Tag: Diabetes

Have Celiac Disease? You May Need Screening for Other Disorders

SOURCES:

Katarina Mollo, dietitian, Boston.

Alessio Fasano, MD, professor of pediatrics and gastroenterology, Massachusetts General Hospital; professor of nutrition, Harvard T.H. Chan School of Public Health; professor of pediatrics, Harvard Medical School.

Jolanda Denham, MD, pediatric gastroenterologist, Nemours Children’s Hospital, Florida.

Benjamin Lebwohl, MD, president, Society for the Study of Celiac Disease; director of clinical research, Celiac Disease Center, Columbia University.

Robert Rapaport, MD, pediatric endocrinologist, Kravis Children’s Hospital, New York City; professor of pediatric endocrinology and diabetes, Icahn School of Medicine, Mount Sinai.

Journal of Diabetes: “Screening for celiac disease in youth with type 1 diabetes: Are current recommendations adequate?”

Edwin Liu, MD, pediatric gastroenterologist, Children’s Hospital Colorado; director, Colorado Center for Celiac Disease.

Gastroenterology and Hepatology from Bed to Bench: “Prevalence of celiac disease serological markers in a cohort of Italian rheumatological patients.”

Celiac Disease Foundation: “What is Celiac Disease?”

Pediatric Rheumatology: “In a large Juvenile Idiopathic Arthritis (JIA) cohort, concomitant celiac disease is associated with family history of autoimmunity and a more severe JIA course: a retrospective study.”

Therapeutic Advances in Gastroenterology: “Screening for celiac disease in average-risk and high-risk populations.”

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November 18, 2022
You Are Your Own Best Advocate
You know managing your type 2 diabetes may bring challenges, but you shouldn’t feel this way in your doctor’s exam room. If you feel that you have unanswered questions about your condition, you may be able find ways to share your concerns and get better care. Being your own advocate and speaking up is key for managing your type 2 diabetes.

What Is Self-Advocacy?

Self-advocacy is representing your own interests as you manage your condition. It will help you as you find, evaluate, and use information for your health. Learning to be your own advocate can help you feel like you’re in control of your type 2 diabetes, rather than the other way around, says Sneha Srivastava, PharmD, a certified diabetes care and education specialist in Chicago.

Learn What You Can About Type 2 Diabetes

You want to educate yourself and put a healthy living plan into action, with the understanding that you may need to tweak your plan along the way. “Learning as much as you can about type 2 diabetes is important. It’s the knowledge plus action that leads to healthy blood sugar levels and not having the complications associated with high blood sugars,” Srivastava says.

To start, know your numbers (A1c, blood pressure, cholesterol levels) and what they mean. Get familiar with technology options you may have, Srivastava advises. There are apps and devices that can help you manage different aspects of diabetes. These include free phone apps to log what you eat or continuous glucose meters that can measure your blood sugar.

“Understand the ‘How’ and ‘Why’ of your medication,” Srivastava says. “There now are meds that help lower your blood sugar, protect your kidneys or heart, or help you get to a healthy weight. And sometimes, depending on what insurance you have or if you have insurance, there are ways to choose the right medications that are also affordable.”

Lifestyle has a big effect, too. Following your treatment plan helps prevent complications such as heart disease, nerve damage, and blindness. Habits like watching your intake of refined carbs, staying active, and managing stress can keep you off medication.

All this may seem like a big ask at first. For help, you can ask for a referral to a diabetes care and education specialist (DCES). They’ll guide you through any fears or issues and to learn what to expect at your next appointment.
How to Self-Advocate When You Face Care Disparities

Diabetes affects more than 34 million people in the United States, but it doesn’t affect all communities equally, according to the CDC. Managing type 2 diabetes can be especially important for Black, Native American, and Hispanic men and women. These groups are at a greater risk of getting type 2 diabetes, but often face an uphill battle when it comes to diagnosis and treatment.

“There are very real statistics that show people of color have higher rates of type 2 diabetes and complications from diabetes. What contributes to this disparity are injustices and unequal access to care and resources that exists in some communities,” Srivastava says.

“Being your own advocate is essential,” Srivastava says. According to her, this means ensuring that:

Everything on your diabetes checklist is being addressed.

You are being referred to the right specialists as soon as you may need to see them.

You feel respected and heard.

Your values, culture, and preferences are being considered in your care.

If you don’t feel that this is the case, you have the right to find a health care provider that does do all of this and makes you feel a part of the team, Srivastava says.“No matter your race, ethnicity, or gender, diabetes can be managed in a healthy way [with care] based on patient preferences.”
Work With Your Health Care Team

Diabetes can affect you from head to toe, so make sure you are being referred to get your eyes checked, teeth cleaned, feet looked at, lab tests taken, and anything else in between. It takes a medical team to help keep you in your best health with type 2 diabetes.

“Knowing where to get your information is just as important as the information itself,” Srivastava says. “Your health care team can help you navigate to find the right resources. It’s easy to get overwhelmed because there is so much information about diabetes, but you don’t need to know it all at once.”

How to Be a Self-Advocate

Be open and honest. Don’t be afraid of being judged. Even if you’re not usually comfortable speaking up, try to push yourself. If something isn’t working, your doctors may not know if you don’t tell them. It can mean the difference in your care and quality of life.
“It is very natural to be hesitant or feel uncomfortable bringing up what you may need for your diabetes care during medical appointments,” Srivastava says. “It can be overwhelming, and sometimes, appointments can feel rushed.” There are things you can do to make it easier for you to be a part of the conversation:

Come prepared. Keep a diabetes notebook with all your information and all your questions to bring to your appointments.

Bring support. A trusted friend or family member can be calming and can also help you remember all that is said during the visit.

“Too many times, people with diabetes are just told to eat better, move more, and take medications,” Srivastava says. “But what if … the medication costs too much, or you can’t figure out how to make the time to cook, or exercise isn’t working because your knees hurt too much?”

“When you are part of the conversation, you can share what your barriers or challenges are to change, discuss what you are able and willing to do, and understand the recommendations being made,” Srivastava says. “And lastly, to be an advocate means trusting yourself. If something doesn’t feel right or if you feel like you are not truly understanding the recommendations or how to incorporate them, share and ask.”

And when your treatment plan is working well, keep communicating with your doctors and pass along the good news. “At the center of this team is you, the person with diabetes. You know your body, experiences, goals, expectations, questions, and schedule,” Srivastava says. “You know how you’re going to best be able to make the changes to keep your blood sugar at healthy levels and keep the complications away.”
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November 15, 2022
Ask Money Today: Can diabetes, hypertension or high BP lead to the rejection of your health insurance claim?

Question: Is diabetes, hypertension or high BP, considered a pre-existing ailment? Can it lead to a rejection of claims for complications arising out of them? What happens if one didn’t know or didn’t have the condition at the time of buying the policy?

Preeti, Mumbai

Vivek Chaturvedi, CMO and Head of Direct Sales, Go Digit General Insurance

Before buying a health insurance policy, it is imperative to understand the importance of disclosing your pre-existing conditions or diseases. Insurance works on the principle of utmost good faith and therefore, it is expected of the insured and the insurer to disclose all essential information before closing the transaction.

Note that pre-existing diseases (PED) are conditions that exist at the time of buying a health insurance policy. High blood pressure, diabetes, asthma, hypertension etc., fall under PEDs and must be disclosed to the insurer when you are buying health insurance. Non-disclosure of PEDs can lead to a rejection of claims as most policies have a specific waiting period for existing diseases.

Waiting periods for pre-existing conditions could range anywhere from 1-4 years. Despite declaring your PED, insurers could still choose to cover you, perhaps at a relatively higher premium (loading). However, if one fails to be transparent, the consequences could be as harsh as the cancellation of the policy altogether. Any claim arising out of an unrelated illness also could get repudiated if the PED is discovered at the time of the investigation.

If you think you may have a PED, it’s advisable to get the relevant tests done and share the results with the insurer should you get diagnosed with a disease. This not only gives the insurer an opportunity to make necessary amends in the policy but also protects you from having your claims rejected.

Further, if you get diagnosed with a disease after buying the policy and are hospitalised for the same, your insurer will accept the claim. Note that it is also not mandatory to disclose new diseases at the time of renewing the policy because all conditions except the exclusions in the policy will be covered. However, if you choose to disclose the PED at the time of renewal (which should’ve been done while buying the policy), then the insurer may either cancel the policy or apply some restrictions or a waiting period.

Given the importance of health insurance in today’s day and age, it’s advisable to be transparent and disclose all details honestly instead of bearing the brunt of rejected claims or policy cancellations.

(Views expressed by the investment expert are his/her own. E-mail us your investment queries at askmoneytoday@intoday.com. We will get your queries answered by our panel of experts)

Also read: Ask Money Today: Will my lost luggage be covered under travel insurance and is there any time limit for filing the claim?

Also read: Ask Money Today: How much maximum tax benefit can I claim on home loan?

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November 14, 2022
Sleeping with light pollution linked to diabetes, study says | CNN

Editor’s Note: Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.

CNN
—

Sleeping in a room exposed to outdoor artificial light at night may increase the risk of developing diabetes, according to a study of nearly 100,000 Chinese adults.

People who lived in areas of China with high light pollution at night were about 28% more likely to develop diabetes than people who lived in the least polluted areas, according to the study published Tuesday in the journal Diabetologia.

Ultimately, more than 9 million cases of diabetes in Chinese adults age 18 years and older may be due to outdoor light pollution at night, the authors said, adding the number is likely to increase as more people moved to cities.

However, a lack of darkness affects more than urban areas. Urban light pollution is so widespread that it can affect suburbs and forest parks that may be tens, even hundreds, of miles from the light source, the authors said.

“The study confirms prior research of the potential detrimental effects of light at night on metabolic function and risk for diabetes,” said Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine in Chicago, who was not involved in the study

Prior research has shown an association between artificial light at night and weight gain and obesity, disruptions in metabolic function, insulin secretion and the development of diabetes, and cardiovascular risk factors.

A study published earlier this year by Zee and her team examined the role of light in sleep for healthy adults in their 20s. Sleeping for only one night with a dim light, such as a TV set with the sound off, raised the blood sugar and heart rate of the young people during the sleep lab experiment.

An elevated heart rate at night has been shown in prior studies to be a risk factor for future heart disease and early death, while higher blood sugar levels are a sign of insulin resistance, which can ultimately lead to type 2 diabetes.

“Healthy sleep is hugely important in preventing the development of diabetes,” said Dr. Gareth Nye, a senior lecturer of physiology at the University of Chester in the United Kingdom. He was not involved in the Diabetologia study.

“Studies have suggested that inconsistent sleep patterns have been linked to an increased risk of type 2 diabetes,” he said in a statement.

The new study used data from the 2010 China Noncommunicable Disease Surveillance Study, which asked representative samples of the Chinese population about social demographics, lifestyle factors and medical and family health histories. Blood samples were collected and compared with satellite imagery of light levels in the area of China in which each person lived.

The analysis found chronic exposure to light pollution at night raised blood glucose levels and led to a higher risk of insulin resistance and diabetes.

Any direct link between diabetes and nighttime light pollution is still unclear, however, because living in an urban area is itself a known contributor to the development of diabetes, Nye explained.

“It has been known for a long time now that living in (an) urbanised area increases your risk of obesity through increased access to high fat and convenience food, less physical activity levels due to transport links and less social activities,” Nye wrote.

Strategies for reducing light levels at night include positioning your bed away from windows and using light-blocking window shades. If low levels of light persist, try a sleep mask to shelter your eyes.

Be aware of the type of light you have in your bedroom and ban any lights in the blue spectrum, such as those emitted by electronic devices like televisions, smartphones, tablets and laptops — blue light is the most stimulating type of light, Zee said.

“If you have to have a light on for safety reasons change the color. You want to choose lights that have more reddish or brownish tones,” she said. If a night light is needed, keep it dim and at floor level, so that it’s more reflected rather than next to your eye at bed level, she suggested.

Avoid sleeping with the television on — if you tend to fall asleep while it’s still on, put it on a timer, Zee suggested.

Dim ambient lights in the evening at least two to three hours before bedtime, and if you “absolutely have to use computer or other light-emitting screens, change screen light wavelength to longer ones of orange-amber,” Zee said. “Importantly, get light during the day — daylight is healthy!”

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November 14, 2022
Weight-Loss Drug, Approved for Adults, Shows Promise in Kids

Nov. 10, 2022 — The prospect of being involved in a research program that might help her lose weight intrigued Emmalea Zummo. At 15, the self-assured, energetic teenager from Jeanette, PA, weighed 250 pounds – enough to be considered obese. The trial she learned about through her endocrinologist was for a drug called semaglutide.

Before joining the study, Emmalea had exhausted a reservoir of strategies.

“She had been doing a variety of exercise programs, was involved in countless sports and activities to stay active, as some of her early doctors said that would work,” Davina Zummo, Emmalea’s mother, says. “She counted calories, did a gluten-free diet, limited what she ate, when she ate, and how much.”

Emmalea cut out all snacks, junk food, and sweets, but nothing made a difference, Zummo says: “She felt defeated.”

The FDA last year approved semaglutide, which was developed initially as a treatment for type 2 diabetes, for weight loss in adults. But researchers wanted to know if the drug, which targets areas of the brain that regulate appetite, also could help adolescents lose weight. Emmalea was curious, too.

Although often teenagers can be judgmental of each other, Emmalea’s friends “were happy for me, constantly motivating and supportive,” she says.

Today, Emmalea, now nearly 18, says the medication helped her lose 75 pounds, giving a boost to the lifestyle and diet coaching she received throughout the 68-week study.

Parents of teens like Emmalea who struggle with obesity hear the same refrain: If their kids slash the sugar, eat healthy snacks instead of junk foods, and exercise regularly, the results will follow.

But for many overweight youths — as with adults — shedding pounds often proves frustrating. Gains come and go, despite good intentions.

Could medication help?

A new study in the New England Journal of Medicine shows that semaglutide can indeed lead to small but meaningful losses of excess bodyweight. Whether that’s enough to tip the scales, as it were, toward overall better health is unclear, but the findings have specialists in child health optimistic.

“There is a real need for safe and effective medications to treat obesity,” says Silva Arslanian, MD, a pediatric endocrinologist at the University of Pittsburgh School of Medicine and a co-author of the new study.

“Typically, we make lifestyle recommendations: Eat more vegetables; don’t eat fried food; don’t drink soda,” Arslanian says. Unfortunately, she says, we live in a world where “it can be very hard to make those changes.”

Many experts agree that medication should be part of the conversation.

“It’s exciting to see this treatment becoming available. And the study results suggest few side effects, so the drug was safe and tolerable,” says Amanda Staiano, PhD, a researcher at the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge. “Although not approved yet by the FDA, semaglitude and other new medications are transforming obesity treatment for adolescents. It’s going to be an exciting time for treating obesity.”

Staiano stresses, however, that lifestyle and behavioral counseling are key for the success of any obesity treatment, including drugs like semaglutide.

Daniel Weghuber, MD, a pediatrician at Paracelsus Medical University in Salzburg, Austria, says that although obesity is “not an issue of lack of willpower, this drug seems to enable people who are living with obesity to adhere to the recommendations that they have been following for years and years but were not able to achieve the goal. I think that this is important. It enables people to achieve their goals.”

In the new study, 201 obese or overweight boys and girls between the ages of 12 and 18 received either once-weekly injections of semaglutide or sham shots. They also all received lifestyle interventions — counseling on healthy nutrition and physical activity — throughout the nearly 16-month study.

By the end of the study, 75% of the adolescents who received semaglutide had lost and kept off at least 5% of their excess body weight, compared to 17% of those who got the sham injections. On average, those treated with the drug lost 33.7 pounds, compared to an average of just 5.3 pounds in the other group.

Weghuber said the research suggests the combination of lifestyle changes and obesity medications “will open up a new chapter” for treating adolescents with obesity.

More than 340 million children and adolescents worldwide aged 5-19 were overweight or obese in 2016. In the United States, obesity affected 22.2% of 12- to 19-year-olds from 2017 to 2020, according to the CDC.

Obesity is linked with decreased life expectancy and higher risk of developing serious health problems such as type 2 diabetes, heart disease, nonalcoholic fatty liver disease, sleep apnea, and certain cancers. Teenagers with obesity are also more likely to have depression, anxiety, poor self-esteem, and other psychological issues.

While obesity in children has long been a public health concern, the problem has worsened during the COVID-19 pandemic, Melissa Ruiz, MD, with the Pediatric Diagnostic Center in Ventura, CA, says. Some of her patients who had been “chubby” pre-pandemic had weight gains of 20-30 pounds at post-pandemic clinic visits, she estimates.

Ruiz and other experts say parents should discard the notion that obesity is something children – or adults — are doing to themselves, or that they are failing their children by not keeping their weight in check.

“There are genetic components that figure into obesity, and we have to acknowledge that,” Ruiz says.

Parents should seek help from their child’s pediatrician. “If the pediatrician cannot help you, ask, ‘Where can I go?’ Say, ‘I understand that you might not be trained in this yet’ and ask for a reference for someone who can help,” Ruiz says.

But medication should not be considered an all-in remedy, according to one expert.

“Medication is a last resort, only after behavioral interventions fail and after exploring the range of behavioral strategies to weight loss, including changing dietary patterns such as timing and meal plan,” says Lydia Bazzano, MD, PhD, a nutrition researcher at the Tulane University School of Public Health and Tropical Medicine in New Orleans.

Medication and even surgery have a place, but only if patients have exhausted all the dietary and lifestyle options, Bazzano says. “You don’t want the adolescent to have a lifetime of medication. Medication should only be used to kickstart the child to the point he should be — and then maintain that weight,” she says.

Adolescent obesity is a very difficult subject to navigate, Bazzano adds. “You have to engage the entire family, and not just the child. It has to be at the level of the whole family, and that can be very challenging. If the entire family engages together, there can be a modest weight loss.”

And Bazzano says she’s not impressed with the weight loss seen in the latest study. A 5% drop in body weight is helpful, she says, but “that’s not enough of a decrease to say the child is out of the risky range.”

Staiano thinks experts need more information about semaglutide before they should start prescribing it to kids.

“We need to see long-term outcomes from chronic medication use and whether weight rebounds when adolescents stop using the medication,” she says.

“How long should the medication be prescribed? For the rest of their lives? How do we support patients who are able to lose such a significant amount of weight? How do we ensure these treatments — behavioral counseling, medications, and weight loss surgery — are accessible and financially within reach of families?”

Emmalea, who stopped taking semaglutide about a year ago, has maintained her weight thanks to concentrating on a well-balanced diet and exercise. While she says she’s pleased with her progress and “feels comfortable in my own skin,” she doesn’t consider her current weight of 171 pounds to be the end zone. “I’d like to be somewhere between 145-150,” says the 5’4” high school senior.

Still, she says, “I don’t strictly monitor myself because thinking of food in a negative way is not healthy and can actually lead to worsening a food disorder.”

When she embarked on the study, she wasn’t sure it would be effective for her. But because of her interest in medicine and research, she says, she wanted to be involved: “I thought that if it didn’t help me, at least it might others.”

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November 10, 2022
Genome sequencing supports Nile rat animal model for diabetes research

FOR IMMEDIATE RELEASE

Newswise — MADISON — Model organisms are essential for biomedical research and have enabled many important scientific discoveries. The ability to sequence the genomes of these models is a powerful tool to study the genetic factors that impact human health.

The house mouse (Mus musculus) and Norway rat (Rattus norvegicus) are widely used in research due to their genetic similarities to humans. But another rodent is rising through the ranks — Arvicanthis niloticus, the Nile rat.

New research published today in BMC Biology provides a high-quality reference genome assembly for the Nile rat, expanding its potential as a model organism.

“We need research tools that will enable us to do the same things with the Nile rat that we are used to doing with the lab mouse,” says Yury Bukhman, a computational biologist in the Stewart Computational Biology Group at Morgridge and senior author on the project. “Having the reference genome is an advance toward that goal.”

In particular, the Nile rat serves as an alternative model in two research areas where lab mice and rats have limitations — type 2 diabetes and disorders associated with a disrupted circadian rhythm.

Mice and rats are nocturnal animals, and so they are less useful at modeling human circadian cycles. Additionally, they can develop pre-diabetes symptoms with a high-fat diet, but they rarely develop long-term diabetic complications like humans with the disease.

“You can alter their genetics, you can give them exaggerated amounts of fat, or use chemicals to accelerate the process. But that’s a lot of additional confounding factors that you are pushing into the animal model to get what you want,” says first author Huishi Toh, an assistant project scientist at the University of California Santa Barbara who worked with Jamie Thomson, emeritus director of regenerative biology at Morgridge and professor at UCSB.

The Nile rat is diurnal, active during the daytime like humans. It also has more photoreceptors in its eye in comparison to nocturnal rodents, which makes it relevant for studying human retinal disease — including diabetic retinopathy.

“There is still room for a lot of discovery in type 2 diabetes, with questions that are difficult to answer. That’s why we thought that maybe it’s time to take a risk on a newer animal model,” Toh says. “Does it mean it’s more accurate or that you can replace other models? No, of course not. But you can find different information that can be useful, too.”

Another benefit of the Nile rat is that it serves as an outbred model, meaning its genetics are reflective of a diverse population. Many laboratory mice strains have been inbred for generations, creating stable populations that are nearly genetically identical. This is useful for reducing experimental variability, but less useful when studying the complex genetic factors contributing to disease.

“We also know that epigenetics is really important — the environment crossing with the genetic components — so we have to study both. That’s why we require a very high-quality genome to allow the ability to do that,” says Toh.

The Nile rat genome is a product of a large international collaboration involving the Vertebrate Genomes Project, a consortium of researchers aiming to assemble reference-quality genomes of all vertebrate species.

The technology to produce a complete and highly accurate genome sequence is relatively new. Typically, to sequence a large genome, the DNA sequence needs to be chopped into shorter lengths between 100-300 nucleotides and then reassembled into longer contiguous sequences (contigs). But this approach tends to leave lots of gaps.

“An important genome quality measure is what’s the length of an average contig. Basically, the longer it is, the fewer gaps you have,” says Bukhman. “Ours is one of the longest.”

The research team applied long-read sequencing technology to assemble longer contigs from reads of around 10,000 to 20,000 nucleotides in length. They also used multiple additional technologies to join contigs together into scaffolds that run the length of a chromosome. Finally, they were able to fully resolve two copies of the genome — the one that the sequenced individual inherited from its mother and the one from its father.

“These technologies are developing very fast,” Bukhman says. “I think the holy grail would be to just be able to sequence a whole chromosome and do it accurately. However, that hasn’t happened yet.”

Another measure is looking at the completeness of the genome. The team analyzed their Nile rat sequence through a database called BUSCO (benchmarking universal single copy orthologs), which provides a set of genes commonly found in the phylogenetic group of interest, in this case rodents.

“We’re basically in the same league as the other rodent model organisms,” says Bukhman. “We find complete sequences of 99% of BUSCO genes, so we’re not missing a lot of protein coding sequence.”

With a high-quality sequence in hand, the researchers looked for patterns in the genome, such as genes that have different number of copies in Nile rat compared to house mouse, that could be candidates for future study.

They also used Kinderminer and Serial KinderMiner (SKiM) — applications developed by the Stewart Computational Biology Group at Morgridge — to query PubMed abstracts and identify genes associated with type 2 diabetes.

“We don’t have a ‘smoking gun’ at this point,” says Bukhman. “You can always get a list of genes. But then, how do you know that they’re really important in diabetes? That will take years and years of experimental work.”

Now that the Nile rat has a high-quality reference genome, Bukhman and Toh both hope that the species will become more widely used in biomedical research.

“People are resistant to using new animal models, because it’s a lot of money, a lot of effort, and a lot of risk,” says Toh. “But we decided to take the unconventional route. In research, I think, to survive is to find different flavors, different trajectories. And we’ve removed some of that risk.”

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As an independent research organization, the Morgridge Institute for Research explores uncharted scientific territory to discover tomorrow’s cures. In affiliation with the University of Wisconsin-Madison, we support researchers who take a fearless approach to advancing human health in emerging fields such as regenerative biology, metabolism, virology and biomedical imaging. Through public programming, we work to inspire scientific curiosity in everyday life. Learn more at: morgridge.org

Morgridge Institute for Research

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November 9, 2022
New Onset Chronic Kidney Disease in People with Diabetes Highest Among Ethnic, Racial Minorities

Newswise — New onset chronic kidney disease (CKD) in people with diabetes is highest among racial and ethnic minority groups compared with white persons, a UCLA-Providence study finds.

The study, published as a letter to the editor in the New England Journal of Medicine, found that new onset CKD rates were higher by approximately 60%, 40%, 33%, and 25% in the Native Hawaiian/Pacific Islander, Black, American Indian/Alaska Native, and Hispanic/Latino populations, respectively, compared to white persons with diabetes.

Although high CKD incidence in diabetes persists, the rate declined from 8% of the overall diabetes population in 2015-2016 to 6.4% in 2019-2020”.

“The results of our study constitute a call to action to institute directed, targeted efforts aimed at deliberately shifting the trajectory of persistently high rates of diabetes-related CKD and kidney failure that disproportionately affect racial and ethnic minority groups,” said co-author Dr. Susanne Nicholas, associate professor of medicine in the division of nephrology at the David Geffen School of Medicine at UCLA and chair of the UCLA Nephrology Racial and Health Equity Committee. “The first step should be to increase the rates of screening and detection of CKD in individuals with diabetes.”

Researchers from the Geffen School, Providence, and the Centers for Disease Control and Prevention tracked 654,549 adults with diabetes from 2015 through 2020 using electronic health records from Providence Health and UCLA Health, two large not-for-profit health systems serving the Western United States.

The prevalence of kidney failure requiring dialysis or transplant more than doubled to nearly 800,000 persons in the United States between 2000 and 2019, with diabetes as the leading cause. The rate of new onset of CKD in people with diabetes was previously unknown, yet the value of such incidence data is vital for identifying high-risk populations, determining the effectiveness of interventions, and assessing the effects on health care delivery and public health responses. Even more striking, less than 10% of patients with early stage kidney disease are aware of having CKD at this stage in its progression, when therapies are most effective.

“Given the rapidly growing population with diabetes in the United States and the corresponding high rates of kidney failure, the persistently high incidence of CKD marked by racial and ethnic disparities is troubling,” said lead author Dr. Katherine Tuttle, executive director for research at Providence Inland Northwest Health and professor of medicine at the University of Washington. “Inclusive strategies for prevention, detection, and intervention are needed to reduce CKD risk in people with diabetes.”

Additional study authors are Dr. O. Kenrik Duru and Dr. Keith Norris of UCLA; Cami Jones, Kenn Daratha, Dr. Radica Alicic, and Joshua Neumiller of Providence; and Nilka Ríos Burrows, Alain Koyama, and Dr. Meda Pavkov of the Centers for Disease Control and Prevention.

University of California, Los Angeles (UCLA), Health Sciences

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October 31, 2022
Facing Vision Problems Head-On

By Chelcie Rice, as told to Hallie Levine

I learned I had diabetic retinopathy in 2004. Unfortunately, my diagnosis came a little too late, and I lost most of the vision in my right eye. Today, when I do advocacy work, I stress how important it is to stay up to date on your eye exams. It could save your sight, literally. Here’s what I want others with diabetic retinopathy to know.

Don’t blame yourself.

When I was diagnosed, I had a lot of self-loathing. I’d noticed symptoms months earlier, when I bent over to pick something up and noticed black jellyfish-like streaks that drizzled down my left eye. I went to a local eyeglass shop for an eye exam from an optometrist, who told me I needed to see a retina specialist.

Unfortunately, I didn’t have health insurance at the time, so I put it off. Eventually, my symptoms got so bad that I had no choice. I needed a vitrectomy, which is a surgical procedure where the surgeon makes a tiny incision in your eye to drain blood from the middle of the eye and remove scar tissue that tugs on the retina. A year later, I had to have the same procedure done on my right eye, but it was too late. My retina completely detached, and I lost most of my vision.

I blamed myself, which seems ridiculous now. It wasn’t my fault that I couldn’t afford to pay for my medical care. But for those first few years after my eye surgeries, I lived in the fear of it happening again. If I lost the vision in my left eye, I’d be pretty much left blind. That stress is almost impossible to carry. You can’t live your life on pins and needles. I had to learn to push forward. One of the ways I did that was to begin taking my diabetes more seriously than I had in years past. I knew that if I got my blood sugars under better control, I would have less risk of other health complications, including loss of vision.

You can still live your life.

Thankfully, I can continue to do most day-to-day activities, with some modifications. While I can no longer read with my right eye, my vision is still good enough that I can drive and go to my day job at a credit union. My left eye is 20/20, but my right eye only has about 10% of its vision. That means when I look at something on my right, it’s very blurry, so much so that it’s like looking through a distorted mirror. There are also large patches of dark spots. I try not to put myself in positions where I have to drive at night, and when I do, I practice the route over and over during daylight hours so I know exactly where I’m going.

It took me a while to wrap my head around the fact that I have a disability and as such, am entitled to certain work-related accommodations through the Americans with Disabilities Act. I’ve been up-front with employers about my vision, and my current job has provided a great deal of modifications — for example, a large monitor for my computer so I can magnify my work.

A few months ago, I had a corneal erosion on my left eye. This is when the layer of cells on the surface of your cornea loosens. It’s very painful and can make your vision very blurry. My symptoms were always worse in the morning, so I couldn’t work for a few hours. But since it was related to my diabetes, I just filled out certain forms for my employer and it wasn’t counted against me. Don’t be afraid to ask for these accommodations. It’s your legal right to have them.

It helps to be open.

I’m a comedian, and for a long time I grappled with how much to tell my audience about both my diabetes and my diabetic retinopathy. But a few years ago, I watched another comedian who lives with cancer open up about his disease on stage. He told me later that it was my responsibility to talk about my diabetes and my vision because you never know whom you’ll reach. He’s right. After my shows, people will come up to me and tell me their personal stories as well.

It helps smooth over some awkward moments too. Like the time in the middle of my act I walked too close to the edge of the stage and almost fell off. It was only about an 8-inch drop, but when you’re almost blind in one eye, that’s really scary! I also always try to work some sort of diabetes joke into my act. I’ve even joked about my retina surgeries. It’s a way to educate people about diabetic retinopathy without them even realizing it.

Get that annual eye exam!

When you have diabetes, you have got to stay on top of all your medical care. You see your endocrinologist every 3 months, your dentist at least twice a year, and foot and eye specialists at least once a year. Otherwise, little problems can become big ones, fast.

You also need to pay close attention to what’s going on with your eyes. People with diabetic retinopathy often see dark spots, or floaters, in their field of vision. I know all of my floaters well. But if I see something new, I pay close attention. If it doesn’t leave after a couple of days, I see my eye doctor. After two surgery scares, I’m not going to take any more chances.

And remember, if you ever feel the need to beat yourself up about your vision, remind yourself: you didn’t do this, diabetes did. Every morning, I wake up, get out of bed, give myself time for my vision to clear, and take on another day. That’s all we as people with diabetes can do. We need to meet all our challenges head-on and commit to staying heathy.

Stay aware of your body — including changes with your vision — and then go out and live your best life. I’m still tossing around the idea of riding a motorcycle, for example. I’ve seen people with eye patches ride them, so why not? I might not be able to ride across the country on a Harley, but I can at least take a spin around town. Anything’s possible. Don’t let your diabetic retinopathy hold you back.

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October 27, 2022
Biosimilars May Finally Stop the Rocketing Cost of Insulin

Oct. 26, 2022 – Trapper Haskins, a 45-year-old musician with type 1 diabetes, says the price of insulin is a constant stressor in his life. The Nashville resident takes two types of insulin daily and sometimes must ration the medicine because his insurance plan caps how much of the pricey drug he can receive each month. Insulin “isn’t like a high blood pressure medication,” he says. “Some days you need more, and then you get to the end of the month and you’re afraid you’ll run out.”

Research shows that among people with type 1 and type 2 diabetes, about one in four must ration their supplies due to cost. In general, most people with diabetes need two or three vials of insulin a month. Each vial can cost hundreds of dollars, meaning patients’ costs could easily reach $1,000 a month.

“The price of insulin has tripled in the last 10 years, and it’s creating a national crisis,” says Lizheng Shi, PhD, a professor of health policy at Tulane University in New Orleans. .

There are 1.5 million people with type 1 diabetes in the U.S. who can’t buy their own insulin and are entirely dependent on it to keep their blood sugar in a safe range. The vast majority of people with diabetes, some 37 million, have type 2 diabetes, which usually results in the use of blood sugar-reducing medications until insulin is introduced later on because the body no longer responds to its own.

The high cost of insulin is largely due to a lack of competition and too few makers of the current products, says Shi. One of the best hopes for more affordable insulin is to increase market competition and drive down prices with the introduction of so-called biosimilar drugs, which are highly similar versions of the original biologic medications – and typically far less expensive.

Creating Competition in the Market

In July 2021, the FDA approved the first biosimilar product that could be used interchangeably with current insulin products. Called Semglee, it’s a long-acting insulin analog and the generic form of Lantus, the world’s leading basal insulin, whose patent expired in 2016. Semglee, which is made by the drug company Mylan, is now available under some 2022 insurance plans and is approved for patients with type 1 and type 2 diabetes. But Semglee isn’t inexpensive – it’s around $133 per vial without insurance. Some versions of Lantus retail for more than $300.

The introduction of insulin biosimilars won’t bring major price cuts anytime soon, says Jing Luo, MD, an assistant professor of medicine at the University of Pittsburgh. One reason, he says, is that it takes years for drugmakers to develop the expertise and capacity to scale up production of biosimilars. Still, Luo is optimistic that we’ll get there in the next 2-3 years, and once we do, it could mean insulin would cost 10 times less.

Luo cites the work of the nonprofit Civica Rx. In March, the organization announced it would produce large-scale generic insulin in an effort to drive down cost.

The company will produce three forms of insulin to be used interchangeably with Lantus, Humalog, and Novolog. The products will be sold for no more than $30 a vial. They’ve already started building their manufacturing plant in Petersburg, VA, and will have products available for purchase by 2024, pending FDA approval.

Additionally, the state of California plans to produce its own generic insulin. The state is investing $50 million to make biosimilar insulin products and another $50 million to build a manufacturing facility.

Not Soon Enough

But for many, price cuts aren’t happening fast enough. Allison Bailey of Ames, IA, who has type 1 diabetes, says that it can feel daunting sometimes to find a way to pay, but she couldn’t survive without the life-saving medication. At times, it’s cost her up to $500 to fill her prescription. Bailey was eventually able to adjust her prescription to a less expensive insulin, but the 35-year-old graphic designer says her insurance coverage still takes up a sizable chunk of her monthly expenses.

The introduction of biosimilars has not driven down the price of insulin fast enough for patients like Bailey, says Robert A. Gabbay, MD, PhD, chief science and medical officer at the American Diabetes Association. That’s why the association is pushing legislation to bring down insulin prices. It lobbied hard to establish a $35-per-month Medicare price cap that will go into effect in 2023. Now it’s focused its efforts on expanding the caps to private insurers, a move that was voted down by Republicans in Congress as part of the Inflation Reduction Act.

“We want to see some transparency in pricing; right now, everyone just points fingers at each other and we don’t know who’s to blame,” Gabbay says.

But people with diabetes like Haskins and Bailey agree that competition from biosimilars and price caps could help bring down what they view as the exorbitant prices for medications they need. “I’m lucky I have insurance, but for those who don’t, it’s often a life-or-death situation,” says Haskins

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October 26, 2022
Yoga, Other Mindfulness Practices Improve Blood Sugar in Type 2 Diabetes

Oct. 14, 2022 — Patients with type 2 diabetes achieve much better control of their blood sugar if they participate in mind-and-body-practices such as yoga, a new study shows.

While past research has been done specifically for yoga, this study, published online recently in the Journal of Integrative and Complementary Medicine, also looked at the benefits of other mind-and-body practices for these patients, including qi gong and meditation.

The study is “the first to show that there is a very consistent effect [on hemoglobin A1c, a marker of diabetes] regardless of which modality you use,” says one of the researchers, Richard Watanabe, PhD.

“So I think one of the important messages … is that any sort of mind-body intervention seems to be helpful, which makes this a much more flexible tool than telling a patient that they should [just] do yoga,” says Watanabe, who is a professor of population and public health sciences at the University of Southern California’s Keck School of Medicine in Los Angeles.

There are other options available, “and if you are a busy person and getting to yoga is not doable, you can learn about meditation and do it anywhere. So again, it [is] … a flexible tool to help their patients with blood sugar control,” he says.

“The most surprising finding was the magnitude of the benefit these practices provide,” says the lead author, Fatimata Sanogo, from the University of Southern California, Los Angeles, in a statement. “We expected there to be a benefit but never anticipated it would be this large.”

But how do mind-body practices reduce A1c? It’s not totally clear, Watanabe says, noting that more research needs to be done to figure this out.

“But I think everyone’s hypotheses is that these methods reduce stress, so the idea is that they reduce stress hormones and since these hormones do have an effect on glucose metabolism, reducing them using these modalities reduces A1c and blood sugar levels,” he explains.

Alternatively, mind-body practices might improve insulin sensitivity. “You basically allow insulin to be more efficient at increasing glucose uptake by insulin-sensitive tissues,” Watanabe says.

So should doctors prescribe any one of the mind-body practices looked at in the study? Maybe, Watanabe says.

“Our results suggest that the effect you are going to see with the mind-body intervention is going to be on top of whatever standard of care patients are getting, so it definitely cannot hurt,” he says. He also notes that for patients with diabetes, constantly having to monitor their blood sugar levels and watch what they eat is very stressful.

“That just contributes to the difficulty in controlling blood sugar,” he says. “So I think physicians need to evaluate their patients and help them pick the thing that fits best with their lifestyle and personality, so it’s really up to the physician to work with patients and help them find something that works for them.”

A Study of Studies

The researchers conducted what is known as a meta-analysis, where they identified 28 studies, published between 1993 and 2022, looking at the use of mindfulness practices in patients with type 2 diabetes.

All studies excluded patients who needed insulin to control their diabetes as well as those with medical complications such as heart disease or kidney complications. The types of mind-body practices analyzed included meditation, breathing techniques, yoga, and an ancient Chinese practice known as qi gong, a type of slow-moving martial arts that’s similar to tai chi.

Using hemoglobin A1c (HbA1c) as a test that tells patients what their average blood sugar levels have been for the last 3 months, the results showed that the overall reduction in average A1c was 0.84 percentage points.

And reductions in A1c were seen with all types of mind-body practices. In patients who practiced mindfulness-based stress reduction, A1c was reduced by a mean of 0.48 percentage points. This practice involves focusing on one’s breath and on a particular thought, object, or activity to engender a stable emotional state and be fully present and aware of one’s surroundings.

The practice of qi gong also reduced A1c by a larger degree of 0.66 percentage points.

But the reduction in A1c was largest among those who practiced yoga, at 1.0 percentage points — about the same degree of reduction in A1c that’s seen with metformin, a drug widely used to treat type 2 diabetes around the world.

In fact, for every additional day of yoga practiced each week, the mean A1c differed by -0.22 percentage points over the study period.

Fasting blood sugar also improved significantly with mind-body practices.

Overall, the average reduction in A1c and fasting blood sugar “was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes,” the study authors said.

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October 14, 2022
Widespread metabolic dysregulation in different organs in type 2 diabetes

Newswise — The most typical alterations in people with type 2 diabetes are insufficient secretion of insulin and reduced sensitivity to insulin in different organs. To examine what happens in these organs when type 2 diabetes develops, the researchers in the current study have looked at proteins both in the cell islets in the pancreas where insulin is produced, and in the main tissues that insulin acts on, namely the liver, skeletal muscle, fat and blood.

The researchers compared proteins in samples from people with type 2 diabetes, prediabetes, i.e. a stage before fully developed type 2 diabetes, and without any diabetes. The results showed far more disturbances in metabolic pathways than previously known. There was also a correlation between the alterations and the different stages of the disease.

“We detected many protein levels that were either higher or lower than normal in tissues from people at different stages of disease. People with prediabetes displayed major alterations that are associated with inflammation, coagulation and the immune system in the pancreatic islets. In fully developed type 2 diabetes there were more widespread abnormalities, for example in lipid and glucose metabolism and in energy production in the liver, muscle and fat,” says Professor Claes Wadelius, who coordinated the study.

The study builds on tissue samples collected from donors at different stages of disease and healthy individuals. The samples have been collected in the strategic initiative EXODIAB, which is led in Uppsala by Professor Olle Korsgren.

Using novel techniques, the researchers could quantify thousands of proteins from each organ and therefore obtain a view of the metabolism that has not been possible before.

“The techniques for measuring proteins have evolved rapidly in recent years and our colleagues at Copenhagen University who participated in the study are world leaders in the field,” says Dr Klev Diamanti, who performed the analyses in Uppsala together with Associate Professor Marco Cavalli and Professor Jan Eriksson.

In summary, the findings show a highly disturbed metabolism in different pathways in examined organs and at different stages of disease. The data points to new potentially causal mechanisms of the disease, which can be further investigated in the search for new ways of preventing or treating type 2 diabetes.

“Our results may also support the development of simple tests that can identify people at high risk of diabetes and its complications, and also guide which type of intervention is best for the individual,” says clinical diabetologist Jan Eriksson.

Uppsala University

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October 7, 2022
Endocrine Society experts recommend individualized approach to use of telehealth
Newswise — WASHINGTON—Following rapid growth during the COVID-19 pandemic, telehealth visits are expected to remain an important part of endocrine care, according to a new Endocrine Society policy perspective published in The Journal of Clinical Endocrinology & Metabolism.

Health care providers need to consider a variety of factors when determining which type of visit best serves an individual patient’s needs at a given moment. For many patients, scheduling a mixture of in-person and telehealth visits can make medical care more convenient and effective.

“Clinicians will need to draw upon their own knowledge of each patient and their clinical goals to decide when to incorporate telehealth into their care,” said Varsha G. Vimalananda, M.D., M.P.H., of VA Bedford Healthcare System in Bedford, Mass., and Boston University School of Medicine in Boston, Mass. She is the policy perspective’s first author. “Telehealth visits can be considered as an option each time we schedule an appointment. Patient preference should be elicited, and decisions guided by weighing the factors we describe in the perspective piece.”

The policy perspective explores five aspects of care that determine when telehealth is appropriate, including:
- Clinical factors, including whether an in-person physical exam or assessment is needed;
- Patient factors, such as geographic distance to the clinic, access to transportation, work and family obligations, and comfort level with technology;
- The patient-clinician relationship;
- The clinician’s physical surroundings and personal circumstances; and
- Availability of infrastructure needed to provide quality telehealth services.
Telehealth can be a valuable component of an individualized care plan. Health care providers and patients should discuss how telehealth fits into care as they develop a care plan together, the policy perspective recommended.

Telehealth can play an important role in reducing disparities in health care access. Telehealth appointments can make it easier for patients facing barriers such as travel, cost, mobility, mental health, and work or caregiver responsibilities to access the medical care they need.

Other authors of this study include: Juan P. Brito, M.D., M.S., of the Mayo Clinic in Rochester, Minn.; Leslie A. Eiland, M.D., of the University of Nebraska Medical Center in Omaha, Neb.; Rayhan A. Lal, M.D., of Stanford University in Stanford, Calif.; Spyridoula Maraka, M.D., M.S., of the University of Arkansas for Medical Sciences in Little Rock, Ark., VA Central Arkansas Healthcare System, Little Rock, Ark., and the Mayo Clinic; Marie E. McDonnell, M.D., of Brigham and Women’s Hospital in Boston, Mass., and Harvard Medical School in Boston, Mass.; Radhika Narla, M.D., of the University of Washington in Seattle, Wash., and VA Puget Sound Health Care System in Seattle, Wash.; Mara Y. Roth, M.D., of the University of Washington; and Stephanie S. Crossen, M.D., M.P.H., of the University of California Davis School of Medicine in Sacramento, Calif.

The manuscript, “Appropriate Use of Telehealth Visits in Endocrinology: Perspective Statement of the Endocrine Society,” was published online, ahead of print.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.
Endocrine Society

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October 4, 2022
Yes, coffee can help you live longer and protect you from cardiovascular disease, with a few caveats

Coffee is one of the world’s most popular beverages. Here in the United States and in 17 other countries, September 29th is celebrated as National Coffee Day. For the rest of the world, October 1st is International Coffee Day. It is all about celebrating a love of the caffeinated beverage made from the beans of the tropical evergreen coffee plant and paying respect to the world’s coffee farmers.

The possible health benefits of coffee have been percolating in the news for years: Coffee can lower your risk for diabetes, coffee may protect against disease and even some cancers. More recently, headlines claim that coffee can extend your life or reduce cardiovascular disease risk. Good news, coffee lovers. The claim is mostly true.

New research showed that people that drank two to three cups of coffee a day appear to live longer. The study also found that there was a reduced risk of cardiovascular disease. All types of coffee, including ground, instant, and decaf, appeared to provide this health benefit. The research was published on September 27, 2022, in the European Journal of Preventive Cardiology

Maya Vadivloo backs the claim that coffee is good for you, with some caveats. She is the Associate Professor and Director in Health Sciences Department of Nutrition and Food Sciences at the University of Rhode Island. Vadivloo is an expert on nutrition, appearing often on such outlets as Today.com.

“Based on existing evidence, I would say it is mostly true that coffee consumption appears to protect against cardiovascular and total mortality, with a few caveats. I believe evidence remains inconclusive about intake >5 cups/day and that the method of preparation may matter, with some question about whether compounds released when boiling coffee (vs. drip or similar methods) may be less favorable (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524812/).”

For those who don’t drink our coffee black, are the benefits still there after we add flavorings such as sugar or cream? “The addition of milk etc. to coffee does not eliminate all health benefits,” says Vadiveloo. “However, in line with other recommendations for a healthy dietary pattern, limiting forms of added sugar and replacing high-fat dairy with low-fat products would be better for health outcomes and energy balance.”

Is coffee the magic bullet that will help us live longer, healthier lives? Not quite, says Vadiveloo.

“While I love coffee, I am always cautious of media coverage that suggests there is some ‘magic bullet’ to improve mortality. While I believe there is compelling evidence that 2-3 cups (or even <5 cups of coffee) have cardioprotective and mortality benefits, it’s not a recommendation that exists in isolation. Regular coffee consumption when part of a heart-healthy diet rich in minimally processed fruits, vegetables, healthy sources of protein (mostly plant sources like nuts and legumes, seafood, and fish), whole grains, heart-healthy vegetable oils, and limited in added sugars, salt, and high fat meats as advocated by the recent American Heart Association dietary guidance (https://www.ahajournals.org/doi/10.1161/CIR.0000000000001031) is the secret to improving overall health and mortality. (**disclaimer, I was a part of the AHA writing group)

So I would say, if people enjoy coffee, they should continue to do so as part of a healthy dietary pattern, and to be mindful of what things they add to their coffee to maximize the health benefits. And further, if people want to replace less healthy beverages in their diet (e.g., sodas and fruit juices) with coffee, that would be a positive step.”

Newswise

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September 30, 2022