemiological studies strongly support the suggestion that high intakes of whole grain foods protect against the development of type II diabetes mellitus (T2DM). People who consume approximately 3 servings per day of whole grain foods are less likely to develop T2DM than low consumers (<3 servings per week) with a risk reduction in the order of 20-30%. The role of legumes in the prevention of diabetes is less clear, possibly because of the relatively low intake of leguminous foods in the populations studied. However, legumes share several qualities with whole grains of potential benefit to glycaemic control including slow release carbohydrate and a high fibre content. A substantial increase in dietary intake of legumes as replacement food for more rapidly digested carbohydrate might therefore be expected to improve glycaemic control and thus reduce incident diabetes. This is consistent with the results of dietary intervention studies that have found improvements in glycaemic control after increasing the dietary intake of whole grain foods, legumes, vegetables and fruit. The benefit has been attributed to an increase in soluble fibre intake. However, prospective studies have found that soluble fibre intake is not associated with a lower incidence of T2DM. On the contrary, it is cereal fibre that is largely insoluble that is associated with a reduced risk of developing T2DM. Despite this, the addition of wheat bran to the diets of diabetic people has not improved indicators of glycaemic control. These apparently contradictory findings might be explained by metabolic studies that have indicated improvement in glucose handling is associated with the intact structure of food. For both grains and legumes, fine grinding disrupts cell structures and renders starch more readily accessible for digestion. The extent to which the intact structure of grains and legumes or the composition of foods in terms of dietary fibre and other constituents contribute to the beneficial effect remains to be quantified. Other mechanisms to help explain improvements in glycaemic control when consuming whole grains and legumes relate to cooking, type of starch, satiety and nutrient retention. Thus, there is strong evidence to suggest that eating a variety of whole grain foods and legumes is beneficial in the prevention and management of diabetes. This is compatible with advice from around the world that recommends consumption of a wide range of carbohydrate foods from cereals, vegetables, legumes and fruits both for the general population and for people with diabetes.
breakfast  blood  whole  grain  lsgumes  glucose  peer-reviewed  research  response  insulin  fiber  comparison  review  overview  correlation  type  2  T2D  effect  diet  epidemiology  etiology  self  care  management  long  term  short  soluble  insoluble  metabolism  prevention  diabetes  cause  factor  risk 
september 2017 by Michael.Massing
The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism. - PubMed - NCBI
Findings from epidemiologic studies indicate that there are associations between breakfast consumption and a lower risk of type 2 diabetes mellitus (T2DM) and metabolic syndrome, prompting interest in the influence of breakfast on carbohydrate metabolism and indicators of T2DM risk. The objective of this review was to summarize the available evidence from randomized controlled trials assessing the impact of breakfast on variables related to carbohydrate metabolism and metabolic wellness. Consuming compared with skipping breakfast appeared to improve glucose and insulin responses throughout the day. Breakfast composition may also be important. Dietary patterns high in rapidly available carbohydrate were associated with elevated T2DM risk. Therefore, partial replacement of rapidly available carbohydrate with other dietary components, such as whole grains and cereal fibers, proteins, and unsaturated fatty acids (UFAs), at breakfast may be a useful strategy for producing favorable metabolic outcomes. Consumption of fermentable and viscous dietary fibers at breakfast lowers glycemia and insulinemia. Fermentable fibers likely act through enhancing insulin sensitivity later in the day, and viscous fibers have an acute effect to slow the rate of carbohydrate absorption. Partially substituting protein for rapidly available carbohydrate enhances satiety and diet-induced thermogenesis, and also favorably affects lipoprotein lipids and blood pressure. Partially substituting UFA for carbohydrate has been associated with improved insulin sensitivity, lipoprotein lipids, and blood pressure. Overall, the available evidence suggests that consuming breakfast foods high in whole grains and cereal fiber, while limiting rapidly available carbohydrate, is a promising strategy for metabolic health promotion.
carbohydate  protein  breakfast  blood  whole  grain  unsaturated  fatty  acids  lipids  UFA  glucose  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  type  2  T2D  effect  diet  self  care  management  long  term  short  viscous  soluble  fermentable  insoluble  metabolism  risk  reduction  harm  prevention  diabetes  metabolic  syndrome 
september 2017 by Michael.Massing
Effects of whole grain rye, with and without resistant starch type 2 supplementation, on glucose tolerance, gut hormones, inflammation and appetite... - PubMed - NCBI
Whole grain has shown potential to lower the risk of obesity, cardiovascular disease and type 2 diabetes. One possible mechanism behind the benefits of whole grain is the gut fermentation of dietary fiber (DF), e.g. non-starch polysaccharides and resistant starch (RS), in whole grain. The purpose of the study is to investigate the effect of whole grain rye-based products on glucose- and appetite regulation.
Twenty-one healthy subjects were provided four rye-based evening test meals in a crossover overnight study design. The test evening meals consisted of either whole grain rye flour bread (RFB) or a 1:1 ratio of whole grain rye flour and rye kernels bread (RFB/RKB), with or without added resistant starch (+RS). White wheat flour bread (WWB) was used as reference evening meal. Blood glucose, insulin, PYY, FFA, IL-6 as well as breath H2 and subjective rating of appetite were measured the following morning at fasting and repeatedly up to 3.5 h after a standardized breakfast consisting of WWB. Ad libitum energy intake was determined at lunch, 14.5 h after evening test and reference meals, respectively.
The evening meal with RFB/RKB + RS decreased postprandial glucose- and insulin responses (iAUC) (P < 0.05) and increased the gut hormone PYY in plasma the following morning 0-120 min after the standardized breakfast, compared to WWB (P = 0.01). Moreover, RFB increased subjective satiety and decreased desire to eat, and both RFB and RFB/RKB decreased feeling of hunger (AUC 0-210 min). All rye-based evening meals decreased or tended to decrease fasting FFA (P < 0.05, RFB/RKB: P = 0.057) and increased breath hydrogen concentration (0-120 min, P < 0.001). No effects were noted on energy intake at lunch or inflammatory marker IL-6 (0 + 180 min) after the rye-based evening meals, compared to WWB.
Whole grain rye bread has the potential to improve cardiometabolic variables in an 11-14.5 h perspective in healthy humans. The combination RFB/RKB + RS positively affected biomarkers of glucose- and appetite regulation in a semi-acute perspective. Meanwhile, RFB and RFB/RKB improved subjective appetite ratings. The effects probably emanate from gut fermentation events.
blood  whole  grain  rye  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  comparison  type  2  T2D  second-meal  phenomenon  effect  diet  self  care  management 
september 2017 by Michael.Massing
Effect of cereal test breakfasts differing in glycemic index and content of indigestible carbohydrates on daylong glucose tolerance in healthy subj... - PubMed - NCBI
Frequent hyperglycemic episodes are increasingly being associated with an increased risk of type 2 diabetes and cardiovascular disease.
We studied the extent to which acute glycemia and glycemia after subsequent meals can be modulated by the characteristics of cereal foods, such as glycemic index (GI) and content of indigestible carbohydrates.
Twelve healthy subjects consumed test meals in a random order. In series 1, the test meals were consumed at breakfast, and postprandial blood glucose incremental areas under the curve (IAUCs) were calculated after the test breakfast, standardized lunch, and standardized dinner. In series 2, the subjects consumed test evening meals and IAUCs were calculated after a subsequent standardized breakfast. Breath hydrogen was measured as an indicator of colonic fermentation.
Barley or rye kernel breakfasts lowered the blood glucose IAUC (0-120 min) at breakfast, at a subsequent lunch, and the cumulative IAUCs (breakfast+lunch+dinner) when compared with white-wheat bread (P < 0.05). The lunch blood glucose IAUCs were positively correlated with breakfast IAUCs (r = 0.30, P < 0.05). Breath hydrogen excretion was negatively correlated with blood glucose IAUCs after lunch (r = -0.33, P < 0.05) and dinner (r = -0.22, P < 0.05). A barley kernel evening meal resulted in lower IAUCs (P < 0.05) and higher breath hydrogen (P < 0.001) after a subsequent breakfast compared with white-wheat bread.
Glucose tolerance at subsequent meals can be notably improved during the course of a whole day or overnight by choosing specific low-GI, whole-grain cereal products. A low GI may be sufficient to achieve a second-meal effect from breakfast to lunch. A specific indigestible carbohydrate mixture appears to be required to show benefits on glucose tolerance in a longer time frame (9.5 h), most likely mediated through colonic fermentation.
breakfast  blood  barley  rye  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  comparison  type  2  T2D  second-meal  phenomenon  effect  diet  self  care  management 
september 2017 by Michael.Massing
Matching Meals to Body Clocks—Impact on Weight and Glucose Metabolism
The prevalence of type 2 diabetes continues to rise worldwide and is reaching pandemic proportions. The notion that this is due to obesity, resulting from excessive energy consumption and reduced physical activity, is overly simplistic. Circadian de-synchrony, which occurs when physiological processes are at odds with timing imposed by internal clocks, also promotes obesity and impairs glucose tolerance in mouse models, and is a feature of modern human lifestyles. The purpose of this review is to highlight what is known about glucose metabolism in animal and human models of circadian de-synchrony and examine the evidence as to whether shifts in meal timing contribute to impairments in glucose metabolism, gut hormone secretion and the risk of type 2 diabetes. Lastly, we examine whether restricting food intake to discrete time periods, will prevent or reverse abnormalities in glucose metabolism with the view to improving metabolic health in shift workers and in those more generally at risk of chronic diseases such as type 2 diabetes and cardiovascular disease....

There is a general belief that consumption of more energy throughout the day is preferable to evening consumption. Few studies have examined this prospectively in humans, or for any length of time. Nonetheless, time restricted feeding has shown promise as a tool to mitigate the metabolic sequelae of diet induced obesity in mouse models. Good quality evidence for TRF as a dietary approach to improve glucose control in humans is lacking. Controlled trials are necessary, and must determine if there is adaptation in the approach, whilst keeping in mind the practicality of translating this approach into the community.
opblood  protein  glucose  metabolism  peer-reviewed  research  response  insulin  meal  timing  in  vivo  animal  correlation  comparison  type  2  T2D  circadian  rhythms  social  factor  environmental  etiology  risk  shift  work  obesity  body  fat  diabetes  cause 
september 2017 by Michael.Massing
Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. - PubMed - NCBI
The choice of carbohydrate-rich foods in the habitual diet should take into account not only their chemical composition but also their ability to influence postprandial glycemia (glycemic index). _Fiber-rich foods generally have a low glycemic index (GI), although not all foods with a low GI necessarily have high fiber content._ Several beneficial effects of low-GI, high-fiber diets have been shown, including lower postprandial glucose and insulin responses, an improved lipid profile, and, possibly, reduced insulin resistance. In nondiabetic persons, suggestive evidence is available from epidemiologic studies that a diet based on carbohydrate-rich foods with a low-GI, high-fiber content may protect against diabetes or cardiovascular disease. However, no intervention studies have so far evaluated the potential of low-GI, high-fiber diets to reduce the risk of diabetes, although in studies aimed at diabetes prevention by lifestyle modifications, an increase in fiber consumption was often part of the intervention. In relation to prevention of cardiovascular disease, intervention studies evaluating the effect of a low-GI diet on clinical events are not available; moreover, the results of the few available intervention studies evaluating the effects of GI on the cardiovascular disease risk factor profile are not always concordant. The best evidence of the clinical usefulness of GI is available in diabetic patients in whom low-GI foods have consistently shown beneficial effects on blood glucose control in both the short-term and the long-term. In these patients, low-GI foods are suitable as carbohydrate-rich choices, provided other attributes of the foods are appropriate.
breakfast  blood  protein  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  comparison  prediabetes  type  2  T2D  load 
september 2017 by Michael.Massing
Targeting glucose metabolism for healthy aging. - PubMed - NCBI
Advancing age is the greatest single risk factor for numerous chronic diseases. Thus, the ability to target the aging process can facilitate improved healthspan and potentially lifespan. Lack of adequate glucoregulatory control remains a recurrent theme accompanying aging and chronic disease, while numerous longevity interventions result in maintenance of glucoregulatory control. In this review, we propose targeting glucose metabolism to enhance regulatory control as a means to ameliorate the aging process. We highlight that calorie restriction improves glucoregulatory control and extends both lifespan and healthspan in model organisms, but we also indicate more practical interventions (i.e., calorie restriction mimetics) are desirable for clinical application in humans. Of the calorie restriction mimetics being investigated, we focus on the type 2 diabetes drug acarbose, an α-glucosidase inhibitor that when taken with a meal, results in reduced enzymatic degradation and absorption of glucose from complex carbohydrates. We discuss alternatives to acarbose that yield similar physiologic effects and describe dietary sources (e.g., sweet potatoes, legumes, and berries) of bioactive compounds with α-glucosidase inhibitory activity. We indicate future research should include exploration of how non-caloric compounds like α-glucosidase inhibitors modify macronutrient metabolism prior to disease onset, which may guide nutritional/lifestyle interventions to support health and reduce age-related disease risk.

[Note mention of metformin in graphical abstract.]
hyperglycemia  diabetes  type  2  T2D  blood  glucose  diet  foods  legumes  berries  sweet  potatoes  SMBG  self  care  risk  cardiovascular  kidney  neuropathy  nephropathy  chronic  disease  progression  aging  caloric  calorie  restriction  acarbose  metformin  peak  excursion  spike  peer-reviewed  research 
september 2017 by Michael.Massing
Postprandial glucose regulation: new data and new implications. - PubMed - NCBI
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) to guide management.
The objectives of this article are to review current data on postprandial hyperglycemia and to assess whether, and how, management of type 2 diabetes should change to reflect new clinical findings.
Articles were selected from MEDLINE searches (key words: postprandial glucose, postprandial hyperglycemia, and cardiovascular disease) and from our personal reference files, with emphasis on the contribution of postprandial hyperglycemia to overall glycemic load or cardiovascular (CV) risk.
About 33% of people diagnosed as having type 2 diabetes based on postprandial hyperglycemia have normal FPG. PPG contributes > or =70% to the total glycemic load in patients who are fairly well controlled (HbA1c <7.3%). Furthermore, there is a linear relationship between the risk of CV death and the 2-hour oral glucose tolerance test (OGTT). Increased mortality is evident at OGTT levels of approximately 90 mg/dL (5 mmol/L), which is well below current definitions of type 2 diabetes. Biphasic insulin aspart was shown to be more effective at reducing HbA1c below currently recommended levels than basal insulin glargine (66% vs 40%; P < 0.001), and it reduced endothelial dysfunction more effectively than regular insulin (P < 0.01). Repaglinide achieved regression of carotid atherosclerosis (intima-media thickness) in 52% of patients versus 18% for glyburide (P < 0.01) over 1 year, although levels of HbA1c and CV risk factors were similar for both treatment groups. Finally, acarbose reduced the relative risk of CV events by 49% over 3.3 years versus placebo in patients with impaired glucose tolerance (2.2% vs 4.7%; P = 0.03) and by 35% over > or =1 year in patients with type 2 diabetes (9.4% vs 6.1%; P = 0.006).
All components of the glucose triad (ie, FPG, HbA1c, and PPG) should be considered in the management of type 2 diabetes. Therapy targeted at PPG has been shown to improve glucose control and to reduce the progression of atherosclerosis and CV events; therefore, physicians should consider monitoring and targeting PPG, as well as HbA1c and FPG, in patients with type 2 diabetes.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  morbidity  mortality  threshold  peer-reviewed  research  prognostic 
september 2017 by Michael.Massing
Postprandial hyperglycaemia: noxious effects on the vessel wall. - PubMed - NCBI
In recent years postchallenge or postprandial hyperglycaemia has been found to be an independent risk factor for cardiovascular comorbidities and all-cause mortality in impaired glucose tolerance (IGT) and type 2 diabetes. With the database of the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) study, it was also shown that atherosclerosis as measured by intima-media thickness of the common carotid arteries was associated with 2-hour postchallenge glucose level when HbA1c was normal. Taken together there are now comprehensive and consistent data from pathophysiological as well as epidemiological studies that excessive post-load glucose excursions have acute and chronic harmful effects on the endothelium and vessel wall. This is supported by four outcome studies that included control of postprandial glucose to prevent cardiovascular disease: Diabetes Intervention Study (DIS), Kumamoto study, DIGAMI study, and STOP-NIDDM trial. Therefore, in addition to HbA1c and fasting blood glucose, postprandial glucose monitoring should be an integral part of treatment to prevent acute and chronic complications.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  peer-reviewed  research 
september 2017 by Michael.Massing
Postprandial peaks as a risk factor for cardiovascular disease: epidemiological perspectives. - PubMed - NCBI
A key issue in diabetes care is selecting glucose parameters to monitor and control. The recommendations of the American Diabetes Association for glycaemic control do not address postprandial glucose (PPG), but patients with type 2 diabetes experience wide variations in glucose levels after meals. We have observed a remarkable increase in plasma glucose two hours after breakfast and/or lunch in most non-insulin-treated patients; for up to 40% of them the increase is >40 mg/dl (2.2 mmol/l). As many as 70% of patients with an HbA1c <7% have PPG values >160 mg/dl (8.9 mmol/l) after meals. Fasting plasma glucose (FPG) is a poor indicator of plasma glucose at other times. The coefficient of correlation of FPG with plasma glucose at other times ranges from 0.50-0.70. Nor is the correlation of FPG with HbA1c very strong: in hundreds of determinations of HbA1c and FPG in our patients, the coefficient of correlation was not greater than 0.73. For the same FPG value, HbA1c varied markedly, and vice versa; further, the correlation between PPG and HbA1c was no higher than that between FPG and HbA1c (r = 0.65). Thus, monitoring in type 2 diabetes should include PPG along with FPG and HbA1c. Recent data provide direct and indirect evidence suggesting that PPG is independently related to cardiovascular disease (CVD), and supporting the idea that PPG should be assessed and glucose excursions with meals should be controlled: 1. Studies conducted by other investigators and ourselves in patients with type 2 diabetes have shown that the incidence of CVD is independently related to postprandial or post-OGTT (oral glucose tolerance test) blood glucose at baseline. In addition, data collected in the general population show an association between 2-hour OGTT plasma glucose (a surrogate of PPG) and cardiovascular morbidity and mortality that is independent of FPG. Also, subjects with impaired glucose tolerance (IGT) and isolated post-challenge hyperglycaemia have an increased cardiovascular risk over subjects with normal glucose tolerance (NGT). We found that IGT subjects had a risk of carotid stenosis 3-fold higher than subjects with NGT, even after adjustment for several confounders. Thus, a modest increase in post-OGTT plasma glucose and, by extrapolation, PPG seems to have a major detrimental effect on the arteries. 2. When FPG and/or HbA1c were the targets of glucose control in studies of patients with type 2 diabetes (the UGDP, VACSDM, and UKPDS) the effects on CVD were minimal. However, when the targets of glucose control included PPG (the Kumamoto Study and DIGAMI Study) favorable effects on CVD were observed. 3. There is experimental data suggesting that acute hyperglycaemia can exert deleterious effects on the arterial wall through mechanisms including oxidative stress, endothelial dysfunction, and activation of the coagulation cascade. This evidence prompted the European Diabetes Policy Group to set postprandial targets for blood glucose control: postprandial peaks should not exceed 135 mg/dl (7.5 mmol/ml) to reduce arterial risk and should not exceed 160 mg/dl (8.9 mmol/l) to reduce microvascular risk. Thus, glucose care in diabetes is not only "fasting glucose care" or "HbA1c care" but is also "postprandial glucose care."
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  peer-reviewed  research 
september 2017 by Michael.Massing
Peak-time determination of post-meal glucose excursions in insulin-treated diabetic patients. - PubMed - NCBI
The mean peak time after breakfast was 72+/-23 min, which was reached in less than 90 min in 80% of the patients. The apparent glucose rate of increase from pre-meal to the maximum postprandial value was 1.23+/-0.76 mg/dL/min, while the glucose rate of decrease was 0.82+/-0.70 mg/dL/min. Peak time correlated with the amplitude of postprandial excursions, but not with the peak glucose value. Also, peak times were similar after breakfast, lunch and dinner, and in type 1 and type 2 diabetic patients.
To best assess peak postprandial glucose levels, the optimal time for blood glucose monitoring is about 1h and 15 min after the start of the meal, albeit with wide interpatient variability. Nevertheless, 80% of post-meal blood glucose peaks were observed at less than 90 min after the start of the meal.
hyperglycemia  diabetes  type  2  a  T1D  T2D  blood  glucose  postprandial  spike  peak  rhythm  meal  SMBG  timing  insulin  dependent  excursion  peer-reviewed  research 
september 2017 by Michael.Massing
Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes. - PubMed - NCBI
We investigated the effect of carbohydrate distribution on postprandial glucose peaks with continuous blood glucose monitoring (CGMS), when consuming a moderate carbohydrate diet in energy balance in subjects with type 2 diabetes.
Twenty-three subjects with type 2 diabetes were randomly assigned to each of four 3-d interventions in a crossover design with a 4-d washout period. Identical foods were provided for each treatment with a ratio of total carbohydrate to protein to fat of 40%:34%:26% but differing in carbohydrate content at each meal: even distribution (CARB-E; approximately 70 g carbohydrate), breakfast (CARB-B), lunch (CARB-L), and dinner(CARB-D), each providing approximately 125 g carbohydrate in the loaded meal in a 9-MJ diet. Glucose concentrations were continuously measured with CGMS. Outcomes were assessed by postprandial peak glucose (G(max)), time spent > 12 mmol/L (T > 12), and total area under the glucose curve (AUC(20)).
Daily G(max) differed between treatments (P = 0.003) with CARB-L (14.2 +/- 1.0 mmol/L), CARB-E (14.5 +/- 0.9 mmol/L), and CARB-D (14.6 +/- 0.8 mmol/L) being similar but lower than CARB-B (16.5 +/- 0.8 mmol/L). Meal G(max) was weakly related to carbohydrate amount and glycemic load (r = 0.40-0.44). T > 12 differed between treatments (P = 0.014), and a treatment x fasting blood glucose (FBG) interaction (P = 0.003) was observed with CARB-L (184 +/- 74 min) < CARB-B (190 +/- 49 min) < CARB-D (234 +/- 87 min) < CARB-E (262 +/- 91 min). Total AUC(20) was not significantly different between treatments. After adjustment for FBG, treatment became significant (P = 0.006); CARB-L (10 049 +/- 718 mmol/L x 20 h) < CARB-E (10 493 +/- 706 mmol/L x 20 h) < CARB-B (10 603 +/- 642 mmol/L x 20 h) < CARB-D (10 717 +/- 638 mmol/L x 20 h).
CARB-E did not optimize blood glucose control as assessed by postprandial peaks, whereas CARB-L provided the most favorable postprandial profile.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  rhythm  meal  excursion  peer-reviewed  research 
september 2017 by Michael.Massing
State by state, diabetes prevalence—overwhelmingly type 2—and household income
State by state, diabetes prevalence—overwhelmingly type 2—and household income: disease of affluence & indulgence,…
diabetes  etiology  risk  factor  correlation  mapping  poverty  data  type  2  T2D  public  health  epidemiology  diet  cause  from twitter
may 2017 by Michael.Massing
Low Carb Diet for Diabetes
Richard K. Bernstein, MD, is a well-known advocate of carbohydrate restriction. Diagnosed with Type 1 diabetes in 1946 at age 12, he developed a very-low-carbohydrate diet in the early 1970s after years of struggling with large blood glucose fluctuations, vision problems, early kidney disease, and pain from neuropathy (nerve damage). He found that by consuming 30 grams of carbohydrate per day — 6 grams for breakfast and 12 grams each for lunch and dinner — and consequently needing only small amounts of insulin to “cover” such small amounts of carbohydrate, his blood glucose could kept in the normal range.

Dr. Bernstein has continued to follow this regimen for the past 40 years and prescribes it to the patients he treats with both Type 1 and Type 2 diabetes at his practice in New York City. In his book Dr. Bernstein’s Diabetes Solution, he writes, “If the kinds of foods you’re eating give you consistently unpredictable blood glucose levels, then it will be impossible to normalize blood sugars.” To prevent such unpredictability, Dr. Bernstein recommends that dietary carbohydrate come only from nonstarchy vegetables, nuts, and other slow-digesting carbohydrate sources.

Steven Parker, MD, is the author of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet and owner of the Diabetic Mediterranean Diet website (http://diabeticmediterraneandiet.com). Both the book and website provide low-carbohydrate and ketogenic versions of the traditional Mediterranean diet. Parker’s low-carbohydrate version contains 60–100 grams of carbohydrate per day, and his ketogenic version 20–40 grams. The ketogenic version is so named because while some people develop higher blood ketone levels with a “regular” low-carbohydrate diet, many people need to keep their carbohydrate intake under 50 grams per day to see higher ketone levels.

Dr. Parker does not treat people with diabetes on an outpatient basis, but he discusses low-carbohydrate eating plans with the patients he encounters in his job as a hospitalist in Scottsdale, Arizona. He believes carbohydrate restriction can play a valuable role in blood glucose control. And although he recognizes the effectiveness of Dr. Bernstein’s plan, Dr. Parker recommends 60&ndahs;80 grams of net carbohydrate per day for long-term management because he feels it is more acceptable and easier to maintain. (Parker defines net carbohydrate as total carbohydrate minus grams of fiber.)

Helen Hilts, MD, has been prescribing a low-carbohydrate diet to her patients with diabetes for several years. She is the medical director of the DiabeVita medical practice in Scottsdale, Arizona. After being diagnosed with Type 2 diabetes nine years ago, she began following a very-low-carbohydrate diet based on her own research as well as a mentorship with Dr. Bernstein.

“I have a few hundred patients who have followed a very-low-carbohydrate diet for at least two years,” she says. “I recommend no more than 30–45 grams of carbs a day, and those only come in low-carbohydrate vegetables, Greek yogurt, nuts, small portions of berries or tomatoes, etc. No roots, fruits, grains, or liquid milk.” Dr. Hilts follows the same eating plan and maintains an A1C under 5% without medication.

“I see more doctors and diabetes educators reluctantly accepting very-low-carb as viable because they have seen such good results in their patients,” she says, noting that cardiologists seem to accept carbohydrate restriction faster than endocrinologists. “They understand carbohydrates’ effects on insulin resistance, hyperinsulinemia, lipids, and the metabolic syndrome.”

After being diagnosed with Type 1 diabetes in 1998, Keith Runyan, MD, had a difficult time controlling his blood glucose levels on the low-fat diet he was advised to follow. While preparing for his first Ironman triathlon in 2011, he began researching dietary strategies to keep his blood glucose stable for long periods. By February 2012, he had devised the very-low-carbohydrate, high-fat, whole-foods–based diet that he continues following today. Dr. Runyan says that he no longer has large blood glucose fluctuations and that hypoglycemia is now a very rare occurrence for him. In addition, he reports having better energy levels during endurance exercise, as well as overall. He recommends this way of eating for the patients with diabetes, obesity, and kidney disease seen in his St. Petersburg, Florida, medical office.
low  carb  carbohydrate  diet  type  1  2  diabetes  T1D  T2D  mellitus  mealplanning  restriction  science  history  guidelines 
march 2017 by Michael.Massing
Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating. - PubMed - NCBI
Dietary chromium supplementation for the treatment of diabetes remains controversial. The prevailing view that chromium supplementation for glucose regulation is unjustified has been based upon prior studies showing mixed, modest-sized effects in patients with type 2 diabetes (T2DM). Based on chromium's potential to improve insulin, dopamine, and serotonin function, we hypothesize that chromium has a greater glucoregulatory effect in individuals who have concurrent disturbances in dopamine and serotonin function--that is, complex patients with comorbid diabetes, depression, and binge eating. We propose, as suggested by the collective data to date, the need to go beyond the "one size fits all" approach to chromium supplementation and put forth a series of experiments designed to link physiological and neurobehavioral processes in the chromium response phenotype.
chromium  picolinate  comorbidity  depression  T2D  type  2  diabetes  individual  response  variability  treatment  intervention  psychotropic  appetite  carbohydrate  craving  peer-reviewed  research  Plexus  opinion  overview 
march 2017 by Michael.Massing
FDA lets Lilly cite Jardiance heart data, shares jump | Reuters
At the time of approval [of Lilly's SGLT2 inhibitor Jardiance] the FDA asked that a separate trial be conducted to show the drug did not increase the risk of cardiovascular problems.

The study instead unexpectedly showed Jardiance slashed deaths by 32 percent in patients with type 2 diabetes at risk of heart attack and stroke, when added to standard diabetes medications.

It was the first time any diabetes drug was shown to reduce risk of cardiovascular death. Moreover, patients taking Jardiance had a 35 percent lower rate of hospitalization for heart failure. That information can now be included on the drug's label.

[Other SGLT2 inhibitors] include Johnson & Johnson's $1.3 billion-a-year Invokana and AstraZeneca Plc's Farxiga.

[Per @MarkHamel, Victoza has similar data.]
drug  effects  benefit  treatment  diabetes  type  2  T2D  cardiovascular  heart  risk  morbidity  mortality  dcde 
december 2016 by Michael.Massing
Half of All Type 1 Diabetes Develops After 30 Years of Age
MUNICH — Onset of type 1 diabetes is just as likely to occur in people older than 30 years of age as in those younger, new research shows.

The data were presented September 16, 2016, here at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting by Dr Nicholas JM Thomas, of the Institute of Biomedical and Clinical Science, University of Exeter Medical School, United Kingdom.

Obtained using genetic data from the UK Biobank, the startling results refute the long-held belief that type 1 diabetes is primarily a "juvenile" condition.

Clinically, the findings are particularly relevant for primary care, where people who develop autoimmune-mediated diabetes in adulthood are often misdiagnosed as having type 2 and prescribed metformin instead of insulin.

"I think it's an eye-opener and obviously has implications for how we diagnose and manage people and also the education people receive. We very much focus on childhood and adolescence and perhaps people diagnosed later don't get the same education," Dr Thomas told Medscape Medical News in an interview.

Still, identifying these individuals in primary care is challenging for a number of reasons: The vast majority of older adults with new-onset diabetes have type 2 diabetes, and antibody tests to identify autoimmune-mediated diabetes are too expensive for routine use. Moreover, overweight/obesity is nearly universal in type 2 but also common in type 1 diabetes....

[Dr Thomas] advised that clinicians should at least be aware that adults can develop autoimmune diabetes, as either classic type 1 or the slower-onset phenomenon known as "latent autoimmune diabetes of adulthood (LADA)."
incidence  presentation  diagnosis  misdiagnosis  type  1  LADA  diabetes  demographics  population  study  research  EASD  adult  onset  age  T!D  genetic  risk  genetics 
october 2016 by Michael.Massing
A Nutritional Biochemist Gives You His Top Diabe... | Diabetic Connect
The order of your meal and the composition of your meal influences how fast the carbohydrates in that meal are digested and enter your blood, raising your blood glucose. In both type 2 and type 1 diabetes, slower increases in blood glucose are easier to manage.

There is evidence that eating your salad or low-carbohydrate vegetables first can slow the digestion of carbohydrates afterward and that meals with protein, before or with the carbohydrates, can also slow the release of the glucose in the carbohydrates.

You may already know about the glycemic index (the relative ranking of how a carbohydrate affects blood glucose), but this concept can be extended to entire meals. Meals made up of low-glycemic carbohydrates will have a lower impact on blood glucose, but meals with higher glycemic index carbohydrates that are consumed with protein and low-carbohydrate vegetables can also slow the release of carbohydrates and decrease the effect on blood glucose.

So, want to help manage your blood glucose? Tip 3: Pick salad as your first course.
diet  meal  planning  eating  blood  glucose  management  glycemic  index  type  1  2  diabetes  T1D  T2D  sugars 
july 2016 by Michael.Massing
Diabetes Mystery: Why Are Type 1 Cases Surging? - Scientific American
For reasons that are completely mysterious, however, the incidence of type 1 diabetes has been increasing throughout the globe at rates that range from 3 to 5 percent a year. Although the second trend is less well publicized, it is still deeply troubling, because this form of the illness has the potential to disable or kill people so much earlier in their lives.
No one knows exactly why type 1 diabetes is rising. Solving that mystery—and, if possible, reducing or reversing the trend—has become an urgent problem for public health researchers everywhere. So far they feel they have only one solid clue.
“Increases such as the ones that have been reported cannot be explained by a change in genes in such a short period,” says Giu­seppina Imperatore, who leads a team of epidemiologists in the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention. “So environmental factors are probably major players in this increase.”
diabetes  type  1  T1D  etiology  data  surge  incidence  global  risk  factor  environment  environmental  cause 
june 2016 by Michael.Massing
New FDA Recommendations for Metformin
Patients who have an eGFR between 30 and 45 mL/min/1.73 m2 can continue to receive metformin or metformin-containing medications as long as there is an appropriate assessment of the risks and benefits of the therapy.

Of course everyone has been concerned about the risk for lactic acidosis with metformin (which is actually relatively rare), particularly in individuals with mild or moderate chronic kidney disease. What is not recommended as part of the new labeling is what some think is appropriate, which is a reduction in the dose of metformin by about 50% in those with an eGFR between 30 and 45 mL/min/1.73 m2.

The new labeling still indicates that metformin should not be used in patients who have an eGFR below 30 mL/min/1.73 m2, but it can be continued in those who start it while their eGFR is above 45 mL/min/1.73 m2. Interestingly enough, the new labeling doesn't recommend starting metformin in patients with an eGFR between 30 and 45 mL/min/1.73 m2. The label indicates that we should only start metformin at an eGFR above 45 mL/min/1.73 m2, continue it with assessment of the risks as it falls below 45 mL/min/1.73 m2, and then stop it altogether if and when the eGFR falls below 30 mL/min/1.73 m2.

There are other cautions about the use of contrast material and so forth that are not new. The good news from this—and I think it was a good move by the FDA—is that the new labeling will now allow access to metformin and metformin-containing medications to many people with diabetes who would benefit from this medication and were not able to receive it in a way that was consistent with the prior black box warning.
metformin  diabetes  treatment  guidelines  risk  benefit  FDA  creatinine  eGFR  prescription  type  2  T2D 
june 2016 by Michael.Massing
dLife Diabetes News - Diabetes | Type 1 Diabetes | Type 2 Diabetes - www.dlife.com
Previous research conducted by the same researchers at Lund University in 2009 showed a gene variant to melatonin receptor 1B increases risk for type 2 diabetes. The variant causes the level of the melatonin receptors in beta cells to increase, making them more sensitive to melatonin and stopping them from secreting insulin.
"A third of all people carry this specific gene variant," Hindrik Mulder, a professor at Lund University, said in a press release. "Our results show that the effect of melatonin is stronger in them. We believe that this explains their increased risk of developing type 2 diabetes."
For the study, researchers recruited 23 healthy carriers of the gene variant and 22 people without the variant, treating them with four milligrams of melatonin before bed for three months.
The researchers found insulin secretion was lower among participants with the genetic variation, and that blood glucose levels were higher among all participants after melatonin treatment -- but most significantly in those with the variation.
genetic  risk  etiology  factor  T2D  type  2  diabetes  melatonin  correlation  peer-reviewed  research  circadian  rhythms  hormone  drug  effects  contraindication  pancreas  insulin  beta  cells  light  body  clock  mutation  genetics  cause 
may 2016 by Michael.Massing
8 things I wish people understood about having Type 1 diabetes - Vox
RT @picardonhealth: "8 things I wish people understood about having Type I #diabetes" via @vo
type  1  diabetes  T1D 
may 2016 by Michael.Massing
The Carb-Sane Asylum: Blood Sugar 140: Context is Everything I - Diabetic vs. Non
I can think of nothing more harmful to health than the insulin phobia rampant in the LC community.  While the frank type 2 diabetic is baseline hyperinsulinemic, they don't produce the appropriate acute insulin response.  Given the health issues accompanying improper insulin/signaling, it seems a no-brainer that establishing  as normal a level of both insulin and glucose as possible....

Normal individuals eating a "normal" diet will regularly exceed 140 mg/dL, though not necessarily by much, to no apparent detriment. Neuropathy would simply be far more common in occur in younger populations if BG's over 140 damaged nerves to any significant level.

In a diabetic, however, not only do postprandial glucose levels climb higher, they tend to stay elevated for longer periods of time, thus if the hyperglycemia is toxic per se, the exposure is greater. The glucose levels also may never fall below, say, 100 or even far higher depending on the degree of glycemic control. Therefore it is not surprising that IGT or diabetes was diagnosed by OGTT in 2/3rds of subjects presenting with neuropathy in this study. I shall discuss the implications of that finding in a separate post as well.

In someone with impaired insulin secretion (T1 = none/insignificant, T1.5 = insufficient, T2 = varying depending) if blood glucose goes over 140, it likely climbs considerably over that and takes longer to clear (and/or is added to by inappropriate endogenous glucose production). The more carbs ingested the higher the glucose spike in somewhat proportional fashion. This is because insulin is not secreted properly and the glucose will be cleared by non-insulin dependent mechanisms. A person with normal insulin secretion will almost never get a glucose spike over around 180 because their glucose stimulated insulin secretion (GSIS) is proportional to the glucose ingested. So a diabetic consumes 50g carb or 100g carb and their BG level climbs quite a lot higher after the 100g load, but a non-diabetic consumes 50g or 100g or 200g, and their BG level may climb 10 or 20 points higher at the high dose, but their GSIS will just increase proportionally to handle the load to avoid runaway glucose levels....

Eating sugar or carbohydrates in general does not cause diabetes. The pancreas has more than enough insulin making capacity to last more than a lifetime. It's not like eggs in your ovaries as I've seen the analogy drawn. Yes, with aging comes some declining function, just as sarcopenia can become an issue, but that decline is not due to having used up some insulin reservoir. Eating a low carb diet to avoid getting diabetes on this basis is, frankly, downright foolish. Equally foolish, IMO, is looking at thresholds and studies in diabetics and applying those same measures to the non-diabetic. A non-diabetic will simply rarely if ever exceed around 180 mg/dL no matter what, and this includes "compensators" -- those with IR for whom an exaggerated GSIS compensates for impaired transport to achieve normoglycemia. So long as one is not continually adding to whatever has caused the IR, there's little indication the pancreas can't keep on keeping on. Remember, the LIRKO mouse is hyperglycemic throughout most of its shortened life, but hyperinsulinemic to the bitter end. We can argue over the glucose and/or insulin being toxic in this mouse, but it's pretty clear that at least in the mouse, raging chronic hyperglycemia didn't kill off its beta cells.

In summary, then, application of thresholds and targets aimed at diabetics to non-diabetics should be qualified and are often so out of context as to be irrelevant. I would agree that maintaining more truly normal glycemic control in the diabetic -- keeping glucose spikes under 200 and 2 hr readings below 140 -- may well be a more effective means to prevent diabetic complications. I'd sure as heck aim for that myself were I diabetic. But I don't see any reason for a non-diabetic to worry or obsess over postprandial spikes exceeding that magic 140 mg/dL number. If your low carb diet has rendered your formerly non-diabetic metabolism into a functionally diabetic one, it may be time to rethink things a bit. Insulin does more than stimulate glucose transport into your cells....

The last [study cited by a correspondent] is very interesting [link] What Is the Best Predictor of Future Type 2 Diabetes?

"The insulin secretion/insulin resistance index is useful as a predictor of future development of type 2 diabetes."

I think I'll do a quick blog post on this paper in the next day or so. If insulin is a better predictor it *may* mean that it is the primary factor in the etiology. This is what I believe based on my reading of the literature (especially recently) demonstrating that postprandial insulin production is impaired early on in the progression of the disease.
insulin  normoglycemia  euglycemia  blood  glucose  excursions  cycle  postprandial  diabetes  type  2  T2D  normal  standards  threshold  eitiology  etiology  cause  factor  risk 
may 2016 by Michael.Massing
Why Very Low Calorie Diets (VLCD) won’t solve the diabetes crisis | HealthInsightUK
“We believe this shows that Type 2 diabetes is all about energy balance in the body,” explained Professor Taylor, “if you are eating more than you burn, then the excess is stored in the liver and pancreas as fat which can lead to Type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others.”

Clearly Prof Taylor did not think that the lack of carbohydrate in the diet was in any way relevant – only weight loss and keeping it off. Even though the low carbs would mean that the patients’ blood sugars were regularised. We know they went into a state known as ketosis when the body switches from burning glucose from carbohydrates to using fat from the diet and from storage for energy.

Some of this gets turned into energy packets called ketones in the liver. It is the state of ketosis that results in fast and substantial weight loss. What is really odd is that at no point did Prof Taylor or Diabetes UK ask whether the critical issue was the low calories or the ketosis or the lack of carbohydrate. This lack of critical thinking may be linked to the fact that weight-loss shakes maker Optifast part funded the original study and may not want people to know that you can get into a state of ketosis with just food from the local store.
diabetes  type  2  T2D  caloric  restriction  peer-reviewed  research  criticism  body  fat  organ  weight  loss  Newcastle  protocol  treatment  remission  reversal  ketosis  symptoms 
may 2016 by Michael.Massing
Tech-Savvy Families Use Home-Built Diabetes Device - WSJ
The latest > Tech-Savvy Families Use Home-Built Diabetes Device - WSJ , see more
OpenAPS  closed-loop  artificial  pancreas  DIYPS  #WeAreNotWaiting  T1D  type  1  diabetes  juvenile  insulin  DIY 
may 2016 by Michael.Massing
Shameless Public Displays of Diabetes – Insulin Nation
I suggest that people who get “squeamish” when quarter-inch needles are around should look away. I can assure them that they are not going to have serious health complications by catching a glimpse of someone taking care of their diabetes. The person on the receiving end of that treatment just might if they miss a shot or a dose in an effort to be discreet, though. Diabetes does not get put on hold when we dine out, go shopping, or attend a party. It’s a 24/7 job and it doesn’t wait for opportune and discreet times to cause havoc.
diabetes  type  1  T1D  insulin-dependent  self  care  treatment  public 
may 2016 by Michael.Massing
The future of medicine is food — Quartz
“We translate the preponderance of dietary evidence,” which Harlan told Quartz supports the oft-praised Mediterranean diet, “for the American kitchen.” That includes consideration of cost as well as nutritional value—diet-related illnesses like obesity are often linked to low income communities, including the New Orleans community that Tulane’s kitchen also serves. This also works out well for training would-be doctors, says Harlan, who are usually on a stringent budget themselves....

While it’s still early days for the Tulane program, two separate studies have shown its effectiveness—for both the patients and med students alike. (Both studies included authors from the Goldring Center.) The first, which looked at patients with Type 2 Diabetes, found, for example, that those that who participated in the program saw a major drop in total cholesterol, while those who did not participate saw an increase. The second found that medical students also benefited: They not only thought nutrition advice was important for their patients, but for themselves, too. By the second year, the participating med students were eating significantly more fruits and vegetables than they had previously.

Harlan expects a sea change to take place in the way doctors treat chronic illness—and the way insurance charges for it. At the conference, Kass described a future where doctors write recipes as prescriptions and insurance companies treat food as a reimbursable expense. (There is, of course, a strong economic argument in favor of a prevention-based approach to health.) Harlan predicts that care plans will eventually include menu planning, recipes and maybe even programming to get the ingredients delivered to patients. “Call me up in ten years and let’s see if that’s true.”
nutrition  food  diet  #MedEd  poverty  correlation  diabetes  type  2  T2D  neighborhood  service  earnest  insurance  etiology  epidemiology  cause  factor  risk 
may 2016 by Michael.Massing
I Wish People Knew That Diabetes... | I Wish People Knew That Diabetes...
@IamSaraFalconer @T2DRemission glad you both were part #IWishPeopleKnewThatDiabetes day &please submit a post 4 !
diabetes  #IWishPeopleKnewThatDiabetes  patient  voices  narrative  type  1  2  T1D  T2D  IWishPeopleKnewThatDiabetes  dsma 
april 2016 by Michael.Massing
Exaggerated effects of particulate matter air pollution in genetic type II diabetes mellitus (PDF Download Available)
Researchers found that exposure to air pollution, over a period of 24 weeks, exaggerates insulin resistance and fat inflammation. “[O]besity has reached epidemic proportions with 34% of adults in the US, ages 20 and over, meeting the criteria...Obesity and diabetes are very prevalent in urban areas and there have been no studies evaluating the impact of poor air quality on these related conditions until now.”
Type 2 diabetes...has soared worldwide with a projected 221 million people expected to suffer from this disease in 2010, a 46 percent increase compared to 1995...[S]cientists fed male mice a diet high in fat over a 10-week period to induce obesity and then exposed them to either filtered air or air with particulate matter for six hours a day, five days a week, over a 24-week period...The air pollution level inside the chamber containing particulate matter was comparable to levels a commuter may be exposed to in...many metropolitan areas in the U.S.
[description by Diabetes in Control - expired link]
in  vivo  animal  correlation  pollution  environment  risk  body  fat  inflammation  heart  circulation  insulin  epidemic  poison  etiology  resistance  T2D  diabetes  type  2  research  peer-reviewed  environmental  factor  public  health  genetic  genetics  cause 
april 2016 by Michael.Massing
UNC study helps clarify link between high-fat diet and type 2 diabetes — UNC School of Medicine
New research from the University of North Carolina at Chapel Hill School of Medicine adds clarity to the connection. The study published online April 10 in the journal Nature Immunology finds that saturated fatty acids but not the unsaturated type can activate immune cells to produce an inflammatory protein, called interleukin-1beta.

“The cellular path that mediates fatty acid metabolism is also the one that causes interleukin-1beta production,” says senior study co-author Jenny Y. Ting, PhD, William Kenan Rand Professor in the Department of Microbiology and Immunology.

“Interleukin-1beta then acts on tissues and organs such as the liver, muscle and fat (adipose) to turn off their response to insulin, making them insulin resistant.  As a result, activation of this pathway by fatty acid can lead to insulin resistance and type 2 diabetes symptoms.”  Ting is also a member of the UNC Lineberger Comprehensive Cancer Center, and the UNC Inflammatory Diseases Institute.
insulin  resistance  mechanism  risk  factor  diabetes  type  2  T2D  inflammation  correlation  etiology  saturated  fat  peer-reviewed  research  diet  food  earnest  liver  fatty  body  metabolic  syndrome  disorder  public  health  cause 
april 2016 by Michael.Massing
8 Signs Your Child May Have Type 1 Diabetes - Medico Journal
8 Signs Your Child May Have Type 1 Diabetes via @Medico_Journal
diabetes  type  1  T1D  diagnosis  symptoms  childhood 
march 2016 by Michael.Massing
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