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Archive for the ‘Diabetes’ Category

Uncovering the social factors lurking within diabetes risk – UC Santa Cruz

Tuesday, January 5th, 2021

For assistant professor of sociology James Doucet-Battle, diabetes research is personal. His grandmother was diabetic, and thats part of what inspired him to delve into the issue through the lens of African American experience.

Im interested in this notion that there is a racial component to risk for type 2 diabetes, he said. I wanted to unpack the ways in which African Americansand, increasingly, Latino peopleare held up as examples of high-risk type 2 diabetes populations.

Diabetes is a medical condition that affects the bodys ability to regulate blood sugar levels, and in type 2 diabetes, cells become resistant to insulin, the hormone produced in the pancreas that normally helps cells convert blood sugar into energy. African American people are far more likely to develop type 2 diabetes than white Americans. But why? And what are the effects of this disparity?

These are some of the questions that Doucet-Battle wanted to explore. And now, his new book, Sweetness in the Blood: Race, Risk, and Type 2 Diabetes, captures findings from that journey in a way that challenges assumptions about race within diabetes research.

For the first phase of the project, Doucet-Battle studied how African American populations with diabetes interact with researchers, healthcare professionals, and diabetes technologies, like glucometers. In particular, he wanted to uncover how the history of racism in the United States has affected trust between African American communities and biomedical researchers.

Doucet-Battle also studied a Silicon Valley-based biotechnology companys efforts to design a diabetes risk algorithm and examined how they navigated race in projecting health outcomes. The company had sought out an African American test group and a group of participants from Mauritius, in the Indian Ocean. It struck Doucet-Battle that both Mauritius and parts of the United States were once sugar colonies. That launched him into a study of how the global geography of diabetes reflects the history of colonialism and slavery.

He also worked with epidemiologists, molecular biologists, and genomicists across the country to look for diabetes risk factors in mitochondrial DNA, a maternally inherited chromosome that plays an important role in human metabolic adaptation to environmental change. Through this workspurred by the 2013 mapping of the genome and epigenome of the maternally derived HeLa cells of Henrietta Lackshe demonstrates the importance of analyzing gender before attempting to examine the social construct of race.

Ultimately, Doucet-Battle says researchers who want to better understand diabetes risk should focus more attention on social factors, because risk is as socially, culturally, politically, and economically created as it is biologically.

For example, he explained that type 2 diabetes is strongly associated with body weight, and many type 2 diabetics may be able to reduce or eliminate their dependence on medication through diet and exercise. Similarly, those who are prediabetic could reduce their risk of developing the disease. However, Doucet-Battle notes that the cultural and economic impulses in this country are mitigating against that. And one of those factors is inequality in access to physical activity.

While we can stay relatively healthy here in Santa Cruz County walking up and down the verdant hills of the Central Coast, for a lot of people, getting that recommended 180 minutes of aerobic exercise per week is quite a challenge, he said. Particularly when youre living in resource-deprived, unsafe, or aesthetically challenging areas.

In his future research, Doucet-Battle wants to continue exploring how barriers to physical activity affect diabetes risk and treatment outcomes. Hes particularly interested in taking a regional look at how COVID-19 lockdowns and poor air quality during Californias 2020 wildfire season have affected the lives of diabetics. To study this, hes assembling a team of UC Santa Cruz undergraduate researchers, with funding from the Building Belonging program administered by the Institute for Social Transformation.

Overall, when he looks back at the experience of writing Sweetness In The Blood, Doucet-Battle says it has helped him visualize the intersection of race, gender, history, and scientific knowledge production in new ways that will have a lasting effect on his approach to research.

I came into this project as a medical anthropologist, he said. I came out of it as a social scientist of science.

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Uncovering the social factors lurking within diabetes risk - UC Santa Cruz

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Lisa La on the Impact of Diabetes in Patients with Multiple Myeloma – Cancer Network

Tuesday, January 5th, 2021

The director of clinical research in the Center for Cancer Care at White Plains Hospital spoke about the implications of a study which evaluated the impact of diabetes in patients with multiple myeloma.

A descriptive analysis of the Connect MM Registry (NCT01081028), a disease registry for patients with newly diagnosed symptomatic multiple myeloma, presented at the 2020 American Society of Hematology Annual Meeting & Exposition revealed an unmet need related to providing better supportive care for diabetes management in patients with this hematologic malignancy.

In an interview with CancerNetwork, Lisa La, director of clinical research in the Center for Cancer Care at White Plains Hospital, discussed the implications of these study results and what she believes they point to regarding research moving forward.

Transcription:

Its always been known in the clinic that patients [with diabetes] possibly had worse overall survival and progression-free survival, but there wasnt a lot of data to prove that. Now that we have [those] data, whats next? Its really [about] providing the patients with more supportive care.

What does that mean? It could mean a lot of different things to a lot of different centerssuch as providing them with [a dedicated] clinician to handle and better manage their diabetes, weight management, healthy eating, [and] following up on them. Ive been doing some preliminary analysis on taking the next steps.

What other data Im interested in after looking at these general findings were [whether or not] race plays a role? Do steroids play a role? We know in myeloma, steroids are a big backbone for all of our treatments in general. And does that play a role in why patients [with diabetes] did not have a fair advantage of getting the same treatment options as those without diabetes just because of their comorbidities?

So, there are a lot of interesting findings. When the data were presented, there was a lot of excitement. Whats the next step? Can we look at race? Can we do subgroup analyses? What about the [patients going to] transplant? There are a lot of things that we can look at from this data.

Reference:

La L, Jagannath S, Ailawadhi S, et al. Clinical features and survival outcomes in diabetic patients with newly diagnosed multiple myeloma (NDMM) enrolled in the Connect MM Registry. Blood. 2020;136(suppl 1):49-50. doi:10.1182/blood-2020-137309.

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Type 2 diabetes is associated with increased risk of critical respiratory illness in patients COVID-19 in a community hospital – DocWire News

Tuesday, January 5th, 2021

This article was originally published here

Obes Med. 2020 Dec 30:100316. doi: 10.1016/j.obmed.2020.100316. Online ahead of print.

ABSTRACT

BACKGROUND: Type 2 diabetes (T2D) is the leading non-communicable disease worldwide and is associated with several microvascular and macrovascular complications. Individuals with T2D are more prone to acquiring selected types of infections and are more susceptible to complications due to these infections. This study aimed to evaluate the relationship between T2D and COVID-19 in the community setting.

METHODS: This was a single-center retrospective analysis that included 147 adult patients with laboratory-confirmed COVID-19 admitted to a community hospital. Demographics, medical history, symptoms and signs, laboratory findings, complications during the hospital course, and treatments were collected and analyzed. The Kaplan-Meier method was used to describe the probability of intubation in patients with T2D as compared with patients without T2D. The hazard ratio for intubation in the survival analysis was estimated using a bivariable Cox proportional-hazards model.

RESULTS: Of 147 patients, 73 (49.7%) had a history of T2D. Patients with T2D had higher requirement of ICU admission (31.5% vs 12.2%; p=.004), higher incidence of ARDS (35.6% vs 16.2%, p=.007), higher rates of intubation (32.9% vs 12.2%, p=0.003), and higher use neuromuscular blocking agents (23.3% vs 9.5%, p=.02). In the survival analysis at 28 days of follow-up, patients with T2D showed an increased hazard for intubation (HR 3.00; 95% CI, 1.39 to 6.46).

CONCLUSION: In our patient population, patients with COVID-19 and T2D showed significantly higher ARDS incidence and intubation rates. The survival analysis also showed that after 28 days of follow-up, patients with T2D presented an increased risk for shorter time to intubation.

PMID:33392411 | PMC:PMC7772088 | DOI:10.1016/j.obmed.2020.100316

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The Best Diets to Prevent and Manage Diabetes – Yahoo News

Tuesday, January 5th, 2021

Diet or diabetes: You decide.

An estimated 34 million people in the U.S. -- or just over 1 in 10 -- have diabetes. Diet is a crucial tool for managing the disease, and weight loss can help people who are overweight prevent Type 2 diabetes. Prevention is particularly important when you consider that diabetes brings complications such as high blood pressure and cholesterol, plus increased risk for heart attack and stroke, kidney disease and blindness.

Consider one of the U.S. News 2021 Best Diabetes Diets, as evaluated by nutrition experts:

No. 1 (tie) The Flexitarian Diet

The Flexitarian Diet marries flexibility with a vegetarian eating plan -- eat like a vegetarian most of the time, but when the urge for a double cheeseburger hits, go for it. Cutting back on meat will likely help you lose weight, which means you stand a better chance of staving off diabetes. Plus, vegetarianism is linked to a lower diabetes risk, according to the Academy of Nutrition and Dietetics.

"The amount of information and guidance in the Flexitarian diet is just enough to make the dieter feel informed without feeling restricted," a U.S. News reviewer says. "Focusing on a plant-based diet has been shown in research to be beneficial for your heart and brain and can help reduce the risk of diabetes and certain cancers."

No. 1 (tie) Mediterranean Diet

Fruits, veggies, whole grains. Fish and seafood. Oh yeah, and wine. The Mediterranean diet is a healthy all-around choice -- and a clear winner when it comes to diabetes management and prevention. One study, for example, found that about 30% of heart attacks, strokes and deaths from heart disease could be prevented by adopting the approach. Another study suggests the Mediterranean diet can help prevent diabetes, since the short-chain fatty acids (a product of fiber fermentation in the gut) the diet promotes are linked to a decreased risk of the disease. As one expert said, "Overall, this is the best diet for long-term health and disease prevention."

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No. 3 (tie) DASH Diet

The DASH diet -- Dietary Approaches to Stop Hypertension -- was designed to curb high blood pressure, but chances are, it can help prevent and manage diabetes, too. It's generally viewed as an ideal eating pattern for both, and it echoes dietary advice touted by the American Diabetes Association. One large 2017 study even linked diets that closely mirror DASH and other healthy eating patterns with an 18% reduced risk of Type 2 diabetes. Better yet, "because it uses regular food and does not depend on supplements or smoothies, it is relatively easy to incorporate into a dietary plan and it provides satiety," one U.S. News panelist said.

No. 3 (tie) Mayo Clinic Diet

The Mayo Clinic Diet aims to recalibrate eating habits and promote weight loss. It emphasizes the right foods (fruits, veggies and whole grains), discourages the wrong ones and mandates physical activity -- all good standards for diabetes prevention. The guidelines mirror those of the American Diabetes Association, and our expert panelists said the plan is better than most other approaches for those worried about diabetes.

No. 3 (tie) Vegan Diet

Going vegan will likely help you lose weight and fend off chronic diseases like diabetes. Research suggests the approach can lower A1C levels, and a small pilot study published in the journal Nutrition & Diabetes in 2015 suggests it can help ease diabetes-related nerve pain. In late 2016, the Academy of Nutrition and Dietetics released a position statement declaring vegetarian diets -- including vegan ones -- to be healthy, nutritionally adequate and potentially able to prevent and treat diseases, including Type 2 diabetes.

A U.S. News reviewer concurs: "If followed in a healthy way, (a vegan) diet has a lot of potential for treating and managing diabetes and for preventing heart disease."

No. 6 Jenny Craig

Jenny Craig offers a lower-carb program for people with Type 2 diabetes. U.S. News panelists suspect the Jenny Craig for Type 2 program can work for diabetes care and applaud its support component, but caution that the cost and packaged foods approach aren't ideal long term. "The lack of preparation (doesn't teach) people to eat a healthy diet for the rest of their lives," one expert said.

No. 7 (tie) The Engine 2 Diet

Experts were impressed with the Engine 2 Diet, a low-fat, vegan plan designed to prevent and perhaps reverse diseases like diabetes caused by the so-called standard American diet. It will almost certainly help you lose weight, which can stave off Type 2 diabetes. Plus, one study found that those on a similar diet were able to ease up on their diabetes medications and lower their A1C hemoglobin levels.

But, as with any restrictive plan, careful planning to consume the right amount of various nutrients is key. "Following this diet alone will not reverse diabetes; you'd still have to pay attention to carbohydrate intake," one reviewer said.

No. 7 (tie) MIND Diet

The MIND diet -- which blends two all-star plans, the DASH and Mediterranean diets -- is designed to prevent Alzheimer's disease with brain-healthy foods such as leafy green vegetables, berries, nuts, beans and whole grains.

While research focuses on brain health, the plan's parent diets may have diabetes-preventive effects. Just make sure you get moving, too. Exercise is one of the most important aspects of preventing diabetes and other chronic diseases, one expert says, "so it's unfortunate that an exercise recommendation is not included with this diet plan."

No. 7 (tie) Ornish Diet

Experts applauded the Ornish Diet as a way to prevent or control diabetes, giving it an impressive rating in this category. The plan's basic principles of emphasizing whole grains and produce and shunning saturated fat and cholesterol are right in line with American Diabetes Association guidelines. And in one study, Ornish dieters decreased their A1C levels (blood sugar measure) by 0.4 percentage points after a year, which was considered meaningful. "I appreciate that this diet takes a more holistic approach to health, including supporting relationships with others and stress reduction," one U.S. News panelist said.

No. 7 (tie) Volumetrics

Filling up on fibrous, bulky foods (think raw carrots) over easy-to-overeat foods (like Cheetos) is tied to weight loss -- and, quite likely, diabetes prevention and management, experts agreed. Research suggests such low-density diets help prevent insulin resistance -- a frequent precursor to Type 2 diabetes.

The Volumetrics diet is flexible, too. "From a behavioral standpoint, it is one of the most reasonable plans to follow over the long term because it is not overly restrictive and allows people to make 'better' choices rather than trying to follow strict guidelines," one U.S. News panelist said.

No. 7 (tie) WW (Weight Watchers)

Want to eat your cake and be able to prevent or manage diabetes, too? WW (Weight Watchers) -- which offers specific plans for people with diabetes and prediabetes -- allows dieters to strategically indulge using a point system. Still, making mindful choices is important, an expert notes: "Since fruits and vegetables are zero points, those with prediabetes and diabetes may be adversely affected by this if they overindulge in these foods."

One yearlong randomized controlled trial of 563 American adults with Type 2 diabetes found that nearly twice as many people who followed WW (Weight Watchers) and received counseling from a certified diabetes educator met their A1C level treatment target in comparison to those who received standard diabetes nutrition counseling and education. WW (Weight Watchers) participants were also more than twice as likely to reduce their diabetes medications. The program also led to greater weight loss and more reduced waistlines.

No. 12 (tie) Nutritarian Diet

The Nutritarian diet's focus on plant foods and limiting of animal proteins is in line with diabetes prevention and management protocols. Research, too, links diets high in fruits, vegetables, whole grains, legumes and nuts with a lower risk of Type 2 diabetes, while diets high in red meat and other animal protein have been linked with higher diabetes prevalence in women. "The Nutritarian diet seems radical," one expert said, "but it's really just trying to pack as many of the healthiest foods as possible and minimize those that have been associated with disease."

No. 12 (tie) Vegetarian Diet

Going vegetarian can help shed pounds and fend off chronic diseases, including diabetes. A meat-free eating plan will likely help you lose weight and keep it off, which can stave off Type 2 diabetes. Research links vegetarianism with a lower diabetes risk, and the American Diabetes Association and the Academy of Nutrition and Dietetics agree it's a healthful option.

Best Diets to Prevent and Manage Diabetes

-- Flexitarian Diet.

-- Mediterranean Diet.

-- DASH Diet.

-- Mayo Clinic Diet.

-- Vegan Diet.

-- Jenny Craig.

-- Engine 2 Diet.

-- MIND Diet.

-- Ornish Diet.

-- Volumetrics.

-- WW (Weight Watchers).

-- Nutritarian Diet.

-- Vegetarian Diet.

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The Best Diets to Prevent and Manage Diabetes - Yahoo News

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For diabetic type 1 patients, the skin autofluorescence predicts ulcers and amputations – DocWire News

Tuesday, January 5th, 2021

This article was originally published here

J Diabetes Complications. 2020 Nov 27:107808. doi: 10.1016/j.jdiacomp.2020.107808. Online ahead of print.

ABSTRACT

We searched whether the accumulation of Advanced Glycation End-products (AGEs), reflected by the skin autofluorescence (SAF), could predict diabetic foot ulcers (DFUs) during the long-term follow-up of people with type 1 diabetes. During year 2009, we measured the SAF with an AGE-Reader in 206 subjects with type 1 diabetes. DFU and amputations were registered during the 10 following years. The relation between the SAF and later DFU was analyzed by Cox model regression, adjusted for vascular risk factors. The 206 participants were mainly men (55.8%), 51 15 years old, with a 22 13 years diabetes duration. Twelve subjects presented a DFU. Their SAF were higher: 2.61 0.89 AU vs 2.11 0.53 for the others (p = 0.003), related to the risk of DFU (OR:3.69; 95% CI: 1.06-12.79) after adjustment for age, gender, diabetes duration, initial HbA1c, arterial hypertension, history of smoking, blood lipids and use of a statin. Five subjects were amputated, also related to the initial SAF: OR: 11.28 (95% CI: 1.76-79.97) after adjustment for age, gender, duration of diabetes, and HbA1c. The SAF has already been related to diabetic neuropathy and peripheral arterial disease. It predicts DFU in type 1 diabetes, which suggests that AGEs play a role in this highly specific and feared complication.

PMID:33386214 | DOI:10.1016/j.jdiacomp.2020.107808

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For diabetic type 1 patients, the skin autofluorescence predicts ulcers and amputations - DocWire News

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Diabetes Education Class To Be Held Virtually In February – KSST

Tuesday, January 5th, 2021

Texas AgriLife Extension Services next diabetes education program will be held virtually on Wednesday in February.

Do Well, Be Well with Diabetes is a program is designed to help people with Type 2 diabetes learn how to manage their blood glucose through basic nutrition and self-care management.

The class was originally scheduled to be start Wednesday, Jan. 4. However, the class has been moved to Wednesdays in February.

The diabetes education program is offered free from 2 to 4 p.m. Feb. 3, 10, 17 and 24 over Zoom, thanks to grant funding.

To register, contact Texas AgriLife Extension Family & Community Health Agent Agent for Hopkins County Johanna Hicks at [emailprotected] or 903-885-3443 by Jan. 30. They will then receive registration forms, materials and a participation link to log into the Zoom sessions facilitated by medical experts and professional educators.

Hicks has collaborated with colleagues in Fannin, Titus, and Rockwall Counties to offer the course.

If individuals are not comfortable with Zoom, or if they dont have reliable internet, they are welcome to view the sessions at my office, Hicks said.

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‘Radically different’ approach to managing Type II diabetes tested – The Union Leader

Tuesday, January 5th, 2021

CHARLOTTESVILLE, Va. A researcher at the University of Virginia School of Medicine is testing what he calls a radically different approach to managing type 2 diabetes for those who cant or dont want to lose weight.

Daniel Cox, PhD, professor of psychiatry and internal medicine, said his program flies in the face of conventionality in that it doesnt insist on weight loss as a key component of controlling blood sugar.

Instead, it combines continuous glucose monitoring with well-informed eating choices, to understand the effect of different foods on blood-sugar levels, and well-timed exercise, to reduce those levels as needed.

The convention is lose weight. And if you lose weight, you lose belly fat, and if you lose belly fat, you lose adipose tissue in the liver. And that, in turn, reduces insulin resistance, Cox said. Thats all fine and good. And if you can, in fact, lose a significant amount of weight and keep it off for a long time a lifetime youre golden. You can even put diabetes in remission. Theres nothing wrong with that approach, and its a very effective approach.

But some people dont need to lose weight, and some people dont want to lose weight, and other people want to lose weight but they cant, or they cant keep it off for a lifetime.

Coxs approach relies on continuous glucose monitoring to help people understand how their food choices affect their blood sugar. Different foods may affect people differently, he notes.

Continuous glucose monitoring involves wearing a sensor on the back of the arm that continually sends a signal to a receiver that shows the persons blood glucose level, without the need for finger sticks.

Continuous glucose monitoring lets people see how a particular food affects their blood-glucose levels, whether its a sugary slice of cake or a seemingly healthy bowl of oatmeal, Cox said. Understanding that lets them make smart choices to keep their blood sugar under control.

If they do choose to indulge in a sugar-spiking food, the program encourages them to use light exercise, such as walking, to help bring their blood sugar back into check.

This is the innovation: One, you dampen how much (blood sugar) goes up by minimizing the amount of carbohydrate you eat, and, two, you hasten its recovery by becoming more physically active, Cox said.

Physical activity does two things: One, the skeletal muscle burns blood glucose as fuel, and, two, physical activity reduces your insulin resistance for a short period of time, about 24 hours.

Instead of fixing supper and having a great dinner and then plopping in front of the TV for the rest of the night, the alternative is becoming more physically active, Cox said. Do your shopping after you eat, walk the dog after you eat, clean your house after you eat.

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Health Matters: How to prevent type 2 diabetes – Bennington Banner

Tuesday, January 5th, 2021

Type 2 diabetes is a serious disease. Its what happens when your body cant make enough insulin or use it properly. Insulin is the hormone that regulates blood sugar. Too much sugar in the blood causes a lot of complications. People with diabetes are at high risk for nerve damage, kidney disease, skin infections, eye problems, and developing a serious case of COVID-19, should they become infected. All of these problems can be very painful and debilitating. And once you have diabetes, it doesnt go away. You have to manage it for the rest of your life.

All of this sounds pretty bleak, but there is good news. The most common type of diabetes, type 2, can sometimes be prevented. The body sends up a warning flag called prediabetes. Those who are tested and find out they have prediabetes can take action to prevent the onset of irreversible diabetes.

The first step is to know your risk. The most significant risk factor is being overweight, especially if you carry more weight around your waist. Men with a waist measurement of 40 inches or more and women with a waist measurement of 35 or more are at greater risk of diabetes.

Age is also a risk factor. Because people tend to exercise less and gain weight as they age, those over 45 are at greatest risk. Pay attention to your family history, as well. If a parent or sibling has been diagnosed with type 2 diabetes, you are more likely to get it.

For a quick and easy screening test from the Centers for Disease Control and Preventions National Diabetes Prevention Program, visit https://www.cdc.gov/diabetes/prevention/pdf/Prediabetes-Risk-Test-Final.pdf.

If you find that you are at risk, ask your primary care provider to test for diabetes. The test your provider will most likely recommend is called a glycated hemoglobin (A1C) test. Its a blood test that shows your average blood sugar level for the past 2 to 3 months. Your provider is looking for a number below 5.6 percent. Measurements 5.7 to 6.4 are an indication of prediabetes. Higher than 6.5 percent on two tests indicates that you have diabetes.

If your test indicates that you already have type 2 diabetes, ongoing visits with a diabetes educator and a very focused and committed approach to diet and exercise can help you manage the effects of the disease. Medications and other therapies are sometimes recommended too.

If you find that you have prediabetes, the most important thing you can do is learn more. Understanding how the disease works will help you make some important life changes. The CDC offers a proven-effective diabetes prevention program specifically designed for people with prediabetes. Local health and fitness professional Andrea Malinowski is conducting a session starting in February. Its free, but you must have a prediabetes diagnosis to join. Ask your primary care provider to connect you with the local diabetes educator for more information.

Paula Haytko, RN, CDE, is a certified diabetes educator at Southwestern Vermont Medical Center.

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Local News: Beat diabetes in the new year (1/2/21) – Monett Times

Tuesday, January 5th, 2021

Cox partners with UM Extension to help keep community healthy

Cox Health and the University of Missouri Extension are teaming up to give residents who may be at risk of type 2 diabetes another resource to stay healthy in 2021.

The new diabetes prevention program is scheduled to begin Monday, Jan. 11 with online classes. Classes will be held from 6:30-7:30 p.m. every Monday for the first six months, and once a month for the final six months of the year-long program.

Community Health Field Specialist Kelsa Ferguson said a grant from the Department of Health and Senior Services is providing a grant that allows the partnership to offer this program for free of charge.

One in three adults are pre-diabetic, and 90 percent are unaware, Ferguson said. By participating in this class, it will reduce their risk of getting type 2 diabetes by 58 percent.

The goal of the program is to help participants lose 5-7 percent of their bodyweight and work up to 150 minutes of physical activity per week by the end of the 12-month course.

Ferguson also said the program will also function as a support group, where members can work together to share information.

We are going to talk a lot about how to heat healthy, how to exercise and stress management, Ferguson said. A lot of it is going to be about getting support as a group.

While the program will begin this month with online meetings, if COVID-19 restrictions are eased later down the road, Ferguson said the group may begin to meet in-person.

This program is being specifically designed for community members who are at risk of contracting diabetes, which could include people with a family history of diabetes, those who are overweight, residents who have been diagnosed with pre-diabetes and women who have been diagnosed with gestational diabetes.

There are 79 million Americans who have pre-diabetes, which increases their risk of heart disease and stroke risk, Ferguson said. Without intervention, 30 percent will develop type 2 diabetes within five years.

Anyone who is interested in enrolling in the program is invited to contact Ferguson at 417-635-4562 or kelsaferguson@missouri.edu.

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Are metabolic hormones the next frontier in cancer treatment? – MedCity News

Tuesday, January 5th, 2021

Conceptual vector illustration. Human diseases. Stop cancer

Its now well established that obesity, visceral (belly) fat and type 2 diabetes (i.e., metabolic dysfunction) increase a persons risk for developing certain cancers. What is only beginning to be appreciated is that cancer patients that have underlying metabolic dysfunction have much worse outcomes and seriously increased mortality rates. This suggests that metabolic hormones play an important role in cancer progression, and could be valuable targets in cancer treatment.

A variety of chronic, adverse health issues are associated with metabolic dysfunction, including type 2 diabetes, cardiovascular diseases, Alzheimers, and most notably cancer. Metabolic dysfunction is linked with worse outcomes for at least 13 types of cancers and is associated with a 33% elevated risk of death from cancer in the US. Of all the various cancer types, some of the most common are highly sensitive to dysregulated metabolic hormones (insulin, leptin, adiponectin) and chronic inflammation stemming from overweight/obesity, pre-diabetes, type 2 diabetes and metabolic syndrome. An estimated 630,000 patients in the United States alone were diagnosed in 2014 with an obesity-related cancer, including breast, prostate, and colorectal cancers. Yet, only now are oncologists and researchers beginning to pay close attention to the profound influence systemic metabolic dysfunction has on cancer progression and patient outcomes.

The nexus of cancer and metabolic dysfunctionMetabolic dysfunction leads to dysregulated hormones that impact known oncogenic pathways causing tumors to grow faster with greater metastatic potential, and may even be implicated in cancer treatment resistance. The metabolic hormone insulin, as well as leptin and adiponectin (aka adipokines), signal through validated oncogenic pathways, including PI3K/Akt/mTOR, MAPK, ERK, JNK, Notch, and STAT3, and trigger deleterious downstream effects such as cell proliferation, migration, angiogenesis, stem cell protection, and metastatic potential. Ultimately, these downstream effects drive tumor growth and metastasis. Moreover, systemic metabolic dysfunction dysregulates the tumor immune microenvironment leading to immune suppression possibly rendering the tumor resistant to cancer treatment.

Sadly, you dont have to be overweight to have metabolic dysfunction. People who maintain a healthy weight according to their body mass index (or BMI) can still have systemic metabolic dysfunction, depending on how their body fat is distributed. These individuals are also at a higher risk of developing cancer, one major example of this being in post-menopausal women and breast cancer. Furthermore, cancer therapies themselves can induce metabolic dysfunction (e.g., hyperglycemia, hyperinsulinemia, weight gain, insulin resistance) which can impact the patients quality of life and even lead to treatment failure.

Why targeting gene mutations isnt enoughCurrent cancer treatments tend to target specific mutations or dysregulated pathways in tumor cells with the goal of blocking cell proliferation and reducing tumor burden. However, as long as metabolic dysfunction is stimulating key oncogenic pathways, oncologists administering these treatments will be fighting a losing battle. Studies with diet and exercise suggest that standard treatments may be more effective if they are administered simultaneously with measures to reduce metabolic dysfunction in cancer patients. This approach addresses the disease on two fronts: molecularly targeted chemotherapeutics arrest cell proliferation and can shrink the tumor size, while restoring normal metabolic hormone levels relieves the external stimulation on oncogenic signaling pathways. Not only does this combination approach impede multiple cancer drivers at both the systemic and cellular levels, but it also improves patients quality of life by boosting their strength and possibly lessening side effects from treatment.

It is now more important than ever that standard cancer treatments account for the critical role that metabolic dysfunction plays in patients prognosis. Rates of obesity, pre-diabetes and type 2 diabetes are on the rise worldwide, driven by poor diets, sedentary lifestyles, and even reduced activity during the Covid-19 pandemic. Furthermore, metabolic dysfunction and cancer are associated with aging, and retiring baby boomers make up a massive aging segment of our population. This growing population of aging individuals combined with an increase in metabolic dysfunction creates the perfect storm in which many more people are likely to develop highly aggressive forms of cancer in the coming years.

How to treat a cancer patient with metabolic dysfunction?When a person with metabolic dysfunction discovers they have cancer, they can work with an endocrinologist or dietician to develop healthier lifestyle habits, such as weight loss, better diabetes control, improved nutrition, and regular physical activity all of which help the patient better tolerate chemotherapy, and improve the treatment outcomes. However, sticking to a rigorous diet and exercise regimen can be challenging for patients, especially while they are undergoing chemotherapy. While adopting healthy habits should always be a goal, cancer patients could benefit from pharmacological options that treat systemic metabolic dysfunction more predictably and reliably to provide a complementary, one-two punch with standard of care cancer therapies so they have a better shot at working. Although there are no drugs on the market specifically targeting this population, the type 2 diabetes drug metformin has been clinically studied in this population, with mixed results.

Treating the patient, not just the cancerWeinbergs The Hallmarks of Cancer got it right a multi-faceted approach to treating cancer is the way forward. Metabo-oncology is the emerging area of research dedicated to understanding and developing treatments for cancers that are sensitive to metabolic dysfunction. A steadily-growing body of clinicians are speaking out on the role of metabolic dysfunction and its implications on cancer patient treatment and clinical outcomes.

Justin Brown PhD, assistant professor and director of the Cancer Metabolism Program at the Pennington Biomedical Research Center in Louisiana is a leader in the field researching how metabo-oncology principles can be put into clinical practice. From Dr. Browns perspective, the diagnosis of cancer triggers two reactions: on one hand, an individual becomes motivated to do everything in their power to maximize the probability for a good outcome; on the other hand, the diagnosis is overwhelming, stressful, and terrifying. Most patients experience some combination of both reactions, and this is where healthy lifestyle habits can be a powerful, enabling tool.

Dr. Brown believes that oncologists should provide the right information about lifestyle choices to the right patient at the right time. When a patient indicates that they are ready, physicians could then initiate a patient-centered discussion about the benefits of pursuing a healthy lifestyle. Once a patient decides they want to adopt a healthier lifestyle, doctors should put the patients in contact with experts (endocrinologists, dieticians) to help improve clinical success.

In reality, however, while oncologists and their patients generally recognize the importance of healthy lifestyle habits, in a 2019 survey conducted by the American Society of Clinical Oncology, oncologists only reported counselling patients about weight management, healthful eating, and physical activity about 40-60% of the time, due to a lack of training, limited referral options, and lack of third-party reimbursement for diet and exercise counseling.

Thats why treating cancer patients with concomitant metabolic dysfunction remains a major challenge for oncologists. The work of a key opinion leader in this field, Emily Gallagher, MD, PhD demonstrates this well. Dr. Gallagher is an endocrinologist at Mount Sinai in New York who specializes in treating cancer patients with metabolic dysfunction. When Dr. Gallagher treats her patients, she never takes a one-size-fits-all approach to addressing their metabolic issues. Instead, she considers the underlying medical reason patients were referred to her, the type of cancer they have, and the type of treatment they are receiving. She considers pre-existing conditions, like type 2 diabetes, current lifestyle, and disease symptoms when devising a treatment regimen that she believes will be most effective. She sets short-term and long-term goals for her patients and follows up regularly to help keep them on track, and encourages them to see a diabetes educator/dietitian to further encourage positive lifestyle changes.

From Dr. Gallaghers perspective, when patients have metastatic cancer, their non-cancer background conditions often go under-treated. But, by ignoring systemic metabolic dysfunction, clinical oncologists may inadvertently be contributing to their patients disease progression. Therefore, its important that oncologists pay close attention to the metabolic health of their cancer patients and monitor for endocrine side effects (hyperglycemia, hyperinsulinemia, obesity/weight gain) induced by the cancer drugs they prescribe. This is why it makes sense to refer these patients to endocrinologists who may have already developed strategies to address these problems. Whats more, by having the oncology team reinforce the importance of systemic metabolic health, it communicates to the patients that their treatment strategy is being administered by a team of doctors using a whole-patient strategy.

While treating physicians know that obesity/systemic metabolic dysfunction leads to worse outcomes for their cancer patients, they face multiple challenges in addressing it: limited pharmacologic interventions that can effectively treat patients metabolic issues, lack of training in the methods endocrinologists use to address these issues, and no payer incentives to encourage better lifestyle choices. While we wait for effective pharmaceutical interventions that can reliably address these issues, anti-diabetic medications and diet and exercise will have to do. Addressing systemic metabolic dysfunction in cancer patients requires communication between diverse medical experts and scientific disciplines. Incorporating a multi-disciplined approach to treating cancer should help foster better clinical practices for cancer patients and improved outcomes for patients with cancers sensitive to metabolic hormones.

Photo: Main_sail, Getty Images

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Know how to boost well-being in winters if you are diabetic – Free Press Journal

Tuesday, January 5th, 2021

New Delhi: People with diabetes face a real challenge during the winter season. The cold weather coupled with reduced physical activity puts stress on the body, causing it to go into a fight-or-flight mode. This results in the release of natural survival hormones like adrenaline and cortisol. Consequently, the liver releases more glucose for energy leading to increased blood sugar levels.

Dr H.P. Bharathi, Deputy Chief Medical Officer, Jindal Naturecure Institute says: Presently, more than 50 million people in India have diabetes and it is expected to go over 6 crores by 2025. So, theres a big challenge in front of the country to tackle this rising concern. A naturopathic approach recommending specific behavioural changes can help in the effective management of diabetes during the winters. He shares six naturopathy and yoga tips that can help people with diabetes during the cold season.

1. Diet: A well-balanced diet is crucial to keep diabetes in control no matter the season. It is recommended to include plenty of vegetables, fruits, whole grains, lentils, beans, and oatmeal. Sweets and fatty foods should be avoided. Also, diabetics should refrain from consuming dry fruits as the fructose in them may spike the sugar level.

2. Yoga: The ancient practice of yoga can work wonders on the body, helping people with diabetes to keep the disease under control and lead a normal, happy life. Science has shown that specific yoga poses that involve the twisting and stretching of the internal muscles and organs stimulate the pancreas and endocrine system. This facilitates insulin secretion, which keeps the blood glucose levels under check.

3. Alternative treatments: Alternative treatment methods like acupuncture, physiotherapy, hydrotherapy, etc., can restore harmony to the body in several ways. Acupuncture, where thin needles inserted into specific points in the body, can help with weight loss, control blood sugar levels, and reduce insulin resistance. Physiotherapy and hydrotherapy promote neurological and musculoskeletal functions that aids in weight loss, reduces stress levels, and lowers blood pressure.

4. Mental health: Those affected with diabetes live with a lot of stress. It can cause spurts of anxiety, mood change, confusion, and depression. The American Diabetes Association says that Seasonal Affective Disorder (SAD) may occur during winters; however, it is treatable. Spending time with loved ones, indulging in hobbies, or getting professional help are some of the ways through which diabetics can find relief.

5. Lose weight: Obesity can increase the risk of developing type 2 diabetes by 80-85 percent. For people with obesity, the pancreas cannot produce enough insulin to meet the body's needs. Therefore, losing weight becomes the only option to stay healthy and fit. Regular exercise, brisk walks, etc., should be incorporated into daily life to get rid of excess weight.

6. Avoid immune suppressing foods: Diabetics should stay away from high-fat food, alcohol, caffeine, and white sugar, suppressing the immune systems effects. Too much high-fat foods can block the lymphatic system, hindering the bodys ability to fight infections.

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Brown fat may protect adults from chronic conditions, including diabetes and heart failure – Study Finds

Tuesday, January 5th, 2021

NEW YORK When youre trying to lose weight, it may not seem like theres such a thing as good fat. Despite this, scientists say brown fat is something everyone needs more of and it can even make you healthier. Aside from burning more energy, a new study reveals having brown fat makes it less likely someone will develop several conditions including diabetes and heart disease.

Researchers from Rockefeller University Hospital say brown fat is much different than the more common white fat. While white fat stores calories and makes up about 90 percent of the bodys fat cells, brown fat is key in energy consumption, fat burning, and generating heat. The one problem with studying the health benefits of brown fat is it can be hard to find. A reason for this is its buried deep inside the body and even gets mistaken for tumors.

The study of over 52,000 participants finds those who have detectable levels of brown fat in their bodies suffer from fewer health problems.

For the first time, it reveals a link to lower risk of certain conditions, says Paul Cohen, a senior attending physician at Rockefeller, in a media release. These findings make us more confident about the potential of targeting brown fat for therapeutic benefit.

While scientists have been researching brown fat for decades in animals and infants, they discovered in 2009 that adults still have these cells as well. Typically, brown fat is located in the neck and shoulders. Unfortunately, researchers ran into a problem when it came to scanning for these cells using PET medical imaging.

These scans are expensive, but more importantly, they use radiation, says study first author Tobias Becher. We dont want to subject many healthy people to that.

The team quickly realized there was an alternative nearby at the Memorial Sloan Kettering Cancer Center. There, patients undergoing evaluation for possible cancers regularly take PET scans. The scan easily detects brown fat and radiologists must make a note of it so doctors dont mistake it as a cancerous mass.

Working with Heiko Schoder and Andreas Wibmer at Memorial Sloan Kettering, the study examined 130,000 PET scans. Those scans reveal nearly 10 percent of the more than 52,000 patients have brown fat tissue. The results find only 4.6 percent of patients with brown fat have type 2 diabetes. That number is 9.5 percent among people who do not have visible brown fat deposits.

Additionally, just 18.9 percent of patients with brown fat have abnormal cholesterol levels, compared to 22.2 percent of those without brown fat. Patients with brown fat tissue also have lower risk for high blood pressure, heart failure, and coronary artery disease. The results even point to brown fat negating some of the health impacts of obesity in overweight patients.

It almost seems like they are protected from the harmful effects of white fat, Cohen says.

Study authors note the number of adults in the general population with brown fat is likely higher. This is because patients at Memorial Sloan Kettering are commonly advised to avoid the cold, exercising, and caffeine. Scientists are still looking for the reasons why brown fat is able to reduce the risks of these conditions. The study says there are some clues though.

Brown fat cells consume glucose as they burn calories. Researchers believe its possible this is lowering the blood glucose levels, which is a major determining factor for diabetes patients. There are fewer clues tying brown fat to hypertension, but its link to the hormonal system may hold the answer.

We are considering the possibility that brown fat tissue does more than consume glucose and burn calories, and perhaps actually participates in hormonal signaling to other organs, Cohen explains.

The natural question that everybody has is, What can I do to get more brown fat?' he adds. We dont have a good answer to that yet, but it will be an exciting space for scientists to explore in the upcoming years.

The study appears in the journal Nature Medicine.

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A Look Back on 2020: Diabetes Year in Review – Healthline

Tuesday, January 5th, 2021

Wow, what a year 2020 has been

Weve had to learn to live in ongoing pandemic crisis mode as COVID-19 remains a public health emergency across the globe.

Pretty much everything is seen through that lens, and as a result, our annual diabetes year in review also looks a bit different this time around.

Traditionally, DiabetesMine has featured a month-by-month breakdown of the biggest happenings of the year.

But 2020 isnt like any other year. Every week and month has felt extraordinarily long, and the days seemed to blend together in ways we just havent ever experienced before.

As such, weve focused our annual review on the big themes defining 2020, along with a handful of notable news items.

The pandemic has hit our Diabetes Community on so many different levels, including but not limited to the following:

We cant overlook the mental health effects all of the above both individually and collectively had on people with diabetes (PWDs).

Mental health has been a lesser-discussed aspect in official research and diabetes care until recently. (This has prompted some community advocates to devote themselves to helping.)

A new study by a team of diabetes experts published in the December 2020 edition of the Journal of Diabetes and Its Complications examined the early effects of COVID-19 nationally on U.S. adults with both type 1 and type 2 diabetes.

The researchers concluded that: There is a substantive increase in level of diabetes-related and general life stress and worry about being vulnerable to the virus, and significant social isolation [and] there is a significant impact on disease management.

Changes in the medium of healthcare delivery were only modest during the early stages of social restriction, but satisfaction with these changes was generally low, they added.

These findings suggest the need for greater attention to the emotional and psychosocial impact of the pandemic on this population and its implications for disease management and diabetes-related healthcare delivery.

The United States endured one of the most volatile presidential administrations and intense elections in modern history.

And with that, it seems everything was viewed through a political lens including the efforts to prevent and respond to the pandemic itself.

This made everything even more confusing and concerning for PWDs. For instance:

Of course, recognition and representation of BIPOC (Black, Indigenous, and People of Color) became a hot-button issue in 2020 following the police killing of George Floyd, sparking historic protests across the country.

Some PWDs were among those arrested, which brought up the issue of whether police were discriminatory or negligent with diabetes care and personal safety on the line.

Meanwhile, there was a great deal of introspection about racial disparities, in COVID-19 responses and beyond, and the implicit bias and systematic racism that exists in our U.S. healthcare system.

As everything began boiling over, some key diabetes advocacy organizations like JDRF and Beyond Type 1 came under fire for lacking diversity and not addressing the issue properly. See the JDRFs response here.

There were many panel discussions and studies presented on this topic at conferences, and a new nonprofit called Diversity in Diabetes (DiD) was formed by advocates of color to elevate efforts.

We at DiabetesMine conducted a survey on BIPOC experiences with diabetes technology and care in fall 2020, and found that more than 50 percent of respondents currently do not feel represented at all.

See also our video of BIPOC advocates expressing their desires for change.

Thankfully, 2020 also brought our D-Community a handful of highlights worth mentioning. Here they are, in no particular order:

Announced in late 2019, a long-awaited policy change finally took effect that allows people with insulin-dependent diabetes to legally pilot commercial airplanes.

Pietro Marsala became the first T1D licensed commercial pilot.

Ironically, this came to be just as the global pandemic sucker punched the travel industry.

Still, its an important change that puts the United States on par with other countries, and it takes away one more cant do for PWDs following their dreams.

While insulin affordability and access remains at crisis level in the United States, we saw two new forms of insulin finally get clearance from the Food and Drug Administration (FDA) and launched this past year:

A few important new diabetes devices were launched this past year as well:

Despite the economic struggles and effects on diabetes nonprofits, weve seen a few new orgs born during 2020 to address specific needs: the aforementioned Diversity in Diabetes (DiD), Beta Cell Foundation, and Mutual Aid Diabetes (MAD).

The latter two are grassroots orgs formed to help people in need get diabetes meds and supplies, beyond whats offered by existing industry-based financial assistance programs.

This year of content streaming gave us the Netflix reboot of The Baby-Sitters Club, once again featuring a main character who wears an insulin pump.

Also in the limelight was the passing of actor and famous diabetes supply spokesman Wilford Brimley. Pop singer Meghan Trainor also shared her gestational diabetes story publicly.

Be on the lookout for the new movie Greenland, written by Chris Sparling, husband of well-known diabetes advocate and author Kerri Sparling.

The movie features a T1D character and was released for on-demand viewing in December 2020. Its heading to HBO Max in 2021.

This past year has been extremely tough for all of us on so many fronts Heres to looking forward to a brighter, less stressful 2021 ahead.

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COVID-19 And Diabetes Can Be A Dangerous Mix – WFYI

Wednesday, December 16th, 2020

FARAH YOUSRY - Side Effects Public Media

Agatha Walston leads a busy life. Shes a nurse in southern Indiana and a single mother of two young kids.

Shes kept control of her type 1 diabetes for over 28 years partly through a healthy lifestyle. I would rather snack on veggies than trash food, the Clarksville woman says.

But when the pandemic hit, she feared that the control she maintained for so long could be unraveling. I told my kids, I said, Okay, there's this super-killer virus on the loose, and I'm a nurse and I will probably get it.

That was really hard conversation to have with the kids to make sure that they knew that, you know, if mom goes, they're still going to have each other.

People living with diabetes are not more likely to get COVID-19. But they are at a much greater risk of developing severe symptoms and complications. A COVID study in England examined more than 20,000 deaths and found that a third of those people were diabetic.

In mid-April, Walston tested positive.

She survived without hospitalization, but months later, she noticed new health issues. She was diagnosed with high cholesterol, elevated blood pressure, heart problems and glaucoma a condition that could cause blindness.

She recalls, The glaucoma specialist, he had said, You know, you're already at risk for glaucoma. So we won't know if it was COVID or diabetes.

Walstons doctors are unsure if COVID is behind any of these complications or if her diabetes was a contributing factor.

But many diabetics worldwide are battling health complications from a COVID infection.

Even if your blood glucose control is perfect, you're still going to have some risks, says Dr. Carmella Evans-Molina, director of the Diabetes Research Center at Indiana University.

COVID has the power to elevate blood sugar levels and cause insulin resistance even in previously healthy people, she says. For diabetics, this effect is magnified.

So they might then need to make changes in their insulin regimen or changes in their diabetes medication, Evans-Molina says. If they're in the hospital, obviously their providers in the hospital will be taking care of these things. But if they're recovering from COVID at home, they need to be very careful and checking their blood glucose very frequently, and then be in communication with their doctors.

She says that such drastic changes in blood sugar levels could cause long-term complications if not managed carefully.

Dr. Francisco Rubino, a professor at Kings College London, also has been watching the emerging problem. Since the beginning of the pandemic, we noticed there is a bidirectional relationship between COVID and diabetes.

In a letter to the New England Journal of Medicine, he and other healthcare professionals noted that the severe insulin resistance caused by COVID might have another shocking effect. Even people who didn't have any history of diabetes, coming up to the hospital with clear signs of having diabetes, he says.

Rubino says data is still limited, so he set up a global registry called CoviDiab to track these cases.

Dr. Evans-Molinas team has studied pancreatic cells of patients who died from COVID. They did not see evidence of the virus being able to trigger new on-set diabetes, she says, adding, I think we're really early in our understanding of that.

She notes that managing COVID patients requires the use of steroids, which causes elevated blood sugar levels. This is one of many factors that could have damaging effects on diabetics or someone with pre-diabetes.

So we know that we're probably seeing people who were very close to a diagnosis pass over that threshold and become diagnosed with diabetes, she says.

As doctors and scientists work to understand the relationship between COVID and diabetes, Walston is dealing with her medical problems. She says this year has been rough physically and emotionally.

She adds, The best thing about 2020 [is] not dying.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

This reporting is supported by the GBH Educational Foundation through the Corporation for Public Broadcasting. To learn more about the diabetes epidemic in America, watch the documentary"Blood Sugar Rising."

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Kids With Type-1 Diabetes Helped by Anti-TNF Therapy – ubmd.com

Wednesday, December 16th, 2020

A research study led by Teresa Quattrin, MD, could prove beneficial for children and young adults with newly-diagnosed Type 1 diabetes.

Published December 16, 2020

A Phase 2 research study led by Teresa Quattrin, MD, UB Distinguished Professor of pediatrics and senior associate dean for research integration, shows that the drug golimumab preserves beta-cell function in children and young adults with newly-diagnosed Type 1 diabetes for at least a year after diagnosis.

Research Published in New England Journal of Medicine

The study published on Nov. 19 in The New England Journal of Medicine represents a major step forward in the effort to find ways to preserve the insulin-making capabilities of children and young adults newly diagnosed with Type 1 diabetes.

The study demonstrates that golimumab, an anti-tumor-necrosis-factor (TNF) therapy, reduced the amount of injected insulin required by children and young adults with newly-diagnosed Type 1 diabetes by preserving their ability to produce insulin on their own, called endogenous insulin.

The need for less injected insulin is a major quality of life improvement for patients with Type 1 diabetes, according to the researchers.

Golimumab, marketed as Simponi, is currently used in the treatment of rheumatoid arthritis, ulcerative colitis and other autoimmune conditions. However, it is not approved by the U.S. Food and Drug Administration for the treatment of Type 1 diabetes.

Quattrin, first author on the study, also presented the findings on June 13 at the annual meeting of the American Diabetes Association (ADA).

The most important finding of our work is that this drug, golimumab, is a potential disease-modifying agent for newly diagnosed Type 1 diabetes, says Quattrin, attending pediatric endocrinologist at the Diabetes Center atUBMD PediatricsandOishei Childrens Hospital. The main goal of the study was to see if golimumab could preserve beta-cell function in these newly-diagnosed patients and it does.

This was assessed by measuring the amount of C-peptide in patients blood during a four-hour mixed meal tolerance test. Because C-peptide reflects only insulin made by the body and not injected insulin, C-peptide levels reveal how well the pancreas is producing insulin.

Higher C-Peptide Levels After 1 Year

Patients treated with golimumab had a higher C-peptide level at week 52 compared to placebo.

This was statistically significant; thus the study met its primary goal, Quattrin says.

Quattrin adds that 41.1 percent of participants receiving golimumab had an increase or a less than 5 percent decrease in C-peptide compared to only 10.7 percent in the placebo group.

Nearly 43 percent of those who received golimumab were in partial diabetes remission (also known as the honeymoon phase) versus 7.1 percent of those receiving placebo. The definition of partial remission was based on insulin dose and blood sugar control levels as indicated by hemoglobin A1C, a measurement of average blood sugar levels over three months.

Blood Sugar Control With Less Insulin

Quattrin explains that a child with Type 1 diabetes requires about 1 unit of insulin per kilogram of body weight per day. That means that a child weighing about 65 pounds typically requires about 30 units of injected insulin per day once they are out of the partial remission period about 3 to 6 months after diagnosis.

In this study, both golimumab and placebo groups achieved good blood sugar control, but patients treated with golimumab achieved it with less insulin, Quattrin says.

During the 52 weeks, insulin dose increased only slightly for those on golimumab 0.07 units per kilogram per day versus 0.24 units per kilogram per day for those on placebo study.

In a post-hoc analysis an analysis conducted after the conclusion of the clinical trial those younger than 18 years had 36 percent fewer episodes where blood sugar was less than 54 mg per deciliter, designated by the ADA as level 2 hypoglycemia.

This is important clinically because low blood sugar reactions are dangerous and can even be fatal if untreated. Low blood sugar levels also require immediate attention, often causing the child to be removed from classroom or recreation activities, compromising quality of life.

UMBD Pediatrics, Oishei Among Trial Sites

The drug is self-administered as a subcutaneous injection every two weeks. No serious side effects related to the study drug such as serious infections were reported.

The randomized, controlled clinical trial was conducted at 27 centers throughout the U.S., including at theDiabetes Center at UBMD Pediatrics andOishei Childrens Hospital in Buffalo. It involved 84 patients, ages 6 to 21 years, with two-thirds receiving golimumab and one-third receiving placebo starting within 100 days from diagnosis.

Throughout three decades as a leading researcher in pediatric endocrinology, Quattrin has been interested in finding ways to extend the remission, or honeymoon period, to preserve the ability of recently diagnosed Type 1 diabetes patients to continue to make insulin on their own.

The current study took place on the basis of positive findings in animal models, as well as Quattrins work with patients treated at the Diabetes Center at UBMD Pediatrics and Oishei Childrens Hospital. It confirms results published by her team in 2009 where in a randomized pilot study 10 patients received another TNF inhibitor and eight received placebo starting within 28 days from diagnosis.

The results of this small proof-of-concept study strongly suggested that this class of drugs might be able to preserve beta-cell function in newly diagnosed patients with Type 1 diabetes.

Jacobs School Faculty Are Sub-Investigators

Jacobs School of Medicine and Biomedical SciencesDepartment of Pediatrics sub-investigators in the research are:

They were supported by the pediatric diabetes-endocrinology research team at the Diabetes Center at UBMD Pediatrics and Oishei Childrens Hospital, led by Amanda House.

Other co-authors of the research presented at the ADA and on the New England Journal of Medicine paper were from Emory University, the University of Colorado, the University of Florida and Janssen Research & Development LLC. The World Without Disease Accelerator a group within Janssen funded the study.

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A Definitive Guide to Wine and Type 1 Diabetes – Healthline

Wednesday, December 16th, 2020

It didnt take long into her adult years for Julia Blanchette, a nurse and diabetes educator at the Cleveland Clinic, to discover shes a wine enthusiast.

The fact that she has celiac disease pushed her toward it in the first place, because she was steering clear of wheat-based beer, she said. And the fact that she has type 1 diabetes (T1D) need not have dissuaded her. With a lot of (fun) sampling and trial and error, Blanchette learned how to embrace her love of wine, she tells DiabetesMine.

It took experimentation for sure. I had to find the wines that didnt raise my blood sugar as much, and I savor the ones that do as more of a dessert, she says.

And once I found the ones that didnt impact my blood sugar immediately, I had to understand how it impacted me later. Did it make me low? Did I have to always eat with it? Did it make me high? Whatever the answer, she says, each one led her to be a confident wine connoisseur who happens to have T1D on board.

Such can be the case for most people with diabetes (PWDs). With study, thought, and guidance from your medical team, experts say theres no reason not to savor the art and joy of wine.

The first thing PWDs need to know about wine is how it works in the body, which does differ a bit from other types of alcohol.

Wine, unlike, say, vodka or beer, is created very much by the hand and mood of nature.

Thats why there are good years and not so good years for wine production.

That dynamic means that even the same wine can vary a bit from season to season.

Thats one of the things about wine, and it goes across every type, Keith Wallace, author, winemaker, sommelier, and a professor and founder of the Wine School of Philadelphia tells DiabetesMine.

Sugar gets fermented, yes, but you are going to find hidden sugar in there, and with wine, it can sometimes be a significant amount, he says.

As a winemaker, I always insist on fermenting everything bone dry so its not as much an issue, he explains.

Wallace does that for his clients, yes. But he does it for himself too. Diagnosed with type 2 diabetes some years ago, he quickly realized that the dryer the wine, the less impact on his glucose readings.

But that doesnt mean PWDs need to limit their wine choices, he says. Rather, understanding the possible impact and what action to take to make it work is the key, he says.

What do doctors say about consuming wine with diabetes? Often not enough, according to Mary Ellen Phipps, registered dietitian nutritionist, founder of MilkAndHoneyNutrition.com, and author of The Easy Diabetes Cookbook. Phipps has lived with T1D since age 5.

There are two camps, generally, she tells DiabetesMine. The doctor who says no, dont drink alcohol at all, and the doctor who says its fine. But heres the thing: They tend to say that with no explanation, without putting a framework of understanding of it for the person with diabetes.Her suggestion? Ask the question and then ask for more details.

Her opinion?

If you are going to drink, wine is a good choice.

Unlike, say, vodka, when you can pretty much know the impact on your blood sugars no matter the brand, wines vary greatly.

Understanding that can help a person with diabetes plan and study it as they begin.

When Phipps advises patients, she speaks of what she knows, not just as a trained nutritionist but as a person living with T1D who also happens to love wine.

Her basic breakdown of wine and blood sugars? A dry white has the least sugar, reds come in a bit higher (but theres no need to avoid them she says) and dessert wines are just like they sound.

Wallace breaks them down like this:

Lower alcohol wines often have more sugar for taste reasons, he said. And so do lower-cost wines, which, he said, are often amped up in sugar for taste reasons.

That, he said, is because the pedestrian wine drinker tends to lean toward sweeter, having not learned the nuances of wine tastes.

A surprise, though: The same can go for a moderately expensive wine.

Theyre trying to appeal to that same general consumer, just a wealthy one, he explains.

To look for a wine with the right alcohol content, he says, look for a label that reads 12.5 percent to 16 percent alcohol. More or less than that can mean added sugars.

As for types, he said, the location of the grape grown can give you hints as well.

Germany, he said, is known for Rieslings, which have a higher sugar content by design. But they also have wines with almost no sugar, known as Trocken (dry).

It has to say that, he says, and it has to say Trocken by itself on the label.

Italian and French wines tend to have less residual sugar overall, he says, because its a cultural thing. Countries that tend to pair wines with food usually make wines with less sugar.

Australian wine drinkers, he says, tend to drink it by itself, and therefore tend toward a bit more sugar.

The modern styles of white wines, Wallace says, (other than Chardonnay) are light, fresh, crisp styles. Those actually have almost no sugar at all.Another hint for hidden sugar? Ironically, Wallace says, it can be the popularity of the brand.

Were seeing this more with, for example, the popularity of Oregon wines, he says. As wines like Pinot Noir get more popular, you often see more sugar. People like it; its as simple as that.

Karen Graham, registered dietitian, diabetes educator, and author of three best-selling books on living with diabetes, is also a wine lover who happens to live a stones throw from vineyards in British Columbia.

Her advice to the wine enthusiast with diabetes is to start with the basics and go from there.

She suggests that you hone in on a few different wine styles you like, experiment with brands, and learn what works for you. Then stick to those as much as you can.

In her book The Complete Diabetes Guide, Graham outlines the general carbohydrate/sugar content of the most popular wines, something she says can be used as a starting point for handling the wines you like best.

Be aware that when it comes to drinking alcohol of any kind, including wine, there are some steps all PWDs should take.

Make sure you never drink on an empty stomach, Graham tells DiabetesMine.

She also reminds PWDs to always have a source of fast-acting glucose on hand, because alcohol can lower blood sugars, and do so quickly.

You should also let any friends you may be enjoying wine with know about your condition, and make sure theyre familiar with the signs of a low blood sugar, which can mimic drunkenness. They should know not to hesitate to ask you about your situation should they see signs.

And, of course, you should pay close attention to your blood sugars both before, during, and for a long time after a wine outing.

With those steps handled, PWDs can enjoy wine and do so without guilt, Graham says.

Choose one or a few you really love and stick with them, or with similar selections, she adds. Going to a friends house for dinner? Bring along a bottle or two and that way you know what youre drinking. And for a restaurant, its always a good idea to peruse the wine list in advance online, to see what you can find that you like and know, or learn about one that sounds interesting ahead of time.

Phipps agrees that preparation and a bit of study makes being a wine lover with diabetes easier, even if it takes more effort upfront.

She suggests keeping a journal, which isnt as odd as it sounds. Many wine aficionados keep a journal of the wines they try. But instead of just recording what you like and why, keep track of how your blood sugars were during and after, what you may have eaten with it, and if any tweaks are needed.

Pay attention to how you respond to it, and then youll know what to choose next time, or what to do if you choose that one again, Phipps says.

And what about a wine tasting evening? Yes, Graham and Phipps agree, it can be not only done but fully enjoyed.

Phipps suggests finding out ahead of time how many ounces a vineyard or event organizer will be pouring, as well as what kinds of wine. That way, you can keep track as you go along.

Graham points out that food may not be readily available at some wine tastings, and may lean toward protein (such as cheeses) rather than carbs. So its a good idea to eat a meal before going, and/or pack some snacks just in case.

Wines with less sugar, in particular, may lower blood sugars, so being prepared is your best bet, she says.

If you should be unsure of the sugar content in a wine, Wallace offers a simple tip, one that will make you look like a true wine pro: Hold your nose for the first sip.

Sweet, sour, bitter, and salty comes from the taste buds, he says. If you block your nose and you taste sugar (as the main flavor), it will inform you that this wine has a lot of sugar.

He reminds us that its important to focus on getting the right amount of food to go along with your wine when it comes to diabetes.

Dont worry about the wine as much as the food you may eat, he says. Thats what can get you in trouble. Dont arrive hungry. Eat a small prep meal beforehand so you can totally enjoy the wine.

Wallace does have some good news: This all could get less challenging in the future. In his classes, hes teaching future winemakers and servers about how different types impact diabetes, so they can help guide consumers better.

One in six people either have diabetes of some kind or are pre-diabetic, he says. Its a huge market, and you dont want to harm your customers. And wine is good, in so many ways. PWDs have so much stress and wine is a great stress reducer. This doesnt have to be a worrisome thing. Done right, its excellent.

In the end, while extra thought is needed, PWDs who love wine say the effort is worth it.

Kelly Kunik, patient advocate and author of the popular blog Diabetesaliciousness, says nearly a lifetime of living with T1D has taught her to do what she must and know all the facts but in the end, its taught her to go with the flow, too.

I wouldnt say Im a sommelier, she tells DiabetesMine. I just like wine. But to be clear: I dont study wine for my diabetes, I study it for my palate. Sometimes a glass of wine is just a glass of wine. And thats totally okay.

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A Definitive Guide to Wine and Type 1 Diabetes - Healthline

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How to Check Blood Sugar Without a Meter: Is It Possible? – Healthline

Wednesday, December 16th, 2020

Diabetes is a chronic condition where the body either doesnt make enough insulin or doesnt use insulin properly or both. This can lead to a higher than normal blood sugar level.

Uncontrolled blood sugar levels can lead to complications, such as:

For these reasons, its important to monitor your blood sugar if you have diabetes.

Prior to using meters, people with diabetes would monitor their blood sugar by testing their urine. This method, however, wasnt as accurate, nor did it provide real-time results.

If you self-test your blood sugar several times a day using a glucometer, or meter, it requires that you prick your finger to draw blood to test. Due to the discomfort of this method, you might look for a way to monitor your level without this tool.

If finger pricks are very bothersome for you, dont worry theres hope. Advances in blood sugar monitoring technology could mean no more finger pricks in the future.

If you have diabetes, there are several portable devices you can use to check your blood sugar level and not all of them require a finger prick.

The one device that does require a finger prick is a meter. This is the most widely available and affordable option.

To use this device, youll insert a test strip into the meter. Youll prick your finger to retrieve a sample of blood, and then place the sample on the edge of the test strip to check your blood sugar.

Glucometers are convenient because theyre small and portable, allowing you to use them anywhere. Your blood sugar results are also accurate and instant.

You can also use a continuous glucose monitor (CGM) to check your blood sugar. This is different from glucometers, which can only monitor blood sugar when you test your blood.

Continuous glucose monitoring, on the other hand, provides real-time glucose, or blood sugar, readings every few minutes. These systems involve the insertion of a tiny sensor underneath your skin (usually in the abdomen).

This sensor measures your interstitial glucose level, and then sends the information to a pager-like monitor, or an app on your phone. An alarm sounds if your blood sugar becomes too high or too low.

Even though continuous glucose monitoring systems place a sensor under the skin, most still require a finger prick at least once a day to calibrate the device.

This is less than the number of finger pricks with a glucometer, which can require four or more per day.

The Freestyle Libre system is another way to check your blood sugar. While this method has certain features in common with a CGM and a meter, it stands out for one reason: It doesnt require a finger prick.

Youll still have a tiny sensor inserted underneath your skin with the Freestyle Libre. Its different from a CGM in that you wont get continuous readings.

But, rather than prick your finger, like you would with a meter, youll use a reader to scan the sensor when you want to check your blood sugar level.

Again, urine is another way to measure sugar levels. This involves inserting a test strip into your urine. The problem, though, is that test strips can only detect sugar in your urine they cant provide an exact blood sugar reading.

Unfortunately, this method of checking blood sugar isnt convenient since youll need a container to collect the urine. Also, it only works when urine hasnt been sitting in your bladder for too long.

Fingertips have more nerve endings, so this part of the finger tends to be the most sensitive.

If you use a finger prick to check your blood sugar level, a few techniques can make the process less painful whether youre using a glucometer or a continuous glucose monitor.

Blood sugar testing is crucial to diabetes management because high or low blood sugar can cause severe complications. If too much blood sugar accumulates in your bloodstream, you can experience major complications such as:

Signs of high blood sugar include:

Signs of low blood sugar can include:

Blood sugar can fluctuate throughout the day especially after meals, after exercising, and during stressful events. So its important to carefully monitor your blood sugar and keep it within a healthy range.

A blood sugar level less than 140 milligrams per deciliter (7.8 millimoles per litre), but greater than 70 mg/dL (3.9 mmol/L) is typically considered in the target range.

You should check your blood sugar regularly, even if you arent experiencing symptoms of a high or low glucose level. Some people with high and low blood sugar dont have any symptoms.

Even though you can monitor blood sugar level with glucometers and CGMs, the future might provide additional ways to manage your diabetes.

Testing your blood sugar is crucial to diabetes management. Using a meter or continuous glucose monitoring can provide accurate results. But you might seek a pain-free method to check blood sugar.

Talk with your doctor or a certified diabetes educator. You might be a candidate for a glucose monitoring device that involves fewer finger pricks or no finger pricks.

Additionally, making a few adjustments in the way you collect your blood sample might reduce the level of pain and discomfort.

Diabetes is a life-long, chronic condition that involves careful monitoring of your blood sugar. This can prevent serious complications such as nerve damage and stroke.

Discuss options for monitoring blood sugar with your doctor to find a device that suits your comfort level.

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Dexamethasone study provides insight into COVID-19 treatment for patients with diabetes, other risk factors – University of Virginia The Cavalier…

Wednesday, December 16th, 2020

A team of scientists, which included University researchers, found that dexamethasone, a steroid used to treat severe cases of COVID-19, is less effective to treat COVID-19 for those with diabetes and other risk factors. The discovery suggests that further research is necessary to understand how to better treat diabetic and at-risk patients with COVID-19.

Dexamethasone is an anti-inflammatory and immunosuppressive steroid used to treat critically-ill, COVID-19 patients who require supplemental oxygen or ventilators. The steroid suppresses the immune system, alleviating the damage done to the lungs in patients with an overactive immune response, a bodily response that can be deadly. Besides COVID-19, dexamethasone has been used to treat severe pneumonia, asthma and other conditions.

What makes this paper special is that there arent that many drugs that are proven to treat COVID-19, said Dariusz Brzezinski, University Medical School research scientist and team member. Thats why dexamethasone is interesting because its been proven to help those severe cases.

For their research, scientists from the University School of Medicine, University of South Carolina and Poland relied on the LabDB Laboratory Information Management System, a database that tracks the structures of proteins. One such plasma protein, serum albumin, is known to transport drugs throughout the bloodstream, including dexamethasone. Serum albumin has different active sites to which drugs can bind in order to be carried throughout the body.

Wladek Minor, lead researcher and a Harrison Distinguished Teaching Professor in the Medical School, explained that by studying and refining the structure of dexamethasone as well as serum albumin, the team of scientists discovered that the steroids transport may influence its effectiveness in patients.

We started to look at this structure [of dexamethasone] and because we were working on albumin, Minor said. We found that dexamethasone binds to the same side as some drugs If the person is taking some other drug, there is a competition for the active site. If his active site is already occupied, [dexamethasone and albumin] cannot bind together.

Minor and the team of researchers demonstrated for the first time how dexamethasone binds with serum albumin for transport. Their new research indicates that other drugs and the hormone testosterone may compete with dexamethasone for the limited sites on serum albumin, resulting in drug displacement. In drug displacement, a drug administered at a high concentration can displace another drug, like dexamethasone, at the binding site, limiting its potential effectiveness. The scientists found that the testosterone molecule binds to albumin in the same way that dexamethasone does, further suggesting a competition between the two.

Those with diabetes have been found to have more severe symptoms of and complications with COVID-19. Diabetic patients often have high blood sugar levels which may modify serum albumin, affecting the binding site of dexamethasone.

In analyzing data from 373 patients at a hospital in Wuhan, China, the researchers also discovered that patients with high blood sugar levels as well as patients with lower than normal levels of albumin made up the majority of those who died from COVID-19.

Apparently if you have a higher level of albumin, you can survive, Minor said. The level of albumin in the case of women is higher than the case of men, and this explains why women have a higher chance to survive.

Further research is still needed to understand how best to treat COVID-19 patients affected by diabetes and high risk factors, like low levels of albumin. The researchers propose that clinical studies investigate alternative ways of administering dexamethasone to these patients.

[Studies] could try to administer small doses of dexamethasone over a longer period of time, Brzezinski said. This way if youre not transporting that much dexamethasone, then [there] wont be that much free dexamethasone in the body, so it wont have negative effects.

Increasing the dosage of dexamethasone for diabetic and at-risk patients may seem like an easy solution to override competing drugs, but too much dexamethasone over a long period of time can be harmful to the body.

The other idea is that you can administer dexamethasone not through injection but through inhalers, Brzezinski said. And this way you dont have albumin, you have a different way of transport and youre avoiding the problem altogether.

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Could You Be Prediabetic or Diabetic and Not Know It? The Signs – The Beet

Wednesday, December 16th, 2020

With 88 millionAmericans or approximately 1 in every 3 adults,suffering from prediabetes in this country (and 34 million Americans, or 1 in 10, with full-blown type 2 diabetes), many people are walking around with a ticking time bomb in their bodies, and don't even know they have the condition.

Prediabetes is when your blood sugar level is higher than it should be for optimal health, butnot high enough for your doctor to diagnose the disease.It's also known asimpaired fasting glucose or glucose intolerance. The scary part is, 90 percent of those with prediabetes dont know that they have it.

We have all heard that excessive thirst or urinating more often than normal is a sign that you could have diabetes, but what are the telltale signals that you may be pre-diabetic? Why does it matter? The sooner you find out the better, for your health and to know that changing your lifestyle can alter the course of the disease and head it off at the pass.

Prediabetes, unlike diabetes, is an asymptomatic condition. The soonersomeone finds out that they are prediabetic the better, experts say, since it's possible to make lifestyle changes that can reverse your health and get you back onto a healthy path, with simple switches like eating more plant-based foods, losing a small amount of body weight, and being more active, such as walking 30 minutes a day, five days a week.

"Prevention is the best medicine!If you are given a prediabetes or diabetes diagnosisdo not despair," since you can make simple lifestyle changes (exercise, diet, and losing a small amount of weight) to reverse course on the disease, saysKellie Antinori-Lent, MSN, RN, andPresident of the Association of Diabetes Care and Education Specialists (ADCES) and diabetes clinical nurse specialist at the University of Pittsburgh Medical Center, Shadyside Hospital in Pittsburgh.

"If someone is at risk for developing prediabetes or diabetes, they should schedule an appointment with their doctor to discuss their concerns and questions. The best first place to begin is with a visit to your providerwhether in person or virtualand dont delay," says Antinori-Lent. Prevention is the best medicine!If you are given a prediabetes or diabetes diagnosisdo not despair!" There are simple things you can do to dial back the condition such as exercise 30 minutes a day, lose 7 to 10 percent of your body weight, and eat a mostly whole-food, plant-based diet, high in fiber and low in added sugars and chemicals.

How do you know if you have diabetes or prediabetes? We asked Antinori-Lent,who makes it her life's work to educate people about the changes they can make to ensure their future health, and here is what she had to tell us:

Kellie: That is a really good question, however, prediabetes does not have symptoms. There is a physical sign of insulin resistance, which is associated with prediabetes. This sign is darkened skin in areas such as the neck, under the arms, and elbows. Some people mistake it as an area of skin they didn't wash wellbut you cannot wash acanthosis nigricans (the name of the dark skin areas). Instead, there are risk factors. These include:

Keep in mind that prediabetes can develop into type 2 diabetes if left untreated. People can prevent this from happening by evaluating their lifestyle habits, including changing their diet, increasing their exercise and activity levels and seeing their doctor regularly, and working withhim or her to prevent the progression.

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Could You Be Prediabetic or Diabetic and Not Know It? The Signs - The Beet

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The Link Between Type 2 Diabetes and Heart Disease – WebMD

Wednesday, December 16th, 2020

Type 2 diabetes raises your odds of developing heart disease, as does prediabetes. If youve been diagnosed with either, start paying attention to your heart health now.

You dont need to have diabetes before you get heart disease, says endocrinologist Matthew Freeby, MD, an assistant clinical professor of medicine and director of the Gonda Diabetes Center at David Geffen UCLA School of Medicine. We know theres a higher risk of heart disease in people with prediabetes.

Prediabetes occurs when your body can no longer keep your blood sugar level within a normal range. Unchecked, over time it may rise high enough to warrant a diagnosis of diabetes. Elevated blood sugar, in both prediabetes and diabetes, can harm your blood vessels and the nerves that keep your heart and blood vessels functioning properly. Over time, this can cause heart disease.

But, says Freeby, thats only part of the picture. Most people diagnosed with prediabetes or diabetes also have other conditions that threaten the heart: high blood pressure, high cholesterol, and obesity. Such health problems, collectively known as metabolic syndrome, boost the likelihood of blood clots as well as damage to the arteries in your heart.

Managing the risk of heart attack and stroke is less about managing diabetes than it is about reducing the risk factors that go along with diabetes, says Freeby.

Both diabetes and heart disease may lead to heart failure, which may weaken your heart so it cant function properly. Its one of the earliest, most serious, and most common heart problems in diabetes. Diabetes often worsens heart failure, while heart failure can complicate your diabetes treatment.

We only have so many tools at hand for lowering your blood sugars, and some of these are medications that should not be used if you have heart failure, says Freeby.

Fortunately, you have your own tools to protect your heart. Reduce your risks of heart disease -- and diabetes if you have prediabetes -- by modifying your lifestyle in ways that will improve your overall health. It may not be easy, but you dont have to make dramatic changes overnight. Some areas to focus on:

Slim down. Excess weight burdens your heart. To shed pounds, start with small, attainable goals. You dont need to set a lofty goal for weight loss says Freeby. That 5 or 10 pounds you do lose will have a big, positive effect.

Get moving. Exercise will help keep your heart healthy. Dont aim to do too much too soon or youll risk injury. Focus, instead, on simply getting started. Find an activity that you like to do that wont cause you pain and that will keep you coming back day after day, Freeby says.

Eat right. Go easy on your favorite foods, especially processed foods and simple sugar treats. Discuss your daily meals with a dietitian and understand you arent alone. Every person is different, says Freeby, but we all struggle to make dietary modifications.

Get screened. Freeby recommends regular screening for diabetes, as early diagnosis can modify the course of diabetes-related complications.

Care for yourself. To help manage diabetes risk or the disease if you have it, try relaxation techniques to reduce stress, get a good night's sleep, and maintain an active social life, says Freeby.

Find more articles, browse back issues, and read the current issue of WebMD Magazine .

SOURCES:

Matthew Freeby, MD, endocrinologist, assistant clinical professor of medicine, and director of the Gonda Diabetes Center, Los Angeles.

Cleveland Clinic: How to Protect Your Heart When You Have Prediabetes.

National Institute of Diabetes and Digestive and Kidney Diseases: Diabetes, Heart Disease, and Stroke.

National Heart, Lung, and Blood Institute: Heart Failure.

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