Tag: Diabetes

Vitamin D Could Be Weapon Against Type 2 Diabetes

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By Amy Norton

HealthDay Reporter

TUESDAY, Feb. 7, 2023 (HealthDay News) — Vitamin D supplements are typically used to guard against bone loss and fractures, but new research offers up another possibility: For folks with pre-diabetes, they may help lower the chances of a full diabetes diagnosis.

Across three clinical trials, investigators found that vitamin D supplements were modestly effective in curbing the risk of pre-diabetes progressing to type 2 diabetes. Over three years, just under 23% of study patients using vitamin D developed diabetes, versus 25% of those given placebo pills.

On average, the study found, supplements lowered the risk of progressing to type 2 diabetes by 15%.

“It’s pretty clear vitamin D has a moderate effect on reducing the risk of type 2 diabetes, if you’re at high risk,” said lead researcher Dr. Anastassios Pittas, of Tufts Medical Center, in Boston.

The findings do not apply to people at average risk of the disease, he stressed, and it’s still unclear what the optimal dose of vitamin D is for people with pre-diabetes.

Plus, Pittas said, no supplement would be a replacement for lifestyle changes, including a healthy diet and regular exercise.

“We don’t want the message to be, take a pill and you won’t need to do the hard work of changing your diet and exercising,” Pittas said.

Type 2 diabetes arises when the body’s cells no longer properly respond to the hormone insulin, which helps shuttle sugars from food into cells to be used as energy. As a result, blood sugar levels remain chronically high, which over time can damage the blood vessels and lead to heart, kidney and eye disease, among other complications.

Pre-diabetes is a state where blood sugar is abnormally high, but not yet high enough to diagnose type 2 diabetes. In the United States alone, about 96 million adults have pre-diabetes, according to the U.S. Centers for Disease Control and Prevention.

The vitamin D study started with the observation that diabetes prevalence is typically greater in places farther from the equator. That, Pittas said, hinted that sunlight exposure — which spurs the body to naturally produce vitamin D — might play a role in diabetes risk.

Subsequent studies found a link between people’s blood levels of vitamin D and their risk of type 2 diabetes. Meanwhile, lab research pointed to some potential reasons: vitamin D can, for instance, restore normal insulin production in animals.

So far, there have been three clinical trials that directly tested whether vitamin D supplements can lower the odds of pre-diabetes progressing to type 2. Each found that participants given vitamin D did have a somewhat lower risk, versus those given a placebo. But the difference was not significant in statistical terms, meaning the supplement could not be declared effective.

So Pittas and his colleagues conducted a “meta-analysis” that pulled together the data from all three trials. The idea is that, with a larger number of patients, it will be easier to detect a moderate effect of vitamin D.

The analysis, published online Feb. 6 in the Annals of Internal Medicine, included just over 4,000 adults with pre-diabetes. Half were randomly assigned to take vitamin D. In two trials, participants took vitamin D3, at a dose of either 4,000 IU a day, or 20,000 IU per week. The third trial used eldecalcitol, a vitamin D “analogue” prescribed for osteoporosis.

Over three years, just under 23% of supplement users developed type 2 diabetes, versus 25% of placebo users.

That’s a modest difference, but the researchers pointed to the bigger picture: There are 374 million people worldwide with pre-diabetes, and these findings suggest that vitamin D can at least delay diabetes in 10 million of them.

“I’d say that’s pretty significant,” said Dr. Isaac Dapkins, chief medical officer of NYU Langone’s Family Health Centers, in New York City.

Dapkins, who was not involved in the study, said it gives him incentive to measure blood vitamin D levels in his patients with pre-diabetes. There were indications that supplements were more effective for participants who started off with vitamin D deficiency (below 12 ng/mL).

Like Pittas, Dapkins stressed the importance of overall lifestyle in halting the progression of pre-diabetes.

“If you were to start an exercise program, it would be more effective [than vitamin D],” he pointed out.

But, Dapkins said, adding a vitamin D supplement could be an easy, low-cost way to get further protection. His advice was for people with pre-diabetes to talk to their doctor, and get a blood vitamin D measurement if they haven’t already.

Pittas said more work is needed to figure out the optimal dose of vitamin D for people with pre-diabetes.

In general, 4,000 IU per day — the dose used in one trial — is considered the upper limit for vitamin D intake. Vitamin D is stored in body fat, Dapkins noted, and there is the potential for very high levels to cause problems, such as kidney stones.

Across the three trials, just over 1% of participants developed kidney stones, and supplement users were not at greater risk.

More information

The U.S. National Institutes of Health Office of Dietary Supplements has more on vitamin D.

SOURCES: Anastassios Pittas, MD, MS, chief, division of endocrinology, diabetes & metabolism, Tufts Medical Center, Boston; Isaac Dapkins, MD, chief medical officer, Family Health Centers, NYU Langone, New York City; Annals of Internal Medicine, Feb. 6, 2023, online

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February 7, 2023
Marriage May Help Keep Your Blood Sugar on Target

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Feb. 7, 2023 — Living with a spouse or a partner may help middle-age and older adults keep their blood sugar level in check, new research suggests.

And it doesn’t even have to be an ideal union. Just having the relationship seems to provide benefit, whether the partners described it as supportive or strained.

Katherine J. Ford, PhD, with the Department of Psychology at Carleton University in Ontario, Canada, led the study, published online today in the journal BMJ Open Diabetes Research & Care.

The team used data from 2004 to 2013 from more than 3,000 people in the English Longitudinal Study of Ageing (ELSA), a sample of adults in England ages 50-89 and their partners.

The people studied had not been diagnosed with diabetes and were asked over a decade about whether they had a wife, husband, or partner and whether there had been a change in their partnership status.

Ford says they saw an improvement – an average 0.2% decrease in HbA1c, a measure of average blood sugar concentrations over 3 months — when participants transitioned into a marriage or domestic partnership and a worsening, in this case a 0.2% increase in HbA1c, when they left such a relationship.

To put the results into some context, the researchers say that other work has suggested that a decrease of 0.2% in the average HbA1c value “would decrease excess mortality by 25%.”

Potential Reasons for Benefit

So why might marriage status affect blood sugar?

Ford says previous studies point to several reasons: “Oftentimes when people are experiencing stress in their life, having the social support of someone could help reduce that stress.”

It may also be the comfort of sharing expenses, such as housing, food, and insurance, reduces stress, she says.

“One partner might be more interested in healthy eating and that, sort of by osmosis, may influence the other partner in terms of their lifestyle choices as well,” Ford says.

Add Lower Blood Sugar to the Marriage Benefits

Other health benefits of living with a partner, particularly in older age, have been well-document in other studies. And studies have linked type 2 diabetes risk with lack of social support, loneliness, and isolation.

But those factors are complex and less easily tracked, so the team focused on easy-to-capture blood sugar levels.

They adjusted for factors that could affect results, such as whether the participants were retired or currently working and whether they reported depression or had changes in body mass index, as that number may change as vigorous exercise can become more difficult with age.

The authors note that this was an observational study of data so the study can’t prove that marriage status causes differences in blood sugar levels.

However, a strength of the study is that it used HbA1c, which is a precise measure, as an outcome instead of a measure that relies on self-reported data.

A limitation is that the database, the English Longitudinal Study of Ageing, includes primarily white participants, so it’s not clear whether the study’s conclusions would hold true for other races, Ford says.

Using the Information

The data may have messages for middle-age and older adults and their doctors.

“If someone’s going through a marital transition — whether they’ve lost a partner or are going through a divorce or separation — for the clinician, it might be important to check these biomarkers, like HbA1c_,” Ford says.

“Likewise, if older adults want to pursue romantic relationships and new partnerships, that should also be supported,” she says.

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February 7, 2023
Risks associated with control of blood sugar in the ICU

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Newswise — Efforts by hospital intensive-care unit teams to reduce glucose readings of patients with diabetes might do more harm than good, according to an analysis published today in Diabetes Care.

Dr. Michael Schwartz, lead author and a UW Medicine endocrinologist, said he decided to study the phenomenon after talking with Dr. Irl Hirsch, a colleague who had witnessed problems emerge among his patients in the ICU.

Schwartz and co-authors found that, among patients with diabetes, efforts to reduce blood glucose levels to what is considered normal in a non-diabetic person may actually harm the patients by triggering a dangerous reaction.

The article noted that relative hypoglycemia – or a decrease in glucose greater than or equal to 30% below prehospital admission levels – “has emerged as a major clinical concern because the standard glycemic target recommended for patients in the intensive care unit is associated with an increased mortality risk among some of the critically ill patients with diabetes.”

Low blood glucose, or hypoglycemia, can be dangerous because the brain depends on a steady supply of glucose to function. When someone’s blood glucose levels fall below a level of approximately 40 mg/dL to 60 mg/dL, the sympathetic nervous system triggers the release of hormones and other chemical signals to drive blood glucose back up. This phenomenon is known as a counterregulatory response.

While this response can help return the blood glucose level to normal, in parallel it also increases the heart rate and blood pressure, and perhaps activates the immune system. Schwartz and others in this review suspect this counterregulatory response may be the cause of higher death rates among ICU patients with diabetes who are treated for a high glucose level.

Patients with diabetes generally have a higher blood sugar level (100 to 200 mg/dL) than patients without diabetes, the study noted. For a patient without diabetes, normal levels are 70 to100 mg/dL

“The target range that is established in in the ICUs doesn’t differentiate between a patient with diabetes and a patient without diabetes,” Schwartz said. To establish the best blood sugar range, he said, a randomized clinical trial would need to determine the ideal glycemic level for ICU patients with, and without, diabetes.

People with diabetes usually have higher than normal blood sugar levels. Over time their bodies get used to these high blood sugar levels. As a consequence, when their blood sugars levels are brought into the normal range with treatment, their bodies incorrectly perceive the levels to be dangrously low, thereby triggering the counter regulatory response. Schwartz and his colleagues are studying how the body monitors and regulates blood sugar levels to try to understand how this response might be prevented or corrected.

While the brain can clearly sense when blood sugar is too low, exactly how this occurs is not well understood.For many years, it was thought that cells responsible for monitoring and regulating blood glucose levels resided in the brain. But work by the UW Medicine researchers now indicate that blood glucose sensing neurons reside outside of the brain, located in places like the liver and along blood vessels. These sensors monitor glucose concentrations in the blood and other tissues and send signals to brain centers that then respond to changes in levels, the study noted.

“We anticipate that future strategies aimed at reversing the underlying defect can ameliorate or even eliminate the problem of relative hypoglycemia in patients with diabetes,” the authors conclude, “To achieve this goal will require an improved understanding of how brain glucose sensing works in normal individuals and how it becomes impaired with patients with diabetes.”

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University of Washington School of Medicine and UW Medicine

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January 26, 2023
Language of Care: University of Utah Health Researchers Co-Design Health Care With the Deaf Community

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Newswise — Navigating health care is hard enough when English is your first language—imagine the difficulty when American Sign is your first language. How can we bridge the linguistic and cultural gaps needed to better care for patients? University of Utah Health is proud to present Language of Care, an incredible story of how a community of Deaf patients are breaking barriers by co-designing their own care with University of Utah Health researchers.

Made possible by generous support from the Kahlert Foundation, Language of Care premiered at Sundance Film Festival 2023. The film showcases an innovative approach to health care being co-created by Michelle Litchman, PhD, her research team, and members of the Deaf community from across the country. Together, they lead a program called Deaf Diabetes Can Together. Litchman is a nurse practitioner, diabetes researcher, and Medical Director of the Intensive Diabetes Education and Support (IDEAS) Program at the University of Utah.

Nearly 40 million people in the U.S. live with diabetes, but the majority of Deaf people with diabetes do not have equal access to health care. The film tells the story of how Deaf Diabetes Can Together is creating solutions for health equity in the Deaf community. By understanding the community’s unique needs, the team is tailoring educational and other types of resources to increase access to accurate information and care. This model is being replicated for rural, Pacific Islander and other under-resourced communities.

“Together, with our patients, we’re changing the way heath care works,” Litchman explains in Language of Care.

Academy Award®-winning filmmaker Ross Kauffman came to Utah to document the Language of Care story. Kauffman has directed a number of award-winning films, including Born into Brothels, Of Medicine and Miracles, and Tigerland. Language of Care was produced by Robin Honan with executive producers Joe Borgenicht of U of U Health, award-winning documentarian Geralyn Dreyfous, and Heather Kahlert of the Kahlert Foundation.

Language of Care is the third film in the U of U Health-produced series New Narratives in Health, which brings together scientists and artists to more broadly communicate advances in knowledge. The first film in the series, One in a Million, tells the story of how advanced genomic technologies combined with expert clinical insights vastly improved the quality of life for Tyler, a boy with a rare, debilitating disease. The second, Meet Me Where I Am, follows Adolphus Nickleberry through his journey at U of U Health’s Intensive Outpatient Clinic as he rewrites his story, which had been shaped by health disparities.

Learn more at languageofcareutah.org.

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About University of Utah Health

University of Utah Health provides leading-edge and compassionate care for a referral area that encompasses Idaho, Wyoming, Montana, and much of Nevada. A hub for health sciences research and education in the region, U of U Health has a $458 million research enterprise and trains scientists and the majority of Utah’s physicians and health care providers at its Colleges of Health, Nursing, and Pharmacy and Schools of Dentistry and Medicine. With more than 20,000 employees, the system includes 12 community clinics and five hospitals. U of U Health is recognized nationally as a transformative health care system and provider of world-class care.

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January 24, 2023
Across the US, white neighborhoods have more greenery, fewer dilapidated buildings, fewer multi-family homes

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Newswise — Historic redlining and other racist policies have led to present-day racial and economic segregation and disinvestment in many cities across the United States. Research has shown how neighborhood characteristics and resources are associated with health disparities such as preterm birth and asthma, but most of these studies are limited in scale and overlook many aspects in a neighborhood that are difficult to measure, including dilapidated buildings and crosswalks.

Now, a new study led by Boston University School of Public Health (BUSPH) and the Center for Antiracist Research (CAR) at Boston University (BU) has utilized panorama digital technology through Google Street View (GSV) to identify these neighborhood characteristics on a national scale and shed light on how they contribute to racial and ethnic disparities in local resources and health outcomes across the US.

Published in the journal JAMA Network Open, the study found that predominantly White neighborhoods had better neighborhood conditions generally associated with good health, such as fewer neglected buildings and multi-family homes, and more greenery than neighborhoods with residents who were primarily Black, of other minority races, or of a variety of races and ethnicities.

The findings underscore the need for comprehensive and accessible data platforms that researchers can utilize to better understand the role of the built environment on racial and health inequities, and inform policies that aim to create equitable neighborhood resources in all communities.

“Large datasets on determinants of health can help us better understand the associations between past and present policies—including racist and antiracist policies—and neighborhood health outcomes,” says study corresponding author Dr. Elaine Nsoesie, associate professor of global health at BUSPH. “Neighborhood images are one dataset that have the potential to enable us to track how neighborhoods are changing, how policies are impacting these changes and the inequities that exist between neighborhoods.”

For the study, Dr. Nsoesie and colleagues analyzed national data on race, ethnicity, socioeconomics, and health outcomes, and 164 million GSV images across nearly 60,000 US census tracts. The team examined five neighborhood characteristics: dilapidated buildings, green spaces, crosswalks, multi-family homes, and single-lane roads.

The largest disparities in neighborhood environments were reflected in green space and non-single family homes. Compared to predominantly White neighborhoods, predominantly Black neighborhoods had 2 percent less green space, and neighborhoods with racial minorities other than Black had 11 percent less green space. Compared to White neighborhoods, neighborhoods with racial minorities other than Black had 17 percent more multi-family homes, while neighborhoods with Black residents and neighborhoods with residents representing a variety of races and ethnicities had 6 percent and 4 percent more multi-family homes, respectively.

The researchers also conducted modeling to measure how the built environment may influence the association between health outcomes and the racial makeup of neighborhoods, and found the strongest connections between sleeping problems among residents in neighborhoods with racial minorities other than Black or White, and asthma among neighborhoods with residents representing a variety of races and ethnicities.

“An interesting finding from our paper is how a considerable portion of the racial/ethnic differences of the built environment conditions was shown at the state level,” says study co-lead author Yukun Yang, a data scientist at CAR. “This prompts us to think practically about how state and local government and policymakers could and should address the inequitable distribution of built environment resources which could further address the health disparities we observed today.”

“Our findings really demonstrate the path-dependent nature of inequality and racial disparities,” says study co-lead author Ahyoung Cho, a racial data/policy tracker at CAR and a political science PhD student at BU. “It is critical to develop appropriate policies to address structural racism.”

**

About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master’s- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally

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Boston University School of Public Health

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January 20, 2023
American Society of Nephrology Statement on U.S. Preventive Services Task Force Draft Research Plan on Screening for Kidney Diseases

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Newswise — Washington, DC (January 20, 2023) —The American Society of Nephrology (ASN) is encouraged by the recent U.S. Preventive Services Task Force (USPSTF) announcement to solicit comment on USPSTF’s draft research plan on screening for kidney diseases. This development follows more than a decade of advocacy in support of more kidney health screening by ASN and other stakeholders dedicated to intervening earlier to slow or stop the progression of kidney diseases.

More than 37 million Americans suffer from kidney diseases that impact virtually every aspect of their lives as well as their families and communities. Kidney diseases are the ninth leading cause of death in the United States, yet 90% of Americans with kidney diseases are unaware that they are affected. Prevention and early detection are key to preventing kidney failure and achieving kidney health.

People with a family history of kidney diseases and people with diabetes, obesity, or other health issues, are at a higher risk of kidney diseases. Older adults, people with lower incomes, and people who are Black/African American, Hispanic/Latinx, Native/Indigenous American, Native Alaskan, Asian, and Native Hawaiian or other Pacific Islander are also most at risk for kidney diseases and kidney failure. Dialysis, the most common therapy for those with kidney failure, has a 5-year mortality rate worse than nearly all forms of cancer and requires billions of dollars annually to manage and treat. The recent approval of numerous therapies that successfully slow or stop the progression of kidney diseases mean it is more important than ever to screen Americans who are at-risk so they can access these effective, novel drugs as soon as possible.

“Early screening to drive faster more comprehensive intervention are critical components of a holistic prevention strategy for kidney diseases,” said ASN President Michelle A. Josephson, MD, FASN. “We fully support USPSTF and their efforts to advance the research agenda on this critical public health priority.” Dr. Josephson added, “The entire kidney community has contributed to this decades-long effort and ASN is committed to continuing our work with other advocates, including the Coalition 4 Kidney Health, and the USPSTF to prioritize screening for kidney diseases as USPSTF finalizes its draft research plan.”

For more information, please visit https://www.asn-online.org/policy/lac.aspx?ID=36

About ASN

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 132 countries. For more information, visit www.asn-online.org and follow us on Facebook, Twitter, LinkedIn, and Instagram.

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American Society of Nephrology (ASN)

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January 20, 2023
High fat diet activates early inflammation in mouse brains, supports link to neurologic disease

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Newswise — Researchers at Michigan Medicine have discovered that a high-fat diet promotes an early inflammatory response in the brains of mice through an immune pathway linked to diabetes and neurologic diseases, suggesting a possible bridge between metabolic dysfunction and cognitive impairment.

For the study, published in Frontiers in Immunology, investigators analyzed activation of the cGAS/STING immune pathway in a high-fat diet mouse model of prediabetes and cognitive impairment or dementia. Though early changes in cognition were not detected, results reveal insulin resistance, as well as inflammatory activation of cGAS/STING and the microglia, the brain’s immune cells, within three days of feeding.

“While there is evidence suggesting a role for cGAS/STING in obesity and diabetes, both of which make patients more vulnerable to cognitive impairment or dementia, its role in the brain has not been previously studied,” said Sarah Elzinga, Ph.D., first author and a postdoctoral fellow at the NeuroNetwork for Emerging Therapies at Michigan Medicine.

“We now see that this pathway is involved in an early burst of immune response in the microglia, which plays a critical role in Alzheimer’s disease and related dementias. If microglia are activated in the hippocampus under high-fat diet conditions, that may contribute to inflammation and degeneration in the nervous system and eventual cognitive impairment or dementia.”

Obesity and diabetes are significantly associated with the development of dementia and other neurologic diseases. Elzinga and the research team say further research is needed to examine if inhibiting the cGAS/STING pathway is a possible treatment target for reversing or preventing harmful changes in the brains of people who develop cognitive impairment or dementias.

“Innovative ideas that can lead to novel treatment paradigms are critical in our battle against Alzheimer’s disease,” said senior author Eva Feldman, M.D., Ph.D., James W. Albers Distinguished Professor at U-M, the Russell N. DeJong Professor of Neurology and director of the NeuroNetwork for Emerging Therapies at Michigan Medicine. “This research with cGAS/STING is one such innovation and opens doors to exciting new therapeutic possibilities.”

Additional authors include Rosemary Henn, Ph.D., Benjamin J. Murdock, Ph.D., Bhumsoo Kim, Ph.D., John M. Hayes, Ian Webber-Davis, Sam Teener, Crystal Pacut, Stephen I. Lentz, Ph.D., all of Michigan Medicine, Faye Medelson

Funding for this study was provided in part by the NIH National Institute of Diabetes and Digestive Kidney Disease and the National Institute on Aging.

Paper cited: “cGAS/STING and innate brain inflammation following acute high-fat feeding,” Frontiers in Immunology. DOI: 10.3389/fimmu.2022.1012594

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Michigan Medicine – University of Michigan

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January 17, 2023
ARVO Foundation Announces 2023 Recipient of Genentech Career Development Award for Underrepresented Minority Emerging Vision Scientists

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Newswise — Rockville, Md.—The Association for Research in Vision and Ophthalmology (ARVO) Foundation congratulates Edmund Arthur, OD, PhD, the 2023 recipient of the Genentech Career Development Award for Underrepresented Minority (URM) Emerging Vision Scientists. Arthur will receive a two-year grant totaling $100,000 to support research and personnel costs for establishing an independent vision research program.

The Genentech Award is intended to provide early-career URM investigators with an opportunity to explore novel and innovative research project ideas. An optometrist and a vision scientist, Arthur is currently an assistant professor of optometry at the University of Alabama at Birmingham. His research is investigating a novel retinal vascular biomarker for early diabetic retinopathy (DR) detection and disease monitoring known as the peripheral capillary free zones.

“This award provides critical support for my research career,” says Arthur. “The data from this two-year pilot study will inform several future research projects in diabetic retinopathy (DR) and diabetic macular edema (DME) in my lab.” Arthur noted this includes a biological variable model for screening and early detection of DR and DME in underserved populations. “This will be a three-year cross-sectional study aimed at developing a biological variable model that includes ethnicity, HbA1c, age, and sex in screening for individuals at risk of worse diabetes associated retinal neurodegeneration in underserved populations.”

As part of the award, ARVO will also match Arthur with a mentor outside of his home institution to provide support for his career advancement.

For more information about the Genentech Career Development Award for Underrepresented Minority Emerging Vision Scientists, visit ARVO’s website.

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The Association for Research in Vision and Ophthalmology (ARVO) is the largest eye and vision research organization in the world. Members include approximately 10,000 eye and vision researchers from over 75 countries. ARVO advances research worldwide into understanding the visual system and preventing, treating and curing its disorders. Learn more at ARVO.org.

Established in 2001, the ARVO Foundation for Eye Research raises funds through partnerships, grants and sponsorships to support ARVO’s world-class education and career development resources for eye and vision researchers of all stages of career and education. Learn more at ARVOFoundation.org.

Founded more than 40 years ago, Genentech is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious and life-threatening medical conditions. The company, a member of the Roche Group, has headquarters in South San Francisco, California. For additional information about the company, please visit Gene.com.

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Association for Research in Vision and Ophthalmology (ARVO)

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January 16, 2023
Artificial Pancreas Device May Help Folks With Type 2 Diabetes

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By Denise Mann

HealthDay Reporter

FRIDAY, Jan. 13, 2023 (HealthDay News) — An artificial pancreas has long been considered the holy grail for people with type 1 diabetes, and new research suggests a more convenient version of this technology may help the millions of people living with type 2 diabetes.

Type 2 is the more common form of diabetes, and is closely linked to obesity.

The pancreas produces insulin, the hormone that helps blood sugar (or glucose) enter cells to be used as energy.People with type 1 diabetes make little to no insulin. When insulin is in short supply, glucose builds up, causing extreme fatigue, blurry vision, weight loss and confusion. Some people with type 2 diabetes also need to take daily insulin to keep their blood sugar in check.

Enter the artificial pancreas, an automated insulin delivery system that mimics the pancreas’ function.

“About 20% to 30% of people living with type 2 diabetes use insulin therapy to manage their diabetes, and we have shown that this way of delivering insulin with a closed-loop system is much more effective than their current insulin injections at reaching glucose targets,” said study author Dr. Charlotte Boughton, a clinical lecturer at the University of Cambridge in England.

With closed-loop systems for type 1 diabetes, the user enters information several times a day about the timing and size of their food intake, but insulin delivery between meals and overnight is automated. By contrast, the new system for people with type 2 diabetes is a fully closed loop. This means users don’t have to input any information.

It was developed using over-the-counter devices, including an off-the-shelf glucose monitor and an insulin pump with an app called CamAPS HX. This software predicts how much insulin is needed to keep blood sugar levels in the target range. People wear the blood sugar sensor and insulin pump and carry a smartphone with them for the system to work, Boughton said.

“This fully automated closed-loop system is a safe and much more effective way for people living with type 2 diabetes to manage their glucose levels than current standard treatment with insulin,” she said.

Just how effective was it? When people with type 2 diabetes used the new system, they spent twice as much time with glucose levels in the target range than when they tested blood sugar and gave themselves insulin shots, the investigators found.

Boughton said this is equivalent to an additional eight hours a day and was achieved without increasing the risk of dangerously low glucose levels.

“We anticipate that the improvement in glucose control we have seen may reduce the risk of diabetes complications such as eye disease, kidney disease and amputations, but a much larger study with longer follow-up is required to investigate this,” she added.

The new study included 26 people with type 2 diabetes. One group used the artificial pancreas for eight weeks and then switched to multiple daily insulin injections. The others were treated in the opposite order.

On average, people using the artificial pancreas were within their target blood sugar range two-thirds of the time. This is double what was seen with standard insulin shots, according to the report.

What’s more, people delivering insulin via shots spent two-thirds of their time with high glucose levels, compared with 33% when using the artificial pancreas, the researchers found.

The system also helped reduce levels of glycated hemoglobin, or HbA1c, which provides a snapshot of blood sugar levels over time.

No one in the study experienced dangerously low blood sugar, or hypoglycemia, which can occur if the device doesn’t keep blood sugar levels in the target range.

And then there is the quality-of-life improvement that comes with not needing to constantly check blood sugar levels, inject insulin or take medication. Nine of 10 participants said they spent less time managing their diabetes when they used the artificial pancreas.

This technology could be game-changing for millions.

“The number of people diagnosed with type 2 diabetes is increasing globally, and people are diagnosed at a younger age, so they are living with type 2 diabetes for longer,” Boughton said. “Anyone with type 2 diabetes who struggles to keep glucose levels where they should be with insulin injections could benefit from this system.”

The devices do cost more than standard insulin injections and glucose testing kits.

“If the closed-loop system can reduce the risk of very expensive diabetes complications in the long-term — such as the need for dialysis, visual impairment and amputations — then they may be cost-effective. But a much larger study with longer follow-up is required to investigate this,” Boughton stressed.

The researchers have previously shown that an artificial pancreas run by a similar algorithm is effective for those with type 1 diabetes and have also tested this system in people with type 2 diabetes who require kidney dialysis.

These systems can be fairly simple to use: You wear the devices, load them with insulin and go about your daily routine, explained Dr. John Buse, chief of endocrinology and director of the Diabetes Center at the University of North Carolina at Chapel Hill.

“No such device is available in the U.S. or, to my knowledge, anywhere in the world,” said Buse, who reviewed the new study.

Similar investigational technologies cost about $10,000 per year for the devices, supplies, insulin and provider support, he said. “[They cost] more in the first year with acquisition costs and less over time,” he explained.

More research is needed before this device is ready for prime time, but the promise is real, Buse added.

“Keeping glucose in a relatively narrow range holds the promise of reducing long-term complications of diabetes — blindness, kidney failure, amputations, heart attacks, strokes, as well as minimizing the risk of urgent hospitalization related to high or low glucose, as well as potentially reduced risk of infection, cognitive decline and other important issues common in diabetes,” he said.

The findings were published online Jan. 11 in Nature Medicine.

More information

Learn more about the artificial pancreas at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Charlotte Boughton, PhD, clinical lecturer, University of Cambridge, U.K.; John Buse, MD, PhD, professor, medicine, director, Diabetes Center and N.C. Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill; Nature Medicine, Jan. 11, 2023, online

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January 13, 2023
Consumption of fast food linked to liver disease

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Newswise — LOS ANGELES — The new year has begun, and with it, resolutions for change.

A study from Keck Medicine of USC published today in Clinical Gastroenterology and Hepatology gives people extra motivation to reduce fast-food consumption.

The study found that eating fast food is associated with nonalcoholic fatty liver disease, a potentially life-threatening condition in which fat builds up in the liver.

Researchers discovered that people with obesity or diabetes who consume 20% or more of their daily calories from fast food have severely elevated levels of fat in their liver compared to those who consume less or no fast food. And the general population has moderate increases of liver fat when one-fifth or more of their diet is fast food.

“Healthy livers contain a small amount of fat, usually less than 5%, and even a moderate increase in fat can lead to nonalcoholic fatty liver disease,” said Ani Kardashian, MD, a hepatologist with Keck Medicine and lead author of the study. “The severe rise in liver fat in those with obesity or diabetes is especially striking, and probably due to the fact that these conditions cause a greater susceptibility for fat to build up in the liver.”

While previous research has shown a link between fast food and obesity and diabetes, this is one of the first studies to demonstrate the negative impact of fast food on liver health, according to Kardashian.

The findings also reveal that a relatively modest amount of fast food, which is high in carbohydrates and fat, can hurt the liver. “If people eat one meal a day at a fast-food restaurant, they may think they aren’t doing harm,” said Kardashian. “However, if that one meal equals at least one-fifth of their daily calories, they are putting their livers at risk.”

Nonalcoholic fatty liver disease, also known as liver steatosis, can lead to cirrhosis, or scarring of the liver, which can cause liver cancer or failure. Liver steatosis affects over 30% of the U.S. population.

Kardashian and colleagues analyzed the most recent data from the nation’s largest annual nutritional survey, the 2017-2018 National Health and Nutrition Examination Survey, to determine the impact of fast-food consumption on liver steatosis.

The study characterized fast food as meals, including pizza, from either a drive-through restaurant or one without wait staff.

The researchers evaluated the fatty liver measurement of approximately 4,000 adults whose fatty liver measurements were included in the survey and compared these measurements to their fast-food consumption.

Of those surveyed, 52% consumed some fast food. Of these, 29% consumed one-fifth or more daily calories from fast food. Only this 29% of survey subjects experienced a rise in liver fat levels.

The association between liver steatosis and a 20% diet of fast food held steady for both the general population and those with obesity or diabetes even after data was adjusted for multiple other factors such as age, sex, race, ethnicity, alcohol use and physical activity.

“Our findings are particularly alarming as fast-food consumption has gone up in the last 50 years, regardless of socioeconomic status,” said Kardashian. “We’ve also seen a substantial surge in fast-food dining during the COVID-19 pandemic, which is probably related to the decline in full-service restaurant dining and rising rates of food insecurity. We worry that the number of those with fatty livers has gone up even more since the time of the survey.”

She hopes the study will encourage health care providers to offer patients more nutrition education, especially to those with obesity or diabetes who are at higher risk of developing a fatty liver from fast food. Currently, the only way to treat liver steatosis is through an improved diet.

Jennifer Dodge, MPH, assistant professor of research medicine and population and public health sciences at the Keck School of Medicine of USC and Norah Terrault, MD, MPH, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School, were also authors on the study.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

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January 10, 2023
Dos and Don’ts of Dieting With Diabetes

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Dos and Don’ts of Dieting With Diabetes

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January 4, 2023
Best Diets in 2023: Mediterranean Diet Wins Again

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Jan. 3, 2022 – It’s officially 2023, and if history repeats, millions of Americans are likely vowing that this year will be one when they drop those unwanted pounds for good. After all, weight loss usually lands one of the top spots on New Year’s resolution surveys.

And just in time, there’s guidance to pick the best plan. Released today are U.S. News & World Report’s annual rankings of the best diet plans.

Once again, the Mediterranean diet, which emphasizes fruits, vegetables, olive oil, and fish, got the top spot, as best diet overall. It’s the sixth consecutive year for that win. But many other diets got top marks as well.

This year, U.S. News, with the help of more than 30 nutritionists, doctors, and epidemiologists, ranked 24 diets in several categories to help people find a plan that meets their goals, whether it’s finding the best weight loss diet, easiest one to follow, or plans for other goals, such as managing diabetes or heart disease. Two new categories were added: Best Diets for Bone & Joint Health and Best Family-Friendly Diets.

In previous years, the publication ranked 40 diets. Even if a diet is no longer ranked, its profile with detailed information remains on the site.

“Each year we ask ourselves what we can do better or differently next time,” says Gretel Schueller, managing editor of health for U.S. News. When the publication got feedback from their experts this year, they had requests to consider sustainability of diets and whether they meet a busy family’s needs, in addition to considering many other factors.

This year’s report ranks plans in 11 categories.

The winners and the categories:

Best Diets Overall

After the Mediterranean diet, two others tied for second place:

DASH (Dietary Approaches to Stop Hypertension) diet, which fights high blood pressure and emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy.

Flexitarian diet, which focuses on fruits, vegetables, and other healthy foods but also allows occasional meat.

Best Weight Loss Diets

WW, formerly known as Weight Watchers, got first place. The plan emphasizes not only weight loss but healthier eating and regular activity. The Points program, which assigns specific points to foods, with a daily Points budget, is more personalized than in the past.

DASH got second place.

Mayo Clinic Diet and TLC diet tied for third place. The Mayo Clinic Diet focuses on fruits, vegetables, and whole grains. It helps people improve their eating habits. The TLC diet (Therapeutic Lifestyle Changes) focuses on vegetables, fruit, lean protein, and reducing cholesterol levels.

Best Fast Weight Loss Diets

The keto diet got first place. It’s a high-fat, low-carb diet that aims to achieve weight loss through fat burning. Four others tied for second place:

Atkins, a diet created by the cardiologist Robert Atkins, which begins with very few carbs and then recommends progressively eating more until the weight loss goal is achieved

Nutrisystem, a commercial program that includes prepackaged meals and focuses on high-protein, lower-glycemic foods to stabilize blood sugar levels

Optavia, a plan focused on low-carb, low-calorie foods and including fortified meal replacements

SlimFast Diet, a plan of shakes, smoothies, and meal bars to replace two of three meals a day

Best Diets for Healthy Eating

Mediterranean

DASH

Flexitarian

Best Heart-Healthy Diets

DASH

Mediterranean

Flexitarian and Ornish tied for third. The Ornish Diet focuses on plant-based and whole foods and limiting animal products. It recommends daily exercise and stress reduction.

Best Diets for Diabetes

DASH

Mediterranean

Flexitarian

Best Diets for Bone and Joint Health

DASH and Mediterranean are in a first-place tie, followed by the flexitarian diet.

Best Family-Friendly Diets

This category has a three-way tie: the flexitarian, Mediterranean, and TLC diets.

Best Plant-Based Diets

Mediterranean was first, then flexitarian and the MIND diet. The MIND diet combines the DASH and Mediterranean diets and focuses on “brain-healthy” foods.

Easiest Diets to Follow

Flexitarian and TLC tied for first, followed by a tie between DASH and Mediterranean.

Best Diet Programs (formerly called commercial plans)

WW

There was a tie for second place between Jenny Craig and Noom, the latter of which focuses on low-calorie foods, with personalized calorie ranges and coaching to help meet goals.

Methodology

A variety of factors were considered, such as whether a diet includes all food groups, how easy it is to follow, whether it can be customized to meet cultural and personal preferences, and if it has a realistic timeline for weight loss.

Response from Diet Plans

Representatives from two plans that received mixed reviews in the rankings responded.

Jenny Craig was ranked second for best diet program but much lower for family-friendly, landing at 22^nd place of 24.

“Our program is designed to address the needs of the individual through personalized experiences,” Jenny Craig CEO Mandy Dowson says. “We have many families that participate in our program together but are still evaluated separately to determine appropriate individual goals.”

Its high ranking for best diet program reflects feedback from satisfied members, she says. Among advances will be the new Jenny Fresh program, a line of entrées prepared fresh and delivered to customers’ doors.

Atkins got second place for best fast weight loss but ranked near the bottom for best overall, best weight loss, diabetes, healthy eating, and heart health. In response, Colette Heimowitz, vice president of nutrition and education for Simply Good Foods, which makes Atkins’s food products, says that low-carb eating approaches are a viable option for anyone today.

“There are more than 130 independent, peer-reviewed published studies that show the efficacy and safety of low-carb eating,” she says. “The studies have been conducted for several decades and counting.”

Expert Perspective

Samantha Cassetty, a registered dietitian, nutritionist, and wellness expert in New York City and author of Sugar Shock, reviewed the report for WebMD. She was not involved in the rankings.

“I think what this shows you is, the best diet overall is also the best for various conditions,” she says. For instance, the Mediterranean, the number one overall, also got high ranking for diabetes, heart health, and bone and joint health, she points out.

For consumers trying to lose weight: “If you see fast weight loss, that should be a red flag. A healthy diet for weight loss is one you can sustain,” she says.

She’s not a fan of the programs with prepackaged foods. “It takes the guesswork out, but the portion sizes tend to be unsatisfying. They don’t teach you how to deal with some of the challenges [such as realizing an ‘ideal’ portion size].”

How to Use the Report

Schueller’s advice: “Recognize that no diet fits everyone.” When considering which plan to choose, she suggests thinking long-term.

“Whatever we choose has to work in the long run,” she says.

Consumers should consider expenses, meal prep time, and whether the diet fits their lifestyle.

Ideally, she says, the best diet “teaches you smart food preparation and how to make healthy choices, allows the flexibility to be social and eat with groups, whether family or friends.”

Before choosing a diet to follow, consult a medical professional for input on the decision, U.S. News cautions.

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January 3, 2023
Protect Your Eyesight

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By Sunir Garg, MD, as told to Hallie Levine

Diabetic retinopathy, a type of diabetic eye disease, is one of the leading causes of blindness in the United States. Despite this, almost 40% of people with diabetes don’t get an annual eye exam. But these screening tests are key, since they can prevent vision loss by catching diabetic retinopathy in the early, more treatable stages of disease.

Diabetic retinopathy can cause permanent vision loss.

Many people are surprised to learn that diabetic retinopathy is the most common cause of vision loss for people with diabetes. Here’s a quick primer.

Diabetes is a disease that affects the small blood vessels throughout the body, including the delicate blood vessels in the back of your eye. These blood vessels are just like pipes: When they become damaged, they weaken and start to leak. Over time, these tiny blood vessels drip blood and plasma onto your retina. This causes retinal tissue to swell, which leads to cloudy or blurred vision. This also causes damage that results in less oxygen and other nutrients getting to your retina.

Sometimes, your body tries to correct the problem by making new blood vessels. But these blood vessels are fragile and can burst and bleed, or form scar tissue that pulls your retina off of your eye wall. All of these scenarios may ultimately lead to blindness.

You can have diabetic retinopathy and not know it.

The condition often has no symptoms in its early stages, which is why an annual eye exam is so important. As it worsens, you may notice symptoms like:

Blurry vision

Vision that changes from blurry to clear

Blank or dark areas in your field of vision

Floaters, or dark spots in your vision

Poor night vision

Colors appear faded

Unfortunately, patients often don’t see an eye specialist until they experience symptoms such as floaters or blurry vision, and by then damage has been done.

There’s a lot you can do to treat diabetic retinopathy.

When we notice signs of diabetic retinopathy during a patient’s routine eye exam, they’re often very frightened. They worry that they will lose their vision. But most of the time, their disease is mild. We explain that the best way to stop vision loss is to make sure their blood sugar and blood pressure are both under good control. They need to watch their diet carefully and take all their medications as prescribed. Oftentimes, we show patients a picture of their eyeball so they can see the damage their diabetes has done. That’s usually enough to help them understand why blood sugar and blood pressure control are so critical to help their overall well-being.

But if your disease is more advanced, don’t panic. The first step is a class of drugs known as anti-VEGFs. These medications help reduce eye swelling, which can slow down vision loss and even improve vision. It’s given as a shot, injected into your eye at your eye specialist’s office. Laser surgery can also help seal off leaking blood vessels, shrink abnormal blood vessels, and reduce retinal swelling. If you have a very advanced case, you may need a type of eye surgery known as a vitrectomy. An eye surgeon will remove blood and plasma from your eye and remove scar tissue from your retina. This will also help you to see more clearly again.

Regular eye exams are key.

People with diabetes need to have a routine eye exam every year by an eye doctor (either an ophthalmologist or an optometrist). This is true even if you otherwise have 20/20 vision. Your doctor will give you some eye drops to dilate, or widen, your pupils so that they can look inside your eyes to check them for diabetic retinopathy and other eye problems.

If you’ve just been diagnosed with diabetes, you need an eye exam right away to make sure your eyes are OK. After that, you should have an eye exam every year — more frequently if you have diabetes-related eye problems such as diabetic retinopathy.

There are also other times in your life when you may need a full eye exam. Women with diabetes who are pregnant, for example, need an eye exam during every trimester, since changes in blood pressure and fluid retention may cause their diabetes to worsen.

Interestingly enough, you also need to get your eyes checked once you get your diabetes under good control. For some reason, that shift can cause some worsening of diabetic eye disease in certain patients. We don’t know why, other than your body has gotten used to things being a hot mess and your eyes don’t know how to cope with this sudden change.

The good news is that most patients with diabetes who get regular eye exams who do go on to develop diabetic retinopathy end up doing very well. When we monitor them appropriately and treat problems when they creep up, we can keep the vast majority of patients seeing quite well for years, sometimes even an entire lifetime. But both the doctor and the patient must work together to make that happen.

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December 20, 2022
Could Intermittent Fasting Help People Ditch Diabetes Meds?

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Dec 15, 2022 – Some people with type 2 diabetes may be able to lose weight, lower their blood sugar, and stop taking diabetes drugs, if they follow anintermittent fasting diet for 3 months, new research suggests.

Intermittent fasting – such as the 5:2 diet, which consists of eating few calories for 2 days followed by eating normally for 5 days – has led to weight loss in previous studies.

But it hasn’t been clear whether intermittent fasting might lower HbA1c levels – a measure of a person’s average blood sugar levels over the past 2 to 3 months.

And specifically, it was not known if intermittent fasting could let people revert to a non-diabetic state, known as diabetes remission – defined as having a blood sugar level below 6.5% for at least 3 months after stopping all diabetes medications.

This new study in 72 patients with type 2 diabetes in China showed that indeed, the 36 patients in the intermittent fasting group lost roughly 13 pounds and maintained this weight loss for 1 year, and close to half achieved diabetes remission. This compared with barely any weight loss for the 36 patients in the control group, of whom just 3% achieved remission.

The results show that “type 2 diabetes is not necessarily a permanent, lifelong disease,” senior author Dongbo Liu, PhD, from the Hunan Agricultural University in China, said in a news release. “Diabetes remission is possible if patients lose weight by changing their diet and exercise habits.”

“The large amount of weight reduction is key to continuing to achieve diabetes remission,” Amy E. Rothberg, MD, PhD, a professor of nutritional sciences at the University of Michigan, said in an interview. Rothberg was not involved with this study.

The bottom line is that “lifestyle changes work,” she says.

Although these findings are specific for an Asian population, they suggest that a similar approach could be tailored to other populations.

People with type 2 diabetes who would like to try intermittent fasting need guidance from a dietitian, Rothberg says, to make sure their diet includes all the necessary micronutrients, vitamins, and minerals on fasting days. They also need to maintain a relatively balanced diet and not gorge themselves on feast days.

She also advises patients: “Try to reduce your calories by a method that you find sustainable, so that you can lose weight and maintain that reduced weight.”

The study was published Dec. 14 in The Journal of Clinical Endocrinology & Metabolism.

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December 15, 2022
Why Are Black Mothers at Higher Risk for Miscarriage?

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NeCara McClendon was 19 weeks pregnant and home on a Tuesday evening after work in August of 2022 when she started to bleed – heavily.

At the nearest ER in Fredericksburg, VA, where she lives, medical personnel told her that her cervix was opening. Her baby and the amniotic sac were moving into the birthing canal too early.

One doctor told her there was no hope, a second doctor said she needed an expert consult, and a third doctor via telehealth recommended a transfer and a technique in which the mother is tilted head down in a hospital bed to try and avoid miscarriage.

The mixed messages were disheartening, Mclendon said. “It felt like they kept giving me a little hope and then taking it away.”

After the transfer, McClendon found out that the new hospital didn’t offer the tilt treatment. Instead, they gave her medicine and told her to wait. And she did – for 3 days – before an ultrasound showed her son’s legs in the birth canal.

The doctor said there was nothing that could be done. McClendon delivered her son the next morning at 19 weeks and 5 days, too young to survive outside her womb.

“The days afterward were nonstop crying – asking [myself] why did this happen to me. I started to feel like a failure.”

Why It Happens

Miscarriage is more common than many people think. It happens in about 1 in 4 pregnancies, usually in the first trimester. It’s often not clear why it happens.

Still, some things raise the risk of miscarriage. Weight is one of them and McClendon is slightly overweight. She also has polycystic ovarian syndrome (PCOS), which means her ovaries produce too many male sex hormones called androgens. PCOS can raise the risk of an early miscarriage in the first 3 months of pregnancy. (McClendon didn’t lose her son until almost the fifth month.)

But there is another factor: McClendon is Black.

In the United States, Black women are 43% more likely than white women to have a miscarriage, according to a 2021 study that looked at more than half a million U.S. women. (A Black mother is also more likely than a white mother to lose her baby after 20 weeks or in delivery (stillbirth), or to lose her life, according to the CDC.)

“The scandal is we really don’t know [why],” said the study’s lead author, Siobhan Quenby, MD. “We desperately need more research. It’s not acceptable in 2022 not to know.”

Doctors do know that health risk factors for miscarriage like diabetes, obesity, and high blood pressure are more common in Black women than white women.

But again, the question is why? Factors include differences in biology, society, culture, lifestyle, and medical care, among others. And these can be quite hard to separate out, according to experts.

Other lesser-studied biological factors may also play a part. For example, fibroids – muscular tumors that grow on the wall of the uterus — can sometimes cause miscarriage. Almost 25% of Black women aged 18 to 30 have them, compared to 6% of white women. Black women are also two to three times more likely to have recurring fibroids or complications, which could add to the problem.

The difference in vaginal microbiota between Black and white women may be involved since the vaginal microbiome has been linked to recurrent miscarriage.

But it’s discrepancies in access and use of medical care that could make the biggest difference, said Ana Langer, MD, director of the Women’s Health Initiative at Harvard’s T.H. Chan School of Public Health.

Black women are less likely to seek adequate prenatal care for any number of reasons, Langer said. These may include lack of insurance, lack of financial and educational resources, lack of nearby health facilities, fear of mistreatment, and more. Even the perception of racial discrimination in society at large can delay prenatal care, according to some research.

The effect of race in medical settings can be hard to unpack. In one striking study, the death rate of Black newborns, which is three times higher than white newborns in the U.S., was cut in half when they were cared for by a Black doctor. But oddly, physician race did not affect the mother’s outcomes, the study found. Researchers continue to study these issues.

After the Miscarriage

Since August, McClendon and her partner have been trying to find an in-person grief counselor they could see as a couple. But so far, they’ve had no luck. So they’ve been making their way on their own – with some success. “I won’t say it gets better, but you handle it better,” she said.

The grief comes in waves, she says. Some days they’re OK and other days the pain unexpectedly resurges. The approach of the baby’s due date has been particularly hard.

“This past Saturday was supposed to be the date of my baby shower,” McClendon said. A day intended to celebrate McClendon and her future son turned into a day to remember what she had lost. It was a tough day. But she made it through. “It started off sad, but it eventually turned OK,” she said.

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December 14, 2022
Low-Carb Diet May Be Better Than Counting Calories for Diabetes

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Dec. 14, 2022 — Forget about counting calories. People with type 2 diabetes can lose weight and keep their blood sugar under control by eating a low-carb, high fat diet.

This is according to a new study that found this type of diet did more to help patients with type 2 diabetes than a high-carbohydrate, low-fat diet. And this was true no matter how many calories the person ate.

These findings were based on a randomized, controlled trial, and the results were published in the journal Annals of Internal Medicine this week.

The trial looked at 185 patients with type 2 diabetes, for whom low-calorie diets are often recommended to help people lose weight and improve glycemic control, a medical term referring to the typical levels of sugar in a person’s blood.

The trouble with this common recommendation, the investigators wrote, is that it often leads to hunger, so few patients stick to it.

“Therefore, calorie-unrestricted diets may be a better alternative to achieve long-term maintenance,” wrote study author Camilla Dalby Hansen, MD, of the University of Southern Denmark, and colleagues.

Study Methods and Results

In the new study, the participants were randomly assigned to one of two diet-based groups. Twice as many participants were put into a group that ate the low-carb, high-fat diet and the other participants were assigned to the high-carb, low-fat diet for 6 months. No calorie restrictions were placed on either group.

Patients’ weight, blood sugar control, and other health measures based on lab tests were evaluated at the beginning of the study, at 3 months, at 6 months. The final analysis included 165 patients.

While patients in both groups lost weight, those in the low-carb, high fat group lost, on average, about 8 pounds more than those in the other group.

The low-carb, high fat diet was linked to improved blood sugar control, but it also led to slightly higher LDL, or what doctors consider to be bad cholesterol levels.

“I believe we have sufficient data to include [low-carb, high-fat] as one of the diet options for people with type 2 diabetes,” Hansen said in a written comment.

But she predicted that some patients would still struggle to stay on it in the real world.

“The LCHF diet can be difficult for some people to follow,” Hansen said. “It is a bit more expensive, and it can be difficult to comply to in social gatherings simply because our society is not suited for this type of diet.”

The Magic of Unrestricted Calories

Jay H. Shubrook, DO, a diabetologist and professor at Touro University California, offered a similar view.

“When you start to fiddle with the diet, it affects not only the person, but all the people they eat with, because eating is a communal experience,” Shubrook said in an interview.

“What’s magic about this study is because it wasn’t calorie restricted, I think it made it a little bit more flexible for people to continue,” Shubrook said.

He said he thinks patients will need a fair amount of coaching and education about food choices in order to lose weight on a diet without calorie restrictions.

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December 14, 2022
What Are the Risks of HIV Treatment-Related Weight Gain?

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Most people with HIV gain weight after they start antiretroviral therapy (ART). In fact, it’s usually a good sign that your ART is working. You might hear your doctor call these early extra pounds a “return to health.” But too much treatment-related weight gain can sometimes lead to future health problems.

“Three decades ago, when the HIV epidemic was fresh and new, we worried about malnutrition and wasting,” says Onyema Ogbuagu, MBBCh, an infectious disease specialist who treats people with HIV at Yale Medicine. “Now that we’ve done a better job of catching people earlier in the disease and have more effective treatments, we have a different kind of metabolic problem, which is obesity.”

Tell your doctor if you’re worried about treatment-related weight gain. They’ll go over all the pros and cons of your ART. They’ll also help you find safe ways to lose weight.

Here are some other topics you might want to go over with your health care team.

What Are the Health Risks of Treatment-Related Weight Gain?

Ogbuagu says older kinds of ART might cause lipodystrophy. That’s when your body shifts how it stores fat. You can end up with the kind of belly fat that’s linked to insulin resistance, diabetes, and heart problems. But those kind of fat changes are a lot less likely to happen with newer drugs.

But there is evidence that short-term treatment-related weight gain from modern ART can still raise your odds of certain metabolic problems. More research is needed to know all of the long-term effects of treatment. But ART-related weight gain might lead to the following:

Type 2 diabetes

High cholesterol (also known as hyperlipidemia)

Non-alcoholic fatty liver disease

“The data for diabetes and liver fat is certainly present,” says John Koethe, assistant professor in the division of infectious diseases at Vanderbilt University. But he says there’s conflicting evidence when it comes to cardiovascular disease. Obesity and overweight up the chances anyone will get cardiovascular disease. But he says it’s still not known whether ART-related weight gain raises those odds even higher. We need more research to find out.

“People with HIV are already at a markedly increased risk of cardiovascular disease,” Koethe says. “The issue there may be that any attributable risk from the weight gain hasn’t really turned up in studies yet.”

Keep in mind that excess body weight, regardless of which ART you’re on, can raise your odds of certain health conditions. That includes the following:

Sleep apnea

Cognitive decline

High blood pressure

Heart disease and stroke

When Should You Watch for Weight Gain?

After you start ART, your odds of weight gain are highest within the first 12 to 18 months, Koethe says. In that period of time, studies show about 37% of people will gain 5% of their body weight. Another 17% will add 10% of their body weight.

Your weight might keep going up for several years after the start of ART, Koethe says, “but at a much slower pace.”

Does All Treatment-Related Weight Gain Come With Risks?

If you’re underweight or normal weight, a few extra pounds can be OK and even healthy. “Weight gain is not always a bad thing,” Ogbuagu says. “For some people, it’s desirable.” He says it might even boost your sense of well-being.

But in general, Koethe says doctors usually start to worry about future health problems if you gain 5% of your body weight after starting ART. People store that weight in different ways, but he says your odds of certain medical problems go up if you hold fat in the area around your internal organs.

“Those folks are at a higher risk of also accumulating fat around the liver, around the heart, and within their skeletal muscles,” Koethe says. “It’s those individuals who are going to be at a higher risk for metabolic diseases like diabetes and other comorbidities down the road.”

It’s hard to tell where your fat is just by looking at your body. But there are some tests your doctor can do to get a more detailed look. Koethe says that might include the following:

Measure around your waist. Your odds of diabetes and heart disease are higher if your waist is greater than 35 inches for women or 40 inches for men.

DEXA (or DXA) scan. This is a type of bone density test. But it can also show where your body stores fat and muscle.

CT scan. This is a more advanced tool that’ll give your doctor info on the fat in and around your liver, skeletal muscles, heart, or other organs.

Who Is More Likely to Gain Weight on ART?

Koethe and his colleagues found that 3 years after the start of ART, about 22% of healthy-weight people became overweight. Among those who were already overweight, he says about one-fifth became obese. But those numbers don’t help experts predict much.

There’s ongoing research into how much of a role your genes play. Koethe says there’s emerging data that certain drug-metabolizing enzymes might affect weight gain. In the future, that might shine a light on who’s more likely put on extra pounds after the start of ART.

Should You Change Your ART?

Talk to your doctor about your treatment. They might want to switch you to a different drug if you’ve gained lots of excess weight. But there are a lot of things to think about it before you make a change.

If you haven’t started treatment, current pre-ART guidelines include a consideration for weight gain or metabolic problems. Bring it up with your doctor if those are health problems you or other family members have had.

But right now, Koethe says there’s not enough scientific data to support a change from the standard guidelines. He says that’s because integrase inhibitors, which are linked to weight gain, “are just so much better when it comes to preventing (drug) resistance.”

The best thing you can do, Koethe says, is to start or continue a healthy diet and exercise routine, especially at the start of ART. And keep your doctor in the loop about your weight gain. They can run routine checks on key health measures, such as:

Blood sugar

Blood pressure

Cholesterol levels

Your doctor might not choose or change your ART based solely on excess weight concerns. But Ogbuagu says you should still talk to your doctor if it happens. “I think we should take action early, in the first few months or year, so that people don’t continue to gain weight and develop new complications along the way.”

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December 8, 2022
Trouble sleeping? You could be at risk of type 2 diabetes

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Newswise — As the Christmas season starts to ramp up, University of South Australia researchers are reminding people to prioritise a good night’s sleep as new research shows that a troubled sleep may be associated with risk factors for type 2 diabetes.

In the first study of its kind, researchers found that people who reported trouble sleeping were on average more likely to have indicators of poor cardiometabolic health – inflammatory markers, cholesterol and body weight – which can contribute to type 2 diabetes.

In Australia, almost one million adults have type 2 diabetes. Globally, type 2 diabetes affects more than 422 million people.

UniSA researcher Dr Lisa Matricciani says different aspects of sleep are associated with risk factors for diabetes.

“Everyone knows that sleep is important. But when we think about sleep, we mainly focus on how many hours of sleep we get, when we should also be looking at our sleep experience as a whole,” Dr Matricciani says.

“How soundly we sleep, when we go to bed and get up, and how regular our sleep habits are, may be just as important as sleep duration.”

“In this study, we examined the association of different aspects of sleep, and risk factors for diabetes, and found a connection between those who had troubled sleep and those who were at risk of type 2 diabetes.”

The study assessed more than 1000 Australian adults* with a median age of 44.8 years. Researchers examined a range of sleep characteristics: self-report trouble sleeping, duration, timing, efficiency, and day-to-day sleep length variability.

“People who reported having trouble sleeping were also more likely to have a higher body mass index, as well as blood markers of cholesterol and inflammation,” Dr Matricciani says.

“When it comes down to the crunch, we know we must prioritise our sleep to help stay in good health. More research is needed, but as this study shows, it’s important to think about sleep as a whole, not just as one aspect.”

Notes to editors:

*Most participants (87 per cent) were mothers.

Approximately half of all participants (48 per cent) reported that they never had troubled sleep.

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University of South Australia

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December 1, 2022
Use of drugs for weight loss causes supply shortage

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Dramatic stories about weight loss seem to be everywhere on social media. Jennifer Huber, who shared her own story online, has lost more than 50 pounds in five months after starting Mounjaro, an injectable drug approved to treat her Type 2 diabetes.

“It’s this miracle,” Huber said. “I’ve got to pinch myself sometimes to say, is this real?”

The drug now has an Food and Drug Administration Fast Track designation as a tool for weight loss.

Mounjaro belongs to a class of drugs called GLP-1 agonists that includes Saxenda and Wegovy, which are already FDA-approved for weight loss in people who are either overweight with at least one weight-related medical problem or obese.

Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Medical Center in Los Angeles, said the drugs have been life changing for her patients.

“The medications help by making the gut feel that it is fuller, so fullness signals go to the brain,” Velazquez said.

It also helps with blood sugar regulation, she said.

However, the popularity of the drugs for weight loss is causing shortages for people who need them for other health issues.

“Someone who may only need to lose about five pounds most likely does not qualify for this,” Velazquez said in regards to whether people who don’t qualify per the criteria should take these medications.

Wegovy has a higher dose of the same active ingredient used in a diabetes drug called Ozempic, which is not approved for weight loss. Both are so popular that some doses are in short supply, which is troubling for people using Ozempic to treat diabetes.

Novo Nordisk, the maker of the drugs, says it’s making “short and long-term investments” to help with Ozempic supply disruptions. While it expects to have “all dose strengths of Wegovy available in December,” health care providers are being asked “to continue to hold off” starting new patients on the drug.

Trending News

Jon LaPook

Dr. Jonathan LaPook is the chief medical correspondent for CBS News.

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November 30, 2022
Holiday Travel: How to Get Where You’re Going (and Stay Well)

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As the busy holiday season approaches, thousands of people head to the airports, jetting to see loved ones or just to get away from it all. Many more will take trains or buses — or pack up the car and cruise onto the highways. But whether by land, sea, or sky, there are likely to be delays along the way.

For people with serious health problems like diabetes and heart disease — and for young children — those travel glitches can be more than an inconvenience. To stay well when you’re traveling, you’ll need to plan well. Here’s how.

If You Have Diabetes

Eat close to your regular schedule. “That’s especially important for diabetics,” says Inyanga Mack, MD, assistant professor of family and community medicine at Temple University School of Medicine in Philadelphia.

Since meal service has been discontinued on most flights, getting to the airport early leaves you time to eat before the flight. Also, bring along healthy snacks to offset the risk of hypoglycemia, whether on the road or in the air, she says.

Wear an appropriate medical alert bracelet. Carry the name of an emergency contact person and your primary care physician, Mack suggests. Keep a list of your medications and doses, so someone can get access to your medication in an emergency.

Take medications with you, not packed in luggage. Carry a few days’ supply of your medications. Then if luggage gets lost, or if you’re trapped in the airport or on the plane for extended periods, your health won’t be in jeopardy. Always eat and take medications according to your regular schedule, even if everything else is in turmoil.

Make sure medications are properly labeled. All prescriptions must have the pharmaceutical label or professionally printed label identifying the drug. If you are not permitted to board with your medications and supplies, ask to speak with the airport’s FAA representative or the security director. You may even want to call ahead of time to be sure you can get on board with what you need.

FAA requirements: Diabetic people carrying syringes and/or needles must also carry the injectable medication. Diabetic people traveling in the U.S. can bring syringes and other such equipment in carry-on bags, but insulin vials must have a professional, printed medication label. Better yet, keep insulin in its original box, since it has the pharmaceutical company label. Needles must be capped. The glucose meter must have the manufacturer’s name on it. Injectable glucagon should also be in its original plastic kit with the pre-printed pharmaceutical label.

If You Have Heart Disease

Don’t get dehydrated or fatigued. Get plenty of rest, says Ronald Krone, MD, professor of medicine and cardiology at Washington University School of Medicine in St. Louis. “If you feel fatigued, find someone to carry your bags. Don’t rush. Getting around a long airport can be like a stress test. Carry as little as possible on board, so you’re not struggling to lift something overhead. Minimize your workload.”

If traveling abroad, give yourself a day to recover. “You should not be on a go-go schedule,” Krone says. “Allow time to get plenty of rest, and make sure you’re well hydrated.”

Carry a copy of your ECG. If you’ve had heart bypass surgery, get a note from your surgeon. This should detail the number of veins and arteries that were used to do the bypass, Krone says. If you’re in a foreign country and need an emergency catheterization, “the cardiologist at your destination would know exactly how to perform the catheterization,” Krone says. “It would make the whole thing much simpler.”

If you’re taking Coumadin and will be abroad a month or more, consider making arrangements at your destination to have your blood checked. Many countries require that you see a local doctor to monitor your blood and write a prescription if necessary. The U.S. embassy can easily make these arrangements, Krone says.

If You’re Traveling with Kids

Have a game plan. “Really consider the amount of time you’re going to be waiting,” says Andrea McCoy, MD, director of primary care at Temple University Children’s Medical Center in Philadelphia. “It’s tough to travel with kids to begin with, and delays and changes in time zones make it even more difficult,” she says.

Let kids run when there’s a chance. “You can’t expect young kids to sit like little soldiers,” McCoy says. “Mom can let kids run in a hallway while Dad stands in line. It’s thankless enough to stand there as a grown-up; you can’t expect your kids to do it.”

Take along snacks, drinks, and activities. Books to read, puzzle books, game boys, and portable checkers keep kids busy. For younger kids, coloring books, little games, action figures will work. Plan activities you know they will like, says McCoy. “Also plan something new and different, something they don’t see every day, or have never seen before. The novelty will help a little bit.” Another idea: keep individual toys wrapped, then bring them out at just the right moment.

Take light snacks. Carry something like bagels, which are starchy and don’t require refrigeration, to offset both hunger and airsickness.

Carry prescription medications on board. Remember to put medications in an icepack if they need to be refrigerated. Let your doctor know ahead of time that you will be traveling, in case a second-choice medicine is more convenient to carry.

Carry acetaminophen — something kids can suck or swallow. These are for normal aches and pains, plus ear pain, McCoy says. The swallowing or sucking action will help clear a child’s ears if you’re flying.

Make sure booster or car seats are available. If you’re renting a car, make the appropriate arrangements at your destination. Also, consider having a car seat on board for a safer flight.

Check at your destination — is it child proof? The same things that apply at home still count when you’re away. Are there gates at the tops of stairs? If you’re staying with someone who has a gun, is it stored out of children’s reach? When you’re done unwrapping gifts, make sure the ribbons and wrappings picked up, so little children won’t suffocate or choke on them. And make sure that leftover party food gets stored safely, so kids won’t get into it if they wake up before you.

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November 28, 2022

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