michael.massing + diabetes + what.i'm.reading   51

The Children's Hospital of Philadelphia Research Institute: CHOP Research Publications: News — Press Releases
“Scientists have identified only about 10 percent of the genetic variants contributing to T2D, and most previous studies have been based on people of European ancestry,” said senior co-author Brendan J. Keating, Ph.D., of the Center for Applied Genomics at The Children’s Hospital of Philadelphia. This international study found that many gene variants associated with T2D overlap across multiple ethnic groups.” The current study included subjects with African-American, Hispanic, Asian and European ancestry....
The research consortium performed a meta-analysis of 39 existing studies of multiethnic populations, comprising over 17,000 cases of individuals with T2D, compared to 70,000 control subjects. This large-scale genetic screening used a customized gene analysis tool to examine 50,000 genetic variants across 2,100 genes known to be associated with cardiovascular and metabolic functions.
The researchers identified variants in four previously unknown genes associated with T2D, discovered six new independent genetic signals in known T2D genes, and verified 16 previously reported T2D-linked variants. A total of nearly 40 gene variants have now been found to raise or lower the risk of T2D. Keating says the current study’s genome-wide screening approach in large multi-ethnic samples should be effective in discovering additional diabetes gene variants relevant to multiple ethnic populations.

Keating BJ, Saxena R. “Large-Scale Gene-Centric Meta-Analysis across 39 Studies Identifies Type 2 Diabetes Loci,” American Journal of Human Genetics, published online Feb. 9, 2012, to appear in print, March 9, 2012. doi: 10.1016/j.ajhg.2011.12.022
type  2  diabetes  T2D  genetics  etiology  cause  origin  medical  research  meta-analysis  peer-reviewed  what.I'm.reading  earnest  CHOP  Children's  Hospital  of  Philadelphia  factor  risk 
march 2013 by Michael.Massing
Sugar Makes You Stupid: Study Shows How a High-Fructose Diet Sabotages Learning, Memory
The DHA-deprived rats also developed signs of resistance to insulin, a hormone that controls blood sugar and regulates synaptic function in the brain. A closer look at the rats' brain tissue suggested that insulin had lost much of its power to influence the brain cells.

"Because insulin can penetrate the blood–brain barrier, the hormone may signal neurons to trigger reactions that disrupt learning and cause memory loss," Gomez-Pinilla said.

He suspects that fructose is the culprit behind the DHA-deficient rats' brain dysfunction. Eating too much fructose could block insulin's ability to regulate how cells use and store sugar for the energy required for processing thoughts and emotions.

"Insulin is important in the body for controlling blood sugar, but it may play a different role in the brain, where insulin appears to disturb memory and learning," he said. "Our study shows that a high-fructose diet harms the brain as well as the body. This is something new."

Gomez-Pinilla, a native of Chile and an exercise enthusiast who practices what he preaches, advises people to keep fructose intake to a minimum and swap sugary desserts for fresh berries and Greek yogurt, which he keeps within arm's reach in a small refrigerator in his office. An occasional bar of dark chocolate that hasn't been processed with a lot of extra sweetener is fine too, he said.

Still planning to throw caution to the wind and indulge in a hot-fudge sundae? Then also eat foods rich in omega-3 fatty acids, like salmon, walnuts and flaxseeds, or take a daily DHA capsule. Gomez-Pinilla recommends one gram of DHA per day.

"Our findings suggest that consuming DHA regularly protects the brain against fructose's harmful effects," said Gomez-Pinilla. "It's like saving money in the bank. You want to build a reserve for your brain to tap when it requires extra fuel to fight off future diseases."

The UCLA study was funded by the National Institute of Neurological Disorders and Stroke. Gomez-Pinilla's lab will next examine the role of diet in recovery from brain trauma.
DHA  earnest  hatmandu  brain  trauma  insulin  omega-3  fatty  acids  supplements  resistance  neurotransmitter  memory  learning  sugar  fructose  what.I'm.reading  medical  behavioral  research  in  vivo  diet  salmon  nuts  walnuts  flax  T2D  diabetes  cognition  correlation  peer-reviewed  type  2  foods  food  processed  industrialization  risk 
may 2012 by Michael.Massing
Drug Helps Diabetics, Trial Finds | Annals of Internal Medicine 2010 | via NYTimes.com
Experts who were not involved in the multi-center trial agreed larger trials were needed, and said the impact of the drug on blood glucose levels[—.5% reduction in A1c over three months at the highest tested dose of 4g daily—]was moderate. But they said the findings were exciting because they suggested Type 2 diabetes could be treated by targeting the underlying inflammation....
Since atherosclerosis is also considered an inflammatory state, this approach may also potentially reduce the risk of cardiovascular complications associated with diabetes...
Salsalate sells for less than a quarter a pill, and does not present the opportunity for profit that would attract large pharmaceutical companies to do the research...
The patients continued with their regular Type 2 diabetes treatment regimen throughout the study.
salsalate  drug  effects  risk  benefit  cost  treatment  self  care  medical  research  peer-reviewed  pharmaceutical  profit  greed  capitalism  what.I'm.reading  diabetes  efficacy  T2D  type  2 
april 2012 by Michael.Massing
Diabetes Remission? | Jane K. Dickinson, RN, PhD, CDE
I have had many patients – with type 2 diabetes – ask if they can get rid of it. I always explain that by making healthy food choices, exercising, managing their stress and losing weight they can get their blood glucose level down. Once their numbers are consistently in the “normal” range (70-110 mg/dL before meals and less than 140 mg/dL 2 hours after meals) they will feel better, have a greatly reduced risk of long-term complications, and they will appear to not have diabetes. However, diabetes is still lurking there: if they were to return to their old habits/lifestyle, their numbers would go right back up.

The article linked above discusses the “remission” of diabetes after gastric bypass/banding. It is very common for diabetes to go away after someone has this type of weight loss surgery. If the person follows a healthy lifestyle consistently – healthy eating and regular exercise – they can keep their blood glucose levels down. Unfortunately, even in these people, returning to unhealthy eating habits and/or lack of exercise can land them back in diabetes-ville. I’ve had patients for whom this has happened.

Healthcare professionals historically used the term, “borderline” to describe what is now called “pre-diabetes”. To those of us in the field, this means type 2 diabetes is knocking on the door, and without sufficient lifestyle adjustments (changes), it’s going to come right in. We no longer say “borderline”, because people just didn’t take it seriously. How many times have you heard someone say, “I’m just borderline. I don’t have to worry about it.” Just as type 2 diabetes can be prevented with a healthy lifestyle, diabetes remission can be prolonged the same way. Regardless, I think it’s risky to call this a “cure” or even “reversal”. I worry that people might truly believe it’s gone, whereas even “remission” implies that it could come back.
diabetes  remission  self  care  diet  exercise  stress  blood  glucose  management  control  what.I'm.reading  body  fat  weight  loss  earnest  T2D  research  type  2  peer-reviewed  maintenance 
april 2012 by Michael.Massing
Stress and Fatigue :: Diabetes Self-Management
The stress response, sometimes called the “fight-or-flight” response [raises blood sugar levels (to provide fuel to the muscles) and increases] insulin resistance (so the other cells won’t use up the glucose the muscles need). It also raises our heart rate and blood pressure so we can run faster, and increases blood clotting in case we are injured.
By increasing insulin resistance, stress can make us extremely tired. Under stress, only the muscles and nerves being used for fight or flight will open to insulin and the glucose it’s carrying. All the other cells are supposed to take a nap. But if the stress goes on a long time, our bodies and brains will not have enough fuel, so they want to just keep napping.,,,
According to the book Overcoming Adrenal Fatigue, by Kathryn Simpson, MS, stress puts pressure on the adrenal glands. Those glands produce adrenaline, cortisol, DHEA, and other chemicals that make up the stress response. If they have to keep producing at high levels...they start to wear out. Sort of like beta cells are thought to wear out if they have to produce too much insulin.
When the adrenals wear down, cortisol levels will drop. That’s when fatigue really sets in. Cortisol helps us wake up in the morning. It also helps control the immune system: Cortisol starts inflammation when needed to fight an injury or infection and stops it when the problem is under control. When cortisol levels are too low, inflammation can go into overdrive and damage healthy cells.
We now know that inflammation is a major cause of the blood vessel and pancreas damage we see in diabetes. Diabetes is often called an inflammatory disease, and to the extent this is true, we need to control stress to deal with it.
Inflammation also makes you very, very tired. Your body is telling you to rest so the infection or injury can be healed. But when cortisol levels are low, you’ll get the same message when there is no injury or illness. It just goes on, and we feel constantly tired.
[Threats and stresses] can be environmental, like being too cold or too hot or being exposed to toxic chemicals....Another major stressor is hunger. Unfortunately, some diabetes diets and most weight-loss diets can leave people feeling hungry, so those diets might need to be changed or avoided.
Since most stressors these days are emotional or economic, we can sometimes reduce stress by changing the way we think about the difficult things in our lives....Anything we can do to actually change situations that threaten us [reduces stress]...
We can also reduce stress by treating infections, by getting enough sleep, and by getting regular moderate exercise (but not overdoing the workouts! That’s stressful too.). It’s also important to eat regularly and not to go hungry. Simpson says five or six small, balanced meals a day may be ideal for most people’s adrenals. She advises protein, fat, and complex carbs at each meal....
Effective stress reduction methods include prayer, meditation, breathing, and gentle exercise like tai chi or qigong. Getting help with stressful life problems, as from a counselor, coach, or friend can also reduce stress....
A number of supplements might help, including Vitamins C and D, chromium, zinc, magnesium, B vitamins, and fish oils. Simpson also suggests taking digestive enzymes and says taking small amounts of hydrocortisone (which is identical to natural cortisol) can be very helpful if your levels are low. Anti-inflammatory medicines like aspirin or salsalate might help, too.
diabetes  stress  fatigue  symptoms  David  Spero  fight-or-flight  response  cortisol  adrenaline  inflammation  DHEA  diet  weight  control  maintenance  hunger  meditation  breathing  exercise  supplements  what.I'm.reading  vitamin  C  D  chromium  zinc  magnesium  B  fish  digestive  enzymes  hydrocortisone  aspirin  salsalate  anti-inflammatory  glucose  hatmandu  earnest  T2D  research  sleep  type  2  human  in  vivo  correlation  insulin  resistance  peer-reviewed  factor  activity  risk  etiology  clinical  trial  body  fat  public  health 
february 2012 by Michael.Massing
Giving Up on Weight Loss | Kahn, R. Health Affairs 2012-01 | via Diabetes Self-Management
Richard Kahn, formerly the chief medical officer of the American Diabetes Association, claims that we don’t know enough right now about the biological processes underlying the body’s regulation of weight to develop effective weight-loss programs that can be applied on a large scale. In the meantime, he writes, public health officials and medical groups should concentrate on finding ways to help people control their diabetes once it develops. This, he believes, is a better use of valuable time and research dollars, since effectively controlling blood glucose levels has shown to be sustainable and leads to a greatly reduced risk of diabetes complications....
As an article published at DiabetesInControl.com notes, several doctors associated with Boston’s Joslin Diabetes Center released a statement indicating strong disagreement with Kahn. Osama Hamdy, medical director of the center’s Obesity Clinical Program, asserted that Kahn was advocating “a surrender in the face of one of the greatest threats to public health the world faces.” Hamdy goes on to say that while maintaining weight loss is “a lifelong battle,” Joslin programs have shown that weight loss can be sustained for long periods of time. One program, he notes, led to a 50% reduction in diabetes medicines taken by participants and a 27% reduction in overall health-care costs....
Is it foolish to suppose that programs administered by a leading diabetes research center can be effectively duplicated across the country? Or is Kahn’s approach too pessimistic — or even, as one writer suggests, possibly distorted by ties to diabetes drug manufacturers?
[The ADA's conservatism on preventive strategies and intimacy with the post-diagnosis treatment industry has long been a thorn in the side of many.—DMM]
body  fat  weight  loss  diabetes  prevention  what.I'm.reading  maintenance  self  care  glucose  behavior  hatmandu  T2D  research  correlation  health  cost  benefit  economics  behavioral  treatment  intervention 
february 2012 by Michael.Massing
Dessert at Breakfast May Help Dieters | Jakubowicz D. Steroids 2012-03-10 | via NYTimes.com
Scientists randomized 144 obese people, ages 20 to 65, to two low-carbohydrate diets providing 1,400 daily calories for women and 1,600 for men. The diets were identical except that one included a high-carbohydrate, protein-enriched breakfast with a choice of cookies, chocolate, cake or ice cream for dessert.
Throughout the study, which appears in the March 10 issue of the journal Steroids, participants were tested periodically for blood levels of insulin, glucose, lipid and ghrelin, a hormone that stimulates appetite.
During an initial 16-week period, the average weight loss in each group was identical — about 32 pounds. But over a 16-week follow-up, people on the dessert-with-breakfast diet lost an additional 13 pounds on average, while the others gained back all but 3.5 of the pounds they had lost.
Those on the dessert regimen maintained lower levels of ghrelin and reported significantly higher levels of fullness. “Most people simply regain weight, no matter what diet they are on...But if you eat what you like, you decrease cravings. The cake — a small piece — is important.”
diet  food  breakfast  dessert  carbohydrates  cravings  satiety  weight  loss  gain  body  fat  medical  research  what.I'm.reading  circadian  rhythms  blood  glucose  sugar  David.E  obesity  behavior  peer-reviewed  behavioral  hatmandu  earnest  T2D  diabetes 
february 2012 by Michael.Massing
African-Americans More Likely to Develop Hypertension But Less Likely to Take Life-Saving Medication | Lewis L. Journal of Cardiovascular Nursing 2012.
Racial disparities in hypertension control account for nearly 8,000 preventable deaths annually among African-Americans, making increased blood pressure control among African-Americans a “compelling goal"...
African-Americans commonly develop hypertension at a younger age, are less likely to have their blood pressure under control, and disproportionately suffer strokes and fatality when compared with their Caucasian counterparts[:] a 30% greater rate of non-fatal stroke, an 80% greater rate of fatal stroke, and a staggering 420% greater rate of end-stage kidney disease for African-Americans...
[Only 51% of all patients with hypertension adhere to their medications;] adherence rates are even lower for African-American patients.
Dr. Lewis identified self-efficacy, depression, and patient-provider communication among the factors in medication nonadherence. She called for further study, but advised that these factors are important for healthcare providers to consider when treating hypertensive African-American patients.
“Increasing blood pressure control requires a comprehensive approach...Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. [Clinicians also] may want to screen their hypertensive patients for depression...”
racial  health  disparities  race  African-Americans  risk  treatment  self  care  hypertension  high  blood  pressure  epidemiology  demographics  stroke  morbidity  mortality  kidney  disease  what.I'm.reading  T2D  research  diabetes  correlation  peer-reviewed 
february 2012 by Michael.Massing
More “Miracle” Supplements…? :: Diabetes Self-Management
Raspberry ketones are on the FDA’s GRAS (generally recognized as safe) list. But in terms of their fat-burning ability, the only research to support this claim dates back years…and that study was done with mice. Not humans. So we really don’t know if this supplement works. And it’s not without some possible serious side effects: increased heart rate and blood pressure, difficulty sleeping, agitation, and maybe hypothyroidism (underactive thyroid). Avoid taking this supplement if you have high blood pressure or thyroid issues. We don’t know enough about it how it affects diabetes control, either....
[Glucocil] is targeted to people with Type 2 diabetes, and its claim to fame is that it can reputedly stabilize postmeal blood glucose levels, decrease carbohydrate absorption, decrease appetite, and promote weight management. Pretty hefty claims for a supplement whose key active ingredient is mulberry leaf extract....
[This supplement also] contains alpha lipoic acid, banaba leaf extract, chromium picolinate, cinnamon bark powder, gymnema sylvestre extract, fish oil, and a few other things thrown in for good measure. Glucocil’s Web site clearly lists the research — but only for each separate ingredient. Nowhere on the site could I find research citing the effectiveness of the actual supplement....As far as mulberry leaf extract goes, a few small studies (mostly done with rats) show some reduction in glucose after ingesting it, but not enough to boast about....
We don’t know if the blend of these ingredients actually live up to Glucocil’s claims of glucose and weight control, nor do we know if the amount of ingredients in this supplement are in the right proportions to be effective. The Web site states that people under the age of 18, pregnant women, and people with liver and kidney problems should not take Glucocil. Also, they state that if you take insulin and don’t have cardiovascular, liver, or kidney problems, you can “consider” taking Glucocil. Side effects include “minor GI discomfort,” such as gas and loose stools.
supplements  hype  risk  benefit  diabetes  blood  glucose  sugar  caution  drug  effects  adverse  what.I'm.reading  interaction  T2D  research  sleep  type  2  human  in  vivo  liver  fatty  body  fat  metabolic  syndrome  disorder  etiology  peer-reviewed  correlation  clinical  trial  factor 
february 2012 by Michael.Massing
Fitness and Fatness Independently Linked with CVD Risk Factors | Lee D. Journal of the American College of Cardiology online 2012-02-06
Individuals who maintained or improved their fitness levels had a 26% and 28% lower risk of developing hypertension, a 42% and 52% lower risk of developing metabolic syndrome, and a 26% and 30% lower risk of developing elevated levels of LDL cholesterol, respectively....
[Subjects who got fatter in follow-up, as measured by percentage of body fat,] had a 26%, 71%, and 48% higher risk of developing hypertension, metabolic syndrome, and hypercholesterolemia, respectively...compared with individuals who lost weight. Similar results were observed when BMI was used as the criterion for fatness levels.
Every 1-MET improvement in fitness was associated with a 7%, 22%, and 12% lower risk of developing hypertension, metabolic syndrome, and hypercholesterolemia, respectively, while every unit increase in percentage of body fat was associated with a 4%, 10%, and 5% increased risk of developing the cardiovascular risk factors...
"In the real world, people change their fitness levels or fatness over time...Fitness and fatness, not the baseline levels, but the changes over time, are both independently important to reduce cardiovascular disease risk factors."
[Patients who had stable or increasing amounts of fatness in combination with loss of fitness had significantly higher rates of cardiovascular risk factors when compared with] individuals who gained fitness over time and lost fat. They did observe that losing fitness regardless of fat changes and getting fatter irrespective of the change in fitness levels were associated with a higher risk of developing metabolic syndrome. The adverse effects of getting fatter were attenuated slightly if fitness was maintained or improved, while declines in fitness could be offset by reductions in body-fat percentage.
"Maintaining or improving fitness levels and preventing fat gain are both important, independent of the changes of each other...[T]he ideal combination is to improve fitness and prevent fat gain, but as long as individuals maintain fitness and fatness, they are not likely to be at higher risk of cardiovascular disease risk factors. Losing weight and gaining fitness is very challenging to the general population, but maintaining fitness and fatness are less so and more doable."
risk  fitness  fatness  body  fat  cardiovascular  hypertension  high  blood  pressure  metabolic  syndrome  hyperlipidemia  cholesterol  LDL  attenuation  mitigation  self  care  weight  loss  gain  independent  variables  what.I'm.reading  medical  research  peer-reviewed  hatmandu  earnest  T2D  diabetes  correlation  factor  etiology 
february 2012 by Michael.Massing
'Do Your Best' Not A Good Enough Goal to Improve Diabetes Diet | Miller C et al. Patient Education and Counseling 2012. Public Health Nutrition 2011.
[After increasing] intake of low-glycemic-index foods, participants as a group lowered their weight, body mass index, waist circumference and [hemoglobin A1c reading]....
[Miller's claim—“I think we have enough data to say that consuming a low-glycemic-index diet has beneficial outcomes for people with diabetes"—is significant] because no guidelines currently exist for consumption of low-glycemic-index foods...[Miller believes a focus on the glycemic index in foods rather than carbohydrates and sugars is not too complicated for patients with diabetes to follow, as long as they receive adequate nutrition education—]another finding of hers in a study published in 2009.
The glycemic index is represented by a scale from 1 to 100. Foods that tend to slow the speed of digestion and prevent rapid increases in blood sugar include many vegetables, whole grains, dairy foods, nuts and seeds, beans and fruits. They are considered low-glycemic-index foods if they have an index of 55 or fewer points. Foods with a point value of 100 are the equivalent of pure glucose....
“What we found is that those who felt more committed to [their respective] goal felt the goal was less difficult. And those who had a higher level of self-efficacy[—agency—]felt that the goal was less difficult"....
It wasn’t until the trial was completed that researchers learned that many participants entered the study already eating about six servings per day of foods with a low glycemic index.
“We learned that we should set the goal for low-glycemic-index foods higher. We also learned that we need to set an individualized goal. We know that people can increase their consumption by almost two servings a day if that specific goal is set"...
Research on goal-setting also emphasizes that people should plan to take action rather than stop doing something. They also can set a substitution goal...a low-glycemic-index food for a high-glycemic-index food.
“One way to build self-efficacy is by helping people set a specific goal that is moderately difficult, action-oriented, and achievable in small successive steps"...
what.I'm.reading  goals  diet  agency  metrics  diabetes  management  glycemic  index  vegetables  body  fat  waist  circumference  medical  research  peer-reviewed  A1c  benefit  standards  self  care  motivation  effectiveness  efficacy  glucose  earnest  T2D 
february 2012 by Michael.Massing
Lack of Sleep Makes Your Brain Hungry | Benedict C et al. The Journal of Clinical Endocrinology and Metabolism. In press 2012-01. American Journal of Clinical Nutrition. n.d.
A single night of total sleep loss in young normal weight men curbed the energy expenditure the next morning...[S]ubjects had increased levels of hunger...[Researchers have] systematically examined which regions in the brain involved in appetite sensation are influenced by acute sleep loss....
“After a night of total sleep loss, these males showed a high level of activation in an area of the brain that is involved in a desire to eat...[O]ur results may explain why poor sleep habits can affect people’s risk to gain weight in the long run. It may therefore be important to sleep about eight hours every night to maintain a stable and healthy body weight.”
body  weight  what.I'm.reading  fat  sleep  gain  medical  research  peer-reviewed  brain  mapping  hunger  diabetes  hatmandu  T2D  type  2  human  in  vivo  correlation  clinical  trial 
january 2012 by Michael.Massing
Vitamin D Could Combat the Effects of Aging in Eyes | Jeffery G et al. Neurobiology of Aging. 2012-01
Inflammation and the [age-related accumulation of the toxic molecule amyloid beta contribute to] increased risk of age-related macular degeneration (AMD), the largest cause of blindness in people over 50 in the developed world...
"When we gave older mice the vitamin D we found that deposits of amyloid beta were reduced in their eyes and the mice showed an associated improvement of vision. [Amyloid beta is linked to Alzheimer's disease;] new evidence suggests that vitamin D could have a role in reducing its build up in the brain"...
Professor Jeffery and his team...found that the mice that had been given the vitamin D supplement also had significantly less amyloid beta built up in their blood vessels, including in the aorta...
"[V]itamin D could be useful in helping to prevent a range of age-related health problems, from deteriorating vision to heart disease"....
For much of human history our ancestors lived in Africa, probably without clothes, and so were exposed to strong sunlight all year round. This would have triggered vitamin D production in the skin. Humans have only moved to less sunny parts of the world and adopted clothing relatively recently and so might not be well adapted to reduced exposure to the sun.
amyloid  beta  Alzheimer's  what.I'm.reading  eyes  supplements  vitamin  cardiovascular  heart  circulation  pathology  improvement  D  diet  sunlight  evolution  human  prevention  protection  brain  macular  degeneration  medical  research  peer-reviewed  disease  neuroprotection  cognition  dementia  T2D  diabetes  correlation  insulin  neuroendocrine  risk  inflammation  resistance  neurotransmitter  type  2  3  blood  glucose  sugar  fats  lipids 
january 2012 by Michael.Massing
Bariatric Surgery Not a Cure for Diabetes | Pournaras D. Br J Surg. 2012:88:100-103.,
"Bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) leads to complete remission in only about one third of patients with type 2 diabetes, and should be viewed as a means for improving glycemic control, not as a cure."
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria[:] 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5%...)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria...
[O]n average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (7.5% before sleeve gastrectomy), and 6.3% (7.7% before gastric banding...
The authors [recommend] "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission...
"The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. [We] emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."
gastric  surgery  diabetes  remission  medical  research  peer-reviewed  definition  risk  benefit  glucose  blood  glycemic  control  what.I'm.reading  A1c  fasting  bariatric  T2D 
january 2012 by Michael.Massing
Statins Can Increase Risk of Diabetes | Culver A. Ma Y. et al. Archives of Internal Medicine. 2012-01-09
Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus.
New data from the Women's Health Initiative (WHI) [indicates risk of diabetes is higher than previous studies have suggested: 48% increased risk]....
Recently published data reported the potential risk of diabetes with statin therapy. Dr. Kausik Ray (St. George's University of London, UK) and colleagues published a meta-analysis of [five trials testing high-dose statin therapy,] and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in The Lancet in 2010 by Dr. Naveed Sattar (University of Glasgow, UK) also showed that statin therapy was associated with a 9% increased risk of diabetes.
[The present study produced an unadjusted risk model associating statin use at baseline] with a 71% (95% CI 1.61–1.83) increased risk of diabetes. After adjusting for potential confounding variables, the risk...declined to 48% (95% CI 1.38–1.59). The association was observed for all types of statins.
Dr. Kirsten Johansen,[ Editor of the Archives of Internal Medicine, noted that previous meta-analyses show no benefit of statins on all-cause mortality in the setting of primary prevention]...
[S[tatins are used with increasing frequency, including in primary prevention, and—based on the JUPITER trial—in patients with normal LDL cholesterol, but elevated C-reactive protein (more than 2.0 mg/L). In the present study, baseline statin therapy was associated with a significant 46% and 48% increased risk of diabetes in women with CVD and without CVD, respectively.
Just 7% of women in the WHI study were taking statins in the analysis, but today that number would be significantly higher, making the potential risk of diabetes at the population level much more widespread.
medical  research  drug  effects  risk  benefit  statins  women  peer-reviewed  meta-analysis  overview  mortality  diabetes  iatrogenic  what.I'm.reading  T2D  correlation  adverse 
january 2012 by Michael.Massing
Link between Bio-clock, Glucose Metabolism Found
Researchers at Salk Institute for Biological Studies in the US found proteins that control the body's biological rhythms, known as cryptochromes also interact with metabolic switches that are targeted by certain anti-inflammatory drugs....

The [finding suggests that serious adverse] effects of current drugs might be avoided by considering patients' biological rhythms when giving drugs...

Glucocorticoids are steroid hormones that occur naturally in the body and help control the amount of sugar in a person's blood, so that nutrient levels rise in the morning to fuel daily activities and fall again at night. They function in cells by interacting with glucocorticoid receptors, molecular switches on the outside of the nucleus, which play a role in regulating inflammation. They are used as anti-inflammatory drugs for diseases like allergies, asthma and rheumatoid arthritis as well as used to treat inflammation in cancer patients.

However, the steroids can disrupt a person's normal metabolism, resulting in dangerous side effects, including excessively high blood sugar levels, insulin resistance and diabetic complications.

Nature, Dec 2012
inflammation  hormones  circadian  biological  rhythms  clock  metabolism  endocrine  drug  treatment  diabetes  interaction  links  what.I'm.reading  cycles  diet  schedule  medical  research  peer-reviewed  T2D  correlation  insulin  resistance  type  2  cancer  glucocorticoid  meal  planning 
january 2012 by Michael.Massing
Genetic Variants Found to Predispose to Weight Regain
Numerous genetic variants predispose people to weight loss [and to weight regain after intentional weight loss.]

Linda M. Delahanty, R.D., from the Massachusetts General Hospital in Boston, and colleagues performed a randomized controlled study of 3,234 overweight/obese adults with impaired glucose tolerance. The subjects were randomly assigned to one of three treatment groups: 850 milligrams of metformin twice daily, rigorous lifestyle modification, or placebo. Consenting participants underwent genetic analysis.
[Specific genetic alleles were] linked to long- and short-term weight reduction regardless of treatment group. In addition, three of 16 obesity-predisposing genetic variants [were associated with weight regain irrespective of treatment group, while another two variants] demonstrated treatment-specific effects.
body  weight  fat  loss  gain  regain  genetics  medical  research  peer-reviewed  impaired  glucose  tolerance  prediabetes  diabetes  links  what.I'm.reading  hatmandu  earnest  T2D  metformin  drug  treatment  effects  type  2 
january 2012 by Michael.Massing
Benefits of Tight Blood Pressure Control in Diabetic Patients With Hypertension
In 2008, when the UK Prospective Diabetes Study (UKPDS) group presented their 30-year findings concerning the possible sustained effects of improved glycemic control after 10 years of extended follow-up in type 2 diabetic patients, a so-called “legacy effect” was reported to address the long-term emergent and/or sustained benefits of early improved glycemic control. Opposite results were obtained by the Hypertension in Diabetes Study (HDS) carried out in the frame of UKPDS, with no evidence of any legacy effect on cardiovascular (CV) outcomes for an initial 4-year period of tight blood pressure (BP) control. Thus, it was concluded that BP control has to be continued over time, since, although it had a short time-to-effect relationship in preventing stroke, BP control was associated with a short persistence of its clinical benefits once the intervention was discontinued. These findings are unique because, whereas most interventional trials in hypertension that included diabetic patients have shown a reduction in CV outcomes shortly after starting treatment, only the UKPDS-HDS specifically explored the possible persistence of clinical benefits after discontinuing intensive BP-lowering intervention. This article aims to provide a critical interpretation of the UKPDS findings of lack of BP legacy, in the context of the currently available evidence on the benefits of antihypertensive treatment. The importance of effective BP control in type 2 diabetic patients to prevent CV outcomes and other diabetes-related complications is underlined, with emphasis on early, tight, and continuous BP control to optimize patients’ protection.
hyperglycemia  hypertension  high  blood  pressure  glucose  intervention  treatment  legacy  effect  early  aggressive  tight  control  what.I'm.reading  self  care  dysglycemia  morbidity  risk  medical  research  diabetes  T2D  correlation  benefit  self-monitored  monitoring  SMBG  behavior  behavioral  peer-reviewed  dcde 
january 2012 by Michael.Massing
Status of herbal medicines in the treatmen... [Curr Diabetes Rev. 2009] - PubMed - NCBI
[Diabetes mellitus] has reached epidemic proportions in the US and more recently worldwide. The morbidity and mortality associated with diabetes is anticipated to account for a substantial proportion of health care expenditures. Although there are several drug treatments currently available, the need for new herbal agents for treatment of diabetes are required. The treatment goals for patients with diabetes have evolved significantly over the last 80 years, from preventing imminent mortality, to alleviating symptoms, to the now recognized objective of normalization or near normalization of glucose levels with the intent of forestalling diabetic complications. The present review stated several findings from an extensive literature search of natural plants that have been assessed for the anti diabetic activity over past 80 years. An attempt has been made to summarize the information in order to highlight those chemical entities and plant species which are of worthy for further investigation as leads to the drug developments. Over 100 plant species from wide range of families containing various chemical classes of compounds have been cited here which are worthy for the researchers and the industrialist concerned to diabetes.
medical  research  herbal  natural  treatment  drug  diabetes  alternative  medicine  literature  review  overview  peer-reviewed  links  what.I'm.reading  efficacy  T2D 
january 2012 by Michael.Massing
Three-week diet curbs diabetes - health - 13 January 2006 - New Scientist | Roberts C. Journal of Applied Physiology (DOI: 10.1152/japplphysiol.01292.2005)
Just three weeks of a high-fibre, low-fat diet and moderate exercise could slow key changes in the body crucial to the development of diabetes... <br />
The new study, along with previous work on the so-called Pritkin diet and exercise programme, found that just 3 weeks of the programme reversed the clinical diagnosis of type 2 diabetes - or its precursor, called metabolic syndrome. The programme worked in half of the overweight patients following it. <br />
"[Contrary to common belief,] type 2 diabetes and metabolic syndrome can be reversed solely through lifestyle changes," says Christian Roberts [of UCLA], who led the study. <br />
The prevailing view is that such an improvement could take place only in months or years rather than weeks, Roberts told New Scientist. "The effect can be very dramatic given that, of the vast majority of people who go through the programme, at least 50% are no longer clinically defined as diabetic after three weeks, which suggests this disease is reversible."
diabetes  remission  diet  fiber  fats  dietary  medical  research  heart  cardiovascular  endothelium  blood  sugar  glucose  links  what.I'm.reading  self  care  earnest  T2D  diagnosis  from delicious
august 2011 by Michael.Massing
Dawn Phenomenon in Diabetes - Symptoms - Diabetes
[In the dawn phenomenon,] hormones tell our liver to release glucose to give us the fuel we need when we wake up. But when these hormones are out of balance with the hormone insulin, the liver releases too much glucose....<br />
[In a study four years ago [(Dyer-Parziale,M. Diabetes Research and Clinical Practice),:28] subjects who ate an ExtendBar at bedtime had an average 28% reduction in morning hypoglycemia....<br />
ExtendBars contain uncooked cornstarch, a naturally occurring resistant starch....Ann, a correspondent in Australia, wrote that [ Hi-Maize 5-in-1-Fiber helps control her dawn phenomenon.] Hi-Maize is also resistant starch. <br />
A recent study shows that Hi-Maize improves insulin sensitivity, which may explain why it can help control the dawn phenomenon.... <br />
Eating a green apple at bedtime lowers the morning reading for many people, according to John Walsh and his wife Ruth Roberts in their 1996 book Stop the Rollercoaster: How to Take Charge of Your Blood Sugars in Diabetes...
dawn  phenomenon  diagetes  blood  sugar  glucose  control  management  supplements  resistant  start  diabetes  links  what.I'm.reading  T2D  research  liver  risk  fatty  body  fat  metabolic  syndrome  disorder  etiology  peer-reviewed  correlation  insulin  resistance  type  2  factor  from delicious
august 2011 by Michael.Massing
Guidance for Industry - Powered by Google Docs
The treatment goals for patients with diabetes have evolved significantly over the last 80 years, from preventing imminent mortality, to alleviating symptoms, to the now recognized objective of normalization or near normalization of glucose levels with the intent of forestalling diabetic complications....
remission  normal  treatment  blood  glucose  sugar  progression  benefit  risk  cardiovascular  medical  research  drug  effects  regulation  via:FDA.gov  references  consensus  mortality  morbidity  diabetes  standards  normoglycemia  links  what.I'm.reading  prediabetes  self  care  management  T2D  diagnosis  from delicious
april 2011 by Michael.Massing
Associations between vascular co-morbidities and depression in insulin-naive diabetes patients: the DIAZOB Primary Care Diabetes study
The prevalence of depression was 11% in the total sample with little difference between the groups with and without any vascular co-morbidity (11.2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex; and being a smoker.
Rates of depression in those with one additional vascular co-morbidity did not differ from patients with diabetes only. Vascular co-morbidities were only associated with higher depression scores in case of multiple co-morbidities.
comorbidities  cardiovascular  diabetes  depression  medical  research  social  via:NLM.NIH.gov  references  mortality  links  what.I'm.reading  affective  mood  disorders  risk  T2D  correlation  support  stress  distress  factor  etiology  from delicious
april 2011 by Michael.Massing
Diabetes Is Linked to Premature Death from Many Causes in Addition to Vascular Disease | New England Journal of Medicine, March 3 2011
The presence of diabetes mellitus approximately doubles the risk of a wide range of vascular diseases according to the study. Evidence is also emerging that diabetes is associated with nonvascular conditions. Fasting glucose levels of more than 100 mg/dL (5.6 mmol/L) were associated with death, but levels of 70 to 100 mg/dL (3.9 - 5.6 mmol/L) were not. Compared with a 50-year-old individual without diabetes, a similar individual with diabetes died 6 years earlier, on average, with excess nonvascular deaths accounting for approximately 40% of the difference in survival time.
mortality  risk  diabetes  all-cause  cardiovascular  standards  cutoff  threshold  via:DiabetesInControl  links  what.I'm.reading  T2D  research  diagnosis  from delicious
april 2011 by Michael.Massing
Use of BP Medication in Non-Hypertensive Patients Shows Possible Risk Reduction of Stroke and CHF
Cardiovascular disease (CVD) is the leading cause of death in the United States and globally, representing 30% of all deaths worldwide. "Cardiovascular disease risk increases beginning at systolic blood pressure levels of 115 mm Hg...In adults 55 years and older, lifetime risk of developing hypertension is greater than 90%.... <br />
[In a meta-analysis of 25 studies], the researchers found that there was a 23% reduction in risk of stroke; 29% reduction in risk of congestive heart failure (CHF) events; 15% reduction in risk of composite (a combination of disease outcomes) CVD events; and a 13% reduction in risk for all-cause mortality.
blood  pressure  risk  prevention  threshold  cutoff  heart  circulattion  target  mortality  cardiovascular  diabetes  links  what.I'm.reading  T2D  research  standards  diagnosis  hypertension  high  correlation  treatment  peer-reviewed  from delicious
april 2011 by Michael.Massing
Scientists Find a New Way Insulin-Producing Cells Die
“Glutamate, a major signaling molecule in the brain and pancreas, is secreted together with glucagon by alpha cells and affects beta cell integrity...[An imbalance toward more alpha cells and fewer beta cells, as in Type 1 and Type 2 diabetes,] could result in further beta cell destruction.”
Glutamate toxicity is a new mechanism of beta cell destruction not previously known...[Alpha cells were not previously suspected as] a cause of beta cell damage... <br />
The study also found a [protective effect from a protein. GLT1. that controls glutamate levels outside the beta cells, "]like a thermostat controlling the microenvironment of beta cells with respect to glutamate concentration"....
Glutamate poisoning is a new candidate mechanism for beta cell destruction[, joining] high glucose, buildup of a protein called amyloid, and free fatty acids, which are found in patients with type 2 diabetes.
glutamate  glucagon  insulin  beta  cells  alpha  pancreas  amyloid  risk  free  fatty  acids  diet  research  diabetes  medical  links  peer-reviewed  what.I'm.reading  T2D  etiology  factor  from delicious
march 2011 by Michael.Massing
The Benefits of Tight Control (Show All) :: Diabetes Self-Management
The way primary care is organized and reimbursed by insurance companies probably serves as a barrier to achieving optimal blood glucose control....
Before [Maine's] program existed, 80% of people with diabetes had received an HbA1c test within the past year. After a year, 93% of people had received one. The percentage of people with HbA1c values less than 7% rose from 41% to 49%—a 20% increase. The percentage of people with HbA1c values above 8% decreased from 31% to 24%, and the percentage of people with HbA1c values above 9.5% decreased from 13% to 9%. There were similar results in measures of LDL (or “bad”) cholesterol and blood pressure.
“This is not a question of bad doctors or bad patients...It is a question of a care model that is focused on illness instead of prevention, and systems that have been created that don’t accommodate a change in focus. We’re changing the focus, including offering financial incentives for physicians whose patients do better.”
delivery  system  illness  management  diabetes  treatment  remission  A1c  comorbidities  blood  glucose  eyes  neuropathy  kidneys  prevention  tight  control  chronic  health  care  healthcare  Maine  model  self  what.I'm.reading  burden  risk  benefit  T2D  research  kidney  disease  nephropathy  from delicious
february 2011 by Michael.Massing
[Aerobic/Resistance Training Combo Improve Glycemic Control and Decrease Mortality] by 25% for Type 2's
Aerobic and resistance training each improve glycemic control for patients with type 2 diabetes, but the improvement is greatest when both forms of exercise are combined, according to the results of a randomized controlled trial.
exercise  blood  glucose  diabetes  aerobics  strength  resistance  self  care  control  survival  mitigate  morbidity  remission  what.I'm.reading  mortality  type  2  T2D  training  research 
september 2007 by Michael.Massing

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