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SCORED, SOLOIST Trials to Add to Evidence for Treating Diabetes with SGLT2 Inhibitors

The two paired trials evaluated sotagliflozin, a drug that inhibits SGLT2 and SGLT1, according to a study published in The New England Journal of Medicine.

With the results of these large two trials, adding to other recent data about drugs in this class, it is now clear that most patients with type 2 diabetes and either kidney disease or heart failure should be on an SGLT2 inhibitor, said Deepak L. Bhatt, MD, MPH, the executive director of Interventional Cardiovascular Programs at the Brigham, in a press release.

Bhatt added that the Sotagliflozin on Cardiovascular and Renal Events in Patients With Type 2 Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (SCORED) trial provides further randomized clinical trial evidence that SGLT2 inhibitors should be part of the standard of care for patients with type 2 diabetes mellitus and kidney disease. Meanwhile, The Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial demonstrates that early, in-hospital initiation of SGLT2 inhibitors is safe, effective, and should become the standard of care in patients with type 2 diabetes mellitus and heart failure.

Further, sotagliflozin inhibits not only SGLT2, but also SGLT1. SGLT2 inhibition helps the body eliminate blood sugar via urine, whereas SGLT1 inhibition leads to blood sugar reduction via the digestive tract.

In the SCORED trial, investigators evaluated whether sotagliflozin could prevent cardiovascular events in patients with diabetes with chronic kidney disease. The trial enrolled 10,584 patients who were followed for an average of 16 months but ended early due to the coronavirus disease 2019 (COVID-19)-related loss of funding. The study authors changed the primary endpoint, but the initial endpoint reached statistical significance.

Unlike previous trials, SCORED enrolled patients across the full range of albuminuria, or leakage of protein into the urine that can happen when a person has diabetes. Further, sotagliflozin significantly reduced the primary endpoint of total occurrences of cardiovascular deaths, hospitalizations for heart failure, or urgent visits for heart failure regardless of the patients degree of albuminuria by approximately 26%.

In addition, sotagliflozin reduced the rate of cardiovascular death, myocardial infarction, or stroke, with an early benefit potentially mediated by the SGLT1 action. There was a reduction in the total number of fatal or non-fatal heart attacks and the total number of fatal or non-fatal strokes by 32% and 34%, respectively.

SCORED is the first trial to show the benefits of SGLT2 inhibitors across the full range of albuminuria, Bhatt said in a press release. It is also the first trial of an SGLT2 inhibitor to show a beneficial effect on stroke.

In the The Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial, 1222 patients with type 2 diabetes mellitus and recent worsening heart failure requiring hospitalization were enrolled. The patients were randomized to sotagliflozin or placebo and followed for an average of 9 months, but the trial ended early due to loss of funding from the COVID-19 pandemic.

Data from the patients who took part in the trial showed a significant 33% reduction in the studys primary endpoint (defined as the total occurrences of cardiovascular deaths, hospitalizations for heart failure, and urgent visits for heart failure) for patients with either heart failure with reduced or preserved ejection fraction. Taking the drug prior to hospital discharge was safe and effective.

SOLOIST is the first large, randomized trial to show the safety and efficacy of SGLT2 inhibitors when initiated in patients hospitalized with acute heart failure, Bhatt said in a press release. Thus, it really changes the field and supports early initiation of this class of drugs.

There were limitations of the SCORED and SOLOIST trials, including premature cessation due to loss of funding that led to an inability to complete the intended duration of follow-up. However, both trials found statistically significant declines in rates of total cardiovascular events for their respective patient populations.

REFERENCESCORED and SOLOIST trials add to evidence for treating diabetes with SGLT2 inhibitors. Brigham Health and Womens Hospital. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3732. Published November 16, 2020. Accessed February 3, 2021.

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SCORED, SOLOIST Trials to Add to Evidence for Treating Diabetes with SGLT2 Inhibitors - Pharmacy Times

The Spare a Rose campaign encourages people to donate the $5 cost of each rose they would have given to someone on Valentine's Day to Life for a Child. Life for a Child believes that no child should die of diabetes and this campaign is critical to help it achieve this goal. The funds raised from the campaign enable the charity to partner with diabetes centers in countries such as Mauritania, Jamaica and India to provide critical supplies, including insulin and testing supplies, as well as much needed diabetes education. Every $5 dollars equates to one month's supply of insulin for a young person and the program currently supports over 22,000 young people in 43 countries.

Ascensia has committed to match their employees' donations up to a maximum of one rose for every one of the company's 1,700 employees. To date Ascensia and its employees have collectively donated over $40,000 to Spare A Rose, making it the largest corporate supporter for this campaign to date. This donation is equivalent to providing life-saving insulin supplies to almost 670 children for a year, who otherwise would have nowhere else to turn.

Rob Schumm, President of Ascensia Diabetes Care, explained: "While people around the world will be buying flowers and cards for their loved one this Valentine's Day, many of our employees will be choosing instead to donate to the Spare A Rose campaign. This is testament to how many employees at Ascensia are passionate about making a difference to the lives of people living with diabetes, both professionally and personally."

Dr. Graham Ogle, General Manager of Life for Child, explained the importance of companies providing support for Spare a Rose: "The tremendous efforts from employees at Ascensia has had a huge impact on our ability to save the lives of children with diabetes across the world. Many children in less resourced countries are walking a tightrope with their diabetes management and often do not have the basic supplies to keep them alive. Through the generous employee donations and company matching we have received from Ascensia, we are able to provide crucial supplies and education that enable more children to have access to the care they need for their diabetes."

Rob continued: "We are proud to have been an avid supporter of this worthwhile campaign, which not only raises funds for insulin and testing equipment, but importantly also helps to highlight the plight of many children with diabetes in countries, where they do not have access to these essential supplies. The work of Life for a Child is literally saving the lives of children around the world and I implore more people to donate, so that together we can make a difference."

Donations to Spare a Rose can be made at https://lfacinternational.org/sparearose/.

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Ascensia Diabetes Care And Its Employees Excited To Support Spare A Rose Campaign For The Fourth Consecutive Year - PRNewswire

With increased awareness of diabetes in all its forms, more funding, compassion, and innovation will follow.

Would you rather have $1.6 million or $123 million ? Which would make a bigger impact in your life?

Personally, Id rather have $123 million, and Im betting you would say the same.

Think of the impact that could be made with that amount of money. You could pay off your student loans, mortgage, and car payment. You could afford the best of the best when it comes to healthcare, food, and experiences.

What would be louder? A crowd of 1.6 million people or 123 million?

Of course, 123 million people would be louder.

According to the American Diabetes Association (ADA), approximately 1.6 million people in the United States live with type 1 diabetes, 34 million people live with type 2 diabetes, and more than 88 million people have prediabetes.

In total, that makes 123 million Americans who are affected by this disease in one form or another.

Do you think we can make more of an impact as a community of 1.6 million people or 123 million?

There are so many factors that contribute to our ability to prevent and manage diabetes in the United States, including access to healthcare and lifesaving medications like insulin, access to healthy foods, finding time to exercise, and so much more.

As a community, we also have a branding problem.

The pink ribbon was introduced for breast cancer awareness in 1991. While its initial debut made quite the splash (and there has been a lot of controversy surrounding its use), it took roughly 15 years before the world took notice.

We now see the pink ribbon everywhere come October.

If the diabetes community is following the same trajectory for awareness as the breast cancer community, things are about to get interesting: 2021 marks 15 years since the blue circle was introduced by the International Diabetes Federation.

Kris Maynard, who lives with type 1 diabetes, is a firefighter and EMT who founded Glucose Revival as a solution to an all too common problem: people with diabetes experiencing low blood sugar levels.

Following the recommendations from the ADA, Glucose Revival makes a necklace that contains 15 grams of quick-acting glucose thats easy to carry, find, and use. Its similar to what EMTs administer daily to people experiencing low blood sugar emergencies.

Maynard is a passionate advocate for uniting the diabetes community. Recently, he approached some of the largest type 1 and type 2 diabetes nonprofit organizations with the idea of adding the blue circle around their logos so that people with diabetes and the world can recognize the blue circle as a symbol of diabetes.

These organizations have incredible influence, which is a key factor in helping us get the message to our legislators, and they dont realize that yet, he says. They dont recognize the power of unity, the power of simplicity, and the power of what the blue circle can bring to the world.

While the top diabetes organizations might not be ready for a rebranding, Maynard is making strides in his local community.

Last November, he asked local landmarks in his community, like the Spokane Pavilion and Steam Plant, to light up blue for American Diabetes Month. Much to his delight, they obliged.

With increased awareness of the disease in all its forms, more funding, compassion, and innovation will follow. To get people to care about this disease, we have to share the stories of the people living with it.

Erik Douds is an endurance athlete living with type 1 diabetes, an adventure filmmaker, and the founder of Diabadass, an education platform where people with diabetes can learn from others living with the disease.

The main reason I make films is to show what life is like with an invisible disease, Douds says.

Ive stayed in the homes of over 60 people living with T1D and visited the technology companies and organizations that make this community. Eventually, I discovered it is the people who have become friends that I learn from the most, which is why I started Diabadass.

Douds is no stranger to roadblocks in his efforts to unite the community, and he says the greatest challenge to unity is when the community loses trust in leadership.

When the community sees themselves at the table, in the truest sense, I think we will see greater collaboration and inspiration for us to all unite, Douds says.

As a creator in the space, my greatest challenge is finding investments in storytelling to share the incredible work being done, alongside the stories that need to be felt in the hearts and minds of leaders outside our space, he says.

In addition to encouraging your favorite diabetes organizations to recognize the blue circle and inviting local landmarks to illuminate with blue lights, both Maynard and Douds call for people to recognize our similarities instead of focusing on our differences.

Douds recommends researching the stereotypes of any types of diabetes to become a better ally for others.

While each type is different, focusing on everything that separates us blinds us from finding our closest allies, he says.

Maynard agrees.

I hear a lot of comparisons between type 1 and type 2 diabetes, as if one is worse than the other, he says. But I have never met anyone with diabetes who wants to have diabetes, so at the very least, we have that much in common.

Sydney Williams is an adventure athlete and author based in San Diego, California. Her work explores how trauma manifests in our minds and bodies, and how the outdoors can help us heal. Sydney is the founder of Hiking My Feelings, a nonprofit organization on a mission to improve community health by creating opportunities for people to experience the healing power of nature. Join the Hiking My Feelings Family, and follow along on YouTube and Instagram.

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Beyond the Blue Circle: Why We Need Unity in the Diabetes Community - Healthline

Advocacy groups are calling on public health officials to prioritize vaccinating Type 1 diabetes patients in their COVID-19 vaccine distribution plans, citing new research on the risks of serious complications after contracting the virus.

A group of 19 diabetes advocacy organizations recently sent a letter to top CDC officials requesting the federal agency recommend that individuals with Type 1 diabetes be included in prioritized vaccine populations. The CDC sets guidelines for tiered vaccine distribution at the state level which state governments have largely followed.

The guidelines say that people between the ages of 65 and 74 and those between 16 and 64 with underlying medical conditions should receive the COVID-19 vaccine in Phase 1C of the rollout. The underlying medical conditions listed include kidney disease, heart disease and Type 2 diabetes, but not Type 1.

The new science leaves little doubt that there should be no distinction between individuals with Type 1 and Type 2 diabetes mellitus, given the common, heightened risk both groups face for the most severe health outcomes of COVID-19, the groups wrote to the CDC last week.

The CDC did not immediately respond to a request for comment.

Disagreements over who should be included in prioritized groups for the vaccine have stemmed in large part from a limited supply of doses. The federal government recently introduced a policy of not holding back second doses of the Pfizer and Moderna vaccines, instead using all available doses to vaccinate as many people as possible.

Robert Gabbay, the chief scientific and medical officer of the American Diabetes Association, said the groups concern began when members noticed that new research showed that Type 1 diabetes carried at least the same risks associated with the novel coronavirus as Type 2 diabetes.

Individuals with Type 1 diabetes are at a 3.3 times higher risk of developing severe illness and are 3.9 times more likely to be hospitalized than those without diabetes, similar to those with Type 2 diabetes, according to the letter to the CDC.

Gabbay said early on in the pandemic, data was more clear that Type 2 diabetes could lead to serious complications in COVID-19 patients. That was due in part, he said, because of the significantly higher number of people who have Type 2 than Type 1 and also because Type 1 patients are sometimes misclassified as Type 2 when hospitalized.

Of the 34 million Americanswith diabetes, almost 1.6 million have Type 1, compared with about 32.6 million with Type 2.

Jen Horney, a professor of epidemiology at the University of Delaware, said a reason why Type 1 diabetes may not have been initially considered as an underlying condition is because of the other health effects of Type 2 that have garnered more attention from the medical community.

She said individuals with Type 2 are more likely to also suffer from comorbidities such as obesity and kidney disease, both of which are included as underlying conditions by the CDC.

The classic example in epidemiology is that people who worked around asbestos were at a higher risk of getting cancer, but people who worked around cancer and smoked there was a synergistic effect, she said. Its more than just additive.

George Huntley, chief executive officer of both the Diabetes Patient Advocacy Coalition and the Diabetes Leadership Council, said that in addition to signing the CDC letter, his organization has sent more than 1,200 letters to governors and state health department officials to open a second front in the effort to include Type 1 diabetes in the prioritized group.

We engaged our policy engine, we engaged our collaborative engine and we also engaged the patients to allow their voices to be heard on this issue thats very important, Huntley said.

Only four states Delaware, Ohio, Tennessee and Virginia consider Type 1 diabetes as an underlying medical condition, Huntley said, adding that updating CDC guidelines would increase the odds of more states adding the disease to their list of prioritized vaccine recipients.

We hope that the CDC will help with that and get them where they need to be, said Stewart Perry, vice chair of the Diabetes Leadership Council board. But were going to continue to focus on the states as well as the CDC.

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Advocacy groups call for including Type 1 diabetes among prioritized vaccine recipients | TheHill - The Hill

Its a new year, and COVID-19 vaccines offer hope for those wanting to protect themselves, especially people with underlying health conditions such as diabetes.

You may have questions about these new vaccines, including when you can get them and what questions you should ask your doctor about them. Experts we talked with say the vaccines are safe, effective, and important for people with diabetes.

The most important thing is that people with diabetes get vaccinated as soon as it becomes available to them, says Robert Gabbay, MD, PhD, chief science and medical officer for the American Diabetes Association (ADA) in Arlington, Virginia.

Below, we detail what you need to know about the COVID-19 vaccines.

RELATED: 10 Diabetes Care Tips to Follow During the COVID-19 Pandemic

It depends on where you live. At a federal level, the Centers for Disease Control (CDC) makes recommendations about who should receive priority for vaccination. It is then up to each state to use those recommendations to plan for and distribute vaccines to counties and residents.

Even so, guidelines are changing. In mid-January, U.S Health and Human Services (HHS) Secretary Alex Azar said Americans 65 years and older and those who are younger but have underlying health conditions should receive priority, as AARP reports.

If your state is following the CDCs recommendations, healthcare workers and nursing home residents are receiving first priority for the vaccine. Next, the CDC recommends vaccinating frontline workers such as firefighters, teachers, and grocery store workers, along with people over 75.

Then, the CDC recommends vaccinating people with type 2 diabetes and other underlying medical conditions due to their increased risk of severe COVID-19-associated illness.

People with type 1 diabetes do not currently have the same priority vaccination with the CDC. But groups including theJuvenile Diabetes Research Foundation (JDRF) and the ADA are advocating for this priority at a federal and state level.

Justin Gregory, MD, assistant professor of pediatrics at Vanderbilt Childrens Hospital in Nashville, who has type 1 diabetes, says that people with type 1 diabetes should have the same priority for vaccination as people with type 2 diabetes because both groups have a similarly increased risk for dangerous and deadly COVID-19 illness.

In the end, states make their own decisions about vaccination priority, so check your state and local health departments website to find out when you are eligible. The ADA has also assembled links to individual states vaccination plans as part of its COVID-19 Vaccination Guide.

RELATED: Track the Vax: Delivering COVID-19 Vaccines at Warp Speed

Potentially. The CDC notes notes that the risk for hospitalization increases with the more high-risk medical conditions a person has its 2.5 times for a person with one condition and 5 times for people with three or more conditions. Nevertheless, having comorbidities, such as heart and kidney disease, does not mean you will be allowed to get vaccinated before someone with only diabetes or another single health condition. Again, it comes down to where you live.

In Massachusetts, for example, people with two or more underlying conditions are prioritized to get a COVID-19 vaccine before those with only one condition. Other states do not designate priority by the number of underlying medical conditions.

Where you can get a vaccine also varies depending on where you live. You may be able to sign up for notification about availability of the vaccine with your county or healthcare provider. Pharmacies, hospitals, doctors offices, and health departments will likely all play a role in administering the vaccine, according to a November report by the Kaiser Family Foundation. Your doctor can also guide you on where to seek a vaccine in your hometown.

Its quite clear that people with diabetes do much worse than people without diabetes in terms of their outcomes with COVID, says Dr. Gabbay. Early in the pandemic, astudy from the CDC found that roughly half of people who died from COVID-19 under age 65 had diabetes.

The protective effects of vaccines are critical for people with diabetes who are at increased risk for severe and deadly infection from COVID-19,says Dr. Gregory. His December 2020 study in Diabetes Care found that people with type 1 or type 2 diabetes are 3 times more likely to be hospitalized or experience severe COVID-19 illness compared with people without diabetes.

Two studies from the United Kingdom showed similar risk. An October 2020 study in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 diabetes were 2 to 3 times more likely to die from COVID-19 in the hospital than people without diabetes. And a December 2020 study in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 were more likely to die or to be treated in the intensive care unit for COVID-19.

Vaccinations for Black, Latino, and Native Americans are critical because these communities are disproportionately affected by both diabetes and COVID-19. African Americans and Latino Americans are over 50 percent more likely to have diabetes than white Americans, according to the ADA. Black, Latino, and Native Americans experienced a death rate from COVID-19 double or more than white Americans in 2020, according to the CDC.

RELATED: Black Americans Have Been Hit Hardest by COVID-19 Heres Why

Two COVID-19 vaccines are currently available in the United States and people with diabetes were included in both the vaccine trials. Both require two doses spaced either 21 days (Pfizer-BioNTech vaccine) or 28 days (Moderna vaccine) apart. With their two doses completed, these vaccines are over 90 percent effective and received emergency use authorization from the U.S. Food and Drug Administration (FDA) in December 2020.

We wanted to make sure we recruited a number of individuals who had the types of underlying medical conditions that can make COVID more severe, says C. Buddy Creech, MD, MPH, director of the Vanderbilt Vaccine Research Program in Nashville and part of the phase 3 trials of the Moderna COVID-19 vaccine.

That included people with diabetes, hypertension, and obesity, says Dr. Creech. People with type 1, type 2, and gestational diabetes were included in the Moderna clinical trial, he adds. The FDA filing from Pfizer-BioNTech says the trial included people with diabetes but does not specify among types.

The vaccines were well-tolerated, highly efficacious, and elicited an immune response in people with underlying conditions, such as diabetes, says Creech.

People with diabetes are going to be prioritized [for COVID-19 vaccination] because we know theyre at increased risk for disease. And they should feel confident that someone a whole lot like them was enrolled in the clinical trial so that we can say with a greater degree of certainty that they can effectively get this vaccine, says Creech.

Gabbay says that the data do not suggest the COVID-19 vaccines pose particular risk for people with diabetes. He also says there is no reason to think there would be interactions with insulin or other medications that people with diabetes might take.

RELATED: America Wants to Know: Where Are Our COVID-19 Vaccines?

In general, the most common side effects of both vaccines are pain, swelling, and redness at the injection site. Other common side effects are chills, tiredness, and headaches. Most of these side effects were mild, but some people had more severe reactions that interfered with daily activities.

Gabbay says side effects of the COVID-19 vaccines are similar to those of flu vaccines. For someone living with diabetes, keeping a sick-day kit with extra medications and supplies is beneficial in case you do not feel well.

Gabbay says the first question patients should ask their providers about the COVID-19 vaccine is, When can I get it?

Be proactive in calling your provider to ask for the vaccine, says Gabbay. Check the websites of your state and local health departments to find out about local vaccine distribution. Being patient, persistent, and informed is the best approach, says Gabbay.

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COVID-19 Vaccines for People With Diabetes: 8 Must-Know Facts - Everyday Health

The question here is which component of an average persons diet triggers insulin resistance? Is it carbohydrates or vegetable oils? Refined sugars and refined oils would take the cake with their high PUFA levels. When combined, these two are the chief reasons behind insulin resistance. These omega-6 fats cause adipocytes or adipose cells, to signal to the peripheral cells to become resistant to insulin.

Apart from this, the PUFAS present in these oils and trans-fats are stored primarily in the fat cells and do not get used fuel. They also stay in your cells for 600-700 days and end up permeating into tissues and organs, including the heart and brain.

PUFAS are largely responsible for clogging up your cells and creating oxidative stress and inflammation. A diet that includes vegetable oils, including deep-fried junk food, processed fats and other processed materials, will lead to diabetes somewhere down the line. Even cold pressed seed oils that most people regard as healthy would create the same problems discussed above. There are a lot of misconceptions surrounding diabetes and carbohydrates.

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Can eating carbs lead to diabetes? - Times of India

To prevent or manage diabetes, your doctor has probably told you to pay attention to what you eat, exercise often, and understand your familys health history. But the quality of the air you breathe could also play a role in your risk for the disease or how well youre able to stabilize your blood sugar. Emerging studies are shedding light on the relationship between air pollution and diabetes.

Wildfire smoke is one example of air pollution, and it's associated with an increase in the risk of health complications in people with diabetes, according to a study published in June 2020 in Environmental Health Perspectives. In other research, such as a review published in September 2020 in Gut Microbes, scientists have uncovered the surprising role that air pollution in cities can play in altering gut bacteria and increasing diabetes risk.

In diabetes care, we focus on the whole person. What is their environment? How do they live? Where do they live? says Melissa Young, PharmD, BC-ADM, CDCES, a clinical pharmacist and spokesperson for the Association of Diabetes Care and Education Specialists (ADCES). Dr. Young provides telehealth primary care for the Department of Veterans Affairs across several states, including Colorado and Idaho.

RELATED: 8 Surprising Risk Factors for Type 2 Diabetes

The global toll of air pollution on diabetes is significant, according to a study published in July 2018 in the Lancet Planetary Health. An estimated 3.2 million cases of diabetes globally could be attributed to elevated air pollution in 2016, with increasing burden falling on people living in low- and lower- to middle-income countries.

Its only recently that air pollution has been considered as a factor contributing to greater risk for type 2 diabetes, says Tanya Alderete, PhD, an assistant professor at the University of Colorado in Boulder who studies the causes and consequences of type 2 diabetes.

Dr. Alderete uncovered health disparities for Latino children living in urban Los Angeles from 2001 to 2012. She found that increased air pollution increased risk factors for type 2 diabetes such as decreased insulin sensitivity and reduced production of insulin in overweight and obese children. Herfindings were published in July 2017 in Diabetes.

Why is pollution so bad? Pollution carries fine particles, including metals and other toxins, that inflame the lungs and other parts of the body. Some experts hypothesize that inflammation from fine particles in air pollution increases the risk of type 2 diabetes.

Alderete suspects air pollution changes the gut in unhealthy ways, potentially contributing to type 2 diabetes. Young adults in Southern California with greater exposure to air pollution had less-diverse gut microbiomes, according toone of her studies, which was published in May 2020 in Environmental International. The gut microbiome is the group of microorganisms, including bacteria, that help your body break down food and may protect against infection.

Air pollution alone does not cause diabetes, cautions Alderete. Its a constellation of risk factors that include poor diet, poor physical activity, and greater exposure to environmental toxicants, she says.

Nevertheless, people should try to limit exposure to air pollution from traffic and industry as much as possible. Try to exercise away from busy roadways. Its never a bad idea to check air quality levels before going outside to exercise. Air quality is now included in many weather apps, or you can download air-quality specific apps like AirVisual.

She hopes her research helps policy makers improve air quality standards and promote changes in public health policy. That could mean building schools or developing affordable housing further away from busy roadways, says Alderete.

RELATED: Loneliness May Be a Risk Factor for Type 2 Diabetes, Study Finds

People with diabetes need to be aware of their surroundings and the air quality, says Young.

Smoke from wildfires is an increasing source of air pollution, according to a report published in November 2020 in the New England Journal of Medicine. Researchers have found people with diabetes may be negatively affected by smoke.

In the previously mentioned study, researchers examined ambulance dispatch calls of roughly 500,000 people over five fire seasons in British Columbia. These included severe fire seasons in 2010, 2014, and 2015, when more than 740,000 acres burned.

Exposure to elevated levels of fine particulate matter in smoke was associated with increased ambulance dispatches, within 24 to 48 hours, for episodes of high and low blood sugar, says Jiayun Yao, PhD, who led the research while at the University of British Columbia School of Population and Public Health. She now works for the British Columbia Centre for Disease Control in Vancouver.

Just the stress of having a fire nearby could increase blood glucose, says Young, a certified diabetes care and education specialist, adding that continued high blood glucose can produce extremely high levels of ketones leading to diabetic ketoacidosis (DKA), a serious and life-threatening complication that is more common in people with type 1 diabetes than those with type 2.

People with diabetes may be more sensitive to fine particles in smoke, especially in light of their high prevalence of heart disease, says Young. Indeed, air pollution has been shown to double the risk for hospital admissions for heart disease in people with diabetes, according to a study in Epidemiology.

RELATED: How Wildfire Smoke Affects Your Health

People with diabetes need to be aware of the potential impact from poor air quality events such as wildfire smoke, and to have an action plan to reduce exposures, Dr. Yao says.

Young recommends that individuals managing diabetes keep track of changes to blood sugar and call their diabetes care team with any questions. She recommends keeping a list of your providers phone numbers handy for when questions arise.

She says that paper or surgical masks, scarves, and bandanas will not protect your lungs from the fine particles in wildfire smoke. An N95 respirator may help reduce the risk, but it must fit properly, so ask your physician if youre considering purchasing one (N95 masks are also in short supply during the pandemic).

A sick day kit is also essential for emergencies because it has enough medication, food and supplies to get you through several days. You can learn how to make a sick day kit at the ADCES website.

We need to be careful and be prepared, says Young, adding that the COVID-19 pandemic has recently forced patients and providers to prepare for all kinds of disasters including wildfires. The Centers for Disease Control and Prevention (CDC) also has information on dealing with wildfires.

RELATED: How to Prepare for a Hurricane if You Have Diabetes

Reducing exposure to air pollution is important for people with diabetes, says Young. Monitor air quality by visiting AirNow.gov, the U.S. Air Quality Index, to find the latest information in your area, she says. Use apps on your phone or tablet or watch the local news to keep tabs on air quality.

Try to stay inside if its a high-pollution day and its recommended to stay indoors if you have a chronic condition. Dont go outside for your walk, says Young.

Being inside more means paying attention to indoor air quality, too. Make sure the filters on your HVAC system are clean, says Young. You can use an air purifier or portable air cleaner designed for single areas of the home. Air cleaners wont remove all pollutants from the air, but they can help, says Young, who recommends checking out the U.S. Environmental Protection Agencys Guide to Air Cleaners in the Home. If the air quality is bad, dont do anything to stir up the air, like vacuuming.

Always be prepared, watchful, and aware of your surroundings, says Young. Be as healthful as possible. Keep up with blood glucose testing, and if you have questions, check with your diabetes care team.

RELATED: How Exercise Helps Prevent and Manage Type 2 Diabetes

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Air Pollution and Type 2 Diabetes: Is There a Connection? - Everyday Health

In an effort to understand patients willingness to adopt remote digital monitoring (RDM) for diabetes, adults with type 1 (T1D) or type 2 diabetes (T2D) living in 30 countries completed a survey weighing its health benefits against the potential inconvenience.

Results, published in JAMA Network Open, indicate patients with diabetes require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional, researchers wrote.

RDM consists of using prescribed sensors to capture patients physiological and behavioral data, which can then be transmitted to their physician to complement in-person consultations or be used to offer real-time feedback provided by artificial intelligence (AI) or a clinician.

The technology is currently used in some clinical settings, but previous research found RDMs costs, like disruptive eating alerts and social stigma, are intrusive to some patients private lives, which may lead to nonadherence. Some patients, however, do prefer RDM for the superior health benefits it can offer compared with the traditional care model.

The researchers designed a vignette-based survey consisting of hypothetical scenarios that described potential applications of RDM. Participants assessed the scenarios based on key components (vignette factors) that are varied to take 1 of several prespecified options (factor levels), the authors explained.

Between February and July 2019, English- and French-speaking participants with T1D or T2D were recruited from multiple channels to complete the survey. Different levels were developed for monitoring tools, duration and feedback loop, and data handling; they were combined to develop 36 unique vignette scenarios.

As part of the survey, each participant assessed 3 randomly selected vignettes by responding to 2 questions, indicating the minimum health benefit they would require to adopt the RDM as their usual care.

A total of 1010 individuals assessed at least 1 vignette, the majority (57%) of whom were female. Nearly 3000 vignette assessments were completed in the study window, with a median of 78 assessments per vignette. Among the participants, 524 had T1D, 723 used insulin, and 687 considered their diabetes controlled.

Data showed:

Despite patients concerns over the intrusiveness of RDM, the researchers noted technological developments could mitigate the effects of these features and reduce the magnitude of health benefits patients expect to adopt RDM.

Our results show that acceptability of RDM is contingent on how it affects health outcomes that are important to patients and how patients perceive its psychological costs, the authors wrote. Therefore, physicians should first discuss the expected efficacy of RDM with patients and codefine treatment goals.

Because the current study only assessed RDM adoption, future studies should examine the association of different RDM modalities, their intrusiveness, and their perceived effectiveness over longer periods of sustained use. Real-world experimental studies are also needed to test actual adoption of RMD, not just perceptions of the technology.

In addition, because many participants were familiar with the use of digital health tools, acceptability rates in the overall population of individuals with diabetes may be lower than study participants, marking a limitation.

Reference

Oikonomidi T, Ravaud P, Cosson E, Montori V, Tran VT. Evaluation of patient willingness to adopt remote digital monitoring for diabetes management. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.33115

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Study Weighs Perceived Benefits, Costs of RDM Adoption for Diabetes Management - AJMC.com Managed Markets Network

This article was originally published here

Diabetes Ther. 2021 Jan 20. doi: 10.1007/s13300-020-00996-7. Online ahead of print.

ABSTRACT

The utilization of telemedicine solutions to reduce outpatient clinic visits and visits to physicians offices, thus saving financial and personal resources as well as time, has gained substantial importance in recent years. The COVID19 pandemic has made it necessary to abruptly adjust outpatient care methods in various medical settings that needlessly require consultations in person to monitor and change the disease management of patients in specific risk groups. People with diabetes represent a vulnerable population who need to be protected from avoidable outpatient clinic visits, particularly in times of influenza or other pandemic outbreaks. However, the treatment and care of patients with diabetes and its comorbidities require careful and regular monitoring and therapy adjustments by medical staff. Advanced age or cognitive impairment and insufficient access to the health care system due to low socioeconomic status can complicate the use of possible alternatives to in-person consultations in outpatient clinics or physicians offices. Telemedicine solutions may offer suitable alternatives to standard face-to-face consultations in outpatient settings and provide sufficient access to appropriate diabetes care. Nevertheless, telemedicine methods for monitoring diabetes issues are yet to find widespread use due to numerous barriers, such as a lack of acceptance and doubt about its time- and cost-effectiveness, availability, and potential technical and regulatory issues. This article offers an overview of existing applications that provide telemedicine diabetes care. Furthermore, it discusses potential ways to restructure and revolutionize diabetes outpatient care.

PMID:33474646 | DOI:10.1007/s13300-020-00996-7

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Application of Telemedicine in Diabetes Care: The Time is Now - DocWire News

Is Mediterranean diet diabetes-friendly? Here is what you must know about it  |  Photo Credit: iStock Images

New Delhi:A balanced diet has proven to be effective against dealing with various diseases and health conditions. Changes to lifestyle and diet is one of the first things recommended by medical professionals in dealing with a health issue. Diabetes is a chronic disease that plagues the entire world. When looking for a diabetes-friendly diet, it must be kept in mind that different types of diets will affect the symptoms differently. Therefore, it is necessary to pick the right diet. Is the Mediterranean diet a healthy diet option for people suffering from diabetes? Here is what you need to know about it.

The recommended diet for people suffering from diabetes is plant-based as it can help manage blood sugar levels in the body effectively. A diabetes-friendly diet may end up being frustratingly restrictive for some people. This is why the Mediterranean diet can be a healthy diet option as it's easier to follow and diverse. It can not only help control symptoms of type 2 diabetes, but it can also contribute to reducing the risks of developing type 2 diabetes due to its properties of promoting heart health and weight management.

Some common benefits offered by the Mediterranean diet are as follows:

Consuming a balanced diet while avoiding foods that can trigger the symptoms of diabetes may be the first preference, however, following a Mediterranean diet canprove effective against diabetes. Apart from a healthy diet, make sure that you consume a sufficient amount of water and maintain a healthy lifestyle that includes physical activity.

Disclaimer: Tips and suggestions mentioned in the article are for general information purpose only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

Get the Latest health news, healthy diet, weight loss, Yoga, and fitness tips, more updates on Times Now

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Is the Mediterranean diet diabetes-friendly? Here is what you must know about it - Times Now

This article was originally published here

J Foot Ankle Res. 2021 Jan 19;14(1):8. doi: 10.1186/s13047-021-00447-x.

ABSTRACT

BACKGROUND: Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease), of DFD (ulcers and infection), and of diabetes-related amputation (total, minor and major amputation) in Australian populations.

METHODS: We systematically searched PubMed and EMBASE databases for peer-reviewed articles published until December 31, 2019. We used search strings combining key terms for prevalence or incidence, DFD or amputation, and Australia. Search results were independently screened for eligibility by two investigators. Publications that reported prevalence or incidence of outcomes of interest in geographically defined Australian populations were eligible for inclusion. Included studies were independently assessed for methodological quality and key data were extracted by two investigators.

RESULTS: Twenty publications met eligibility and were included. There was high heterogeneity for populations investigated and methods used to identify outcomes. We found within diabetes populations, the prevalence of risk factors ranged from 10.0-58.8%, of DFD from 1.2-1.5%, and the incidence of diabetes-related amputation ranged from 5.2-7.2 per 1000 person-years. Additionally, the incidence of DFD-related hospitalisation ranged from 5.2-36.6 per 1000 person-years within diabetes populations. Furthermore, within inpatients with diabetes, we found the prevalence of risk factors ranged from 35.3-43.3%, DFD from 7.0-15.1% and amputation during hospitalisation from 1.4-5.8%.

CONCLUSIONS: Our review suggests a similar risk factor prevalence, low but uncertain DFD prevalence, and high DFD-related hospitalisation and amputation incidence in Australia compared to international populations. These findings may suggest that a low proportion of people with risk factors develop DFD, however, it is also possible that there is an underestimation of DFD prevalence in Australia in the few limited studies, given the high incidence of hospitalisation and amputation because of DFD. Either way, studies of nationally representative populations using valid outcome measures are needed to verify these DFD-related findings and interpretations.

PMID:33468226 | DOI:10.1186/s13047-021-00447-x

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Diabetes-related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian...

As personal health technology improves, remote digital monitoring (RDM) has the potential to improve the health of patients with diabetes, but a new study suggests patients have higher expectations of efficacy as the perceived intrusiveness of the monitoring increases.

Theodora Oikonomidi, MSc, of the Center for Research in Epidemiology and Statistics and the University of Paris, and colleagues wanted to better understand how patient adoption of interventions like RDM are tied to their expectations about the benefits of such programs.

Previous studies have identified the costs of RDM, including disruptive alerts and social stigma, which represent the intrusiveness of RDM in patients private lives, they wrote. Intrusiveness can lead to nonadherence to RDM among some patients, but others may decide to adopt RDM despite its intrusiveness to obtain superior health benefits than those offered by the traditional care model.

To gain a better understanding of the impact of effectiveness and intrusiveness on patient adoption and adherence, the investigators designed 36 scenarios describing different combinations of RDM. Variables included different types of monitoring, such as glucose monitoring and food monitoring; different duration and feedback loops, such as feedback from a provider via telehealth or instant feedback using artificial intelligence; and data handling scenarios (private versus public entities handling the data).

A total of 1577 patients with type 1 or 2 diabetes signed up for the study. Sixty-four percent were females, and the median age was 51 years. Participating patients were asked to assess 3 randomly assigned scenarios. A total of 2860 vignette assessments were completed.

In one-third (36%) of assessments, patients said they would use RDM only if it were much more effective at reducing hypoglycemic episodes compared to their current monitoring. However, in the rest of the cases, patients said they would participate in RDM if it were equally effective or just somewhat more effective than their current monitoring program.

Food monitoring, real-time telehealth feedback, and perceived intrusiveness were found to be key factors in patients judgments.

Oikonomidi told HCPLive she was surprised to see so many patients willing to adopt RDM even if it was not more effective than their current monitoring system.

This shows that patients motivations to adopt RDM vary, she said. For example, some patients may adopt RDM to gain reassurance from being able to access their data in real-time.

At the same time, she said, the study makes clear that a significant proportion of patients have misgivings about the technology, and those patients would need alternative supports or modifications that could mitigate some of their concerns.

The study also found significant variability in patient perceptions. In nearly all cases (94%), more than 25% of participants reviewing a particular scenario said they would accept it if it were equally or less effective than their current monitoring, while at the same time, at least 25% of patients reviewing the same scenario said it would be acceptable only if it were more effective than their current monitoring.

The investigators said such variability demonstrates the importance of shared decision-making when physicians assess the cases of individual patients.

Oikonomidi said physicians also need to understand that while patients have become used to various forms of tracking and monitoring in their daily lives, all tracking is not perceived the same way.

The tracking we experience in daily life is often passive and unobtrusive we do not always notice it, she said. RDM is active: it requires that patients complete certain tasks, such as manually log food intake. Also, RDM does not just track us; it usually gives us some feedback on our health status, which is a sensitive topic for many patients.

Instead of merely telling patients to get used to RDM, she said it is important to proactively lower barriers to RDM by seeking ways to make it less intrusive. She and colleagues have a subsequent study proposing ways to do that, which will be published later this month.

The study, Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management, was published online in JAMA Network Open.

Read more from the original source:
Patients with Diabetes Open to Remote Monitoring, With Caveats - MD Magazine

Ever wonder how much exercise time it takes to start reducing your risk for heart disease and diabetes? It could be as little as 12 minutes, according to a Harvard study published Nov. 17, 2020, in Circulation. Scientists analyzed blood from more than 400 middle-aged men and women before and just after they'd pedaled for 12 minutes on cycling machines, reaching a vigorous rate. In particular, scientists measured levels of almost 600 natural body chemicals (metabolites). Exercise produced significant changes in most metabolites. For example, the level of one metabolite linked to heart disease and diabetes fell by 29%. Another metabolite tied to diabetes risk and liver disease fell by 18%. That suggests, but doesn't prove, that 12 minutes of daily exercise (that includes vigorous activity) might reduce the risk of heart disease and diabetes. What if you're more of a moderate-intensity exerciser? "We don't know yet if moderate-intensity exercise would have a similar effect on metabolites. But study participants started off with very light exercise, and each minute the intensity increased," says Dr. Gregory Lewis, the study's senior author and a cardiologist at Harvard-affiliated Massachusetts General Hospital.

Image: artvea/Getty Images

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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12 minutes of exercise might lower risks for heart disease and diabetes - Harvard Health

Coherent Market Insightshas recently updated its massive report catalog by adding a fresh study titledGlobal Non-Insulin Therapies for Diabetes Market Industry Analysis, Size, Share, Growth, Trends, & Forecast2020 2027. This business intelligence study encapsulates vital details about the market current as well as future status during the mentioned forecast period of 2027. The report also targets important facets such as market drivers, challenges, latest trends, and opportunities associated with the growth of manufacturers in the global market for Non-Insulin Therapies for Diabetes. Along with these insights, the report provides the readers with crucial insights on the strategies implemented by leading companies to remain in the lead of this competitive market.

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Key Vendors of Non-Insulin Therapies for Diabetes Market

AstraZeneca, Boehringer Ingelheim GmbH, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, F. Hoffmann-La Roche Ltd., Janssen Pharmaceuticals, Merck and Company, Novartis AG, Novo Nordisk, Pfizer, Sanofi Aventis, and Takeda Pharmaceuticals.

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There is Multiple Chapter to display the Global Non-Insulin Therapies for Diabetes Market some of them As Follow

Chapter 1,Definition, Specifications and Classification of Non-Insulin Therapies for Diabetes, Applications of Non-Insulin Therapies for Diabetes, Market Segment by Regions;Chapter 2,Manufacturing Cost Structure, Raw Materials, and Suppliers, Manufacturing Process, Industry Chain Structure;Chapter 3,Technical Data and Manufacturing Plants Analysis of Non-Insulin Therapies for Diabetes, Capacity, and Commercial Production Date, Manufacturing Plants Distribution, R&D Status and Technology Source, Raw Materials Sources Analysis;Chapter 4,Overall Market Analysis, Capacity Analysis (Company Segment), Sales Analysis (Company Segment), Sales Price Analysis (Company Segment);Chapter 5 and 6,Regional Market Analysis that includes the United States, China, Europe, Japan, Korea & Taiwan, Non-Insulin Therapies for Diabetes Segment Market Analysis (by Type);Chapter 7 and 8,The Non-Insulin Therapies for Diabetes Segment Market Analysis (by Application) Major Manufacturers Analysis of Non-Insulin Therapies for Diabetes;Chapter 9,Market Trend Analysis, Regional Market Trend, Market Trend by Product Type Natural preservative, Chemical preservative, Market Trend by Application;Chapter 10,Regional Marketing Type Analysis, International Trade Type Analysis, Supply Chain Analysis;Chapter 11,The Consumers Analysis of Global Non-Insulin Therapies for Diabetes;Chapter 12,Non-Insulin Therapies for Diabetes Research Findings and Conclusion, Appendix, methodology and data source;Chapter 13, 14 and 15,Non-Insulin Therapies for Diabetes sales channel, distributors, traders, dealers, Research Findings and Conclusion, appendix and data source.

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Lastly, this report covers the market Outlook and its growth prospects over the coming years, the Report also brief deals with the product life cycle, comparing it to the significant products from across industries that had already been commercialized details the potential for various applications, discussing about recent product innovations and gives an short summary on potential regional market.

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Non-Insulin Therapies for Diabetes Market Industry Key Manufacturers Analysis with Sales, Revenue, Gross Margin Forecasts To 2027 KSU | The Sentinel...

New research shows inhibition of activin type II receptor (ActRII) by the monoclonal antibody bimagrumab can cut body fat by one-fifth in obese patients, while simultaneously increasing muscle mass.

The phase 2 study was based on patients with type 2 diabetes and obesity, and suggested a possible avenue for pharmacologic management of these patients.

People who are overweight or obese often experience a number of related health impacts, such as insulin resistance and chronic inflammation, explained corresponding author Steven B. Heymsfield, MD, of the Pennington Biomedical Research Center at Louisiana State University, and colleagues.

Excess adiposity is reversible, but the primary method of doing solifestyle programsare often unsuccessful. Other methods of solving the problem include bariatric surgery, but Heymsfield and colleagues said most patients with severe obesity are not good candidates for the procedure.

That has led some investigators to consider possible pharmacologic approaches to the problem. One result of that effort is bimagrumab, a monoclonal antibody that binds to the ActRII receptor to inhibit natural ligands that negatively regulate skeletal muscle growth.

A previous 10-week study in healthy volunteers with insulin resistance found a single dose of the antibody reduced total body fat mass (FM), increased lean mass (LM), and improved insulin sensitivity compared to placebo in subjects who were not dieting.

In the new study, Heymsfield and colleagues sought to see what impact the drug would have on body fat and insulin sensitivity over a longer stretch of time 48 weeks.

The investigators recruited 75 patients, with 37 randomized into the bimagrumab group and 38 receiving placebo. A total of 58 patients completed the study. The enrollees had an average age of 60.4 years, an average body mass index (BMI) of 32.9, a mean body weight of 93.6 kg, a mean FM of 35.4 kg, and a mean HbA1c level of 7.8%.

The randomized trial was double-blind. Those in the bimagrumab group received intravenous (IV) infusions of the drug at a dosage of 10 mg/kg up to 1,200 mg in 5% dextrose solution every 4 weeks for 48 weeks. Those in the placebo group received only the dextrose solution at the same intervals.

At the conclusion of the study, FM had dropped 20.5% in the bimagrumab group compared to 0.5% in the placebo group. LM increased 3.6% and dropped 0.8% in the bimagrumab and placebo groups, respectively.

Meanwhile, HbA1c levels dropped 0.76% among patients receiving the drug, compared to 0.04% in the placebo group. Body weight dropped by 6.5% in the bimagrumab group, versus 0.8% among those receiving placebo.

Heymsfield noted that earlier studies with animal models had not shown the adipose tissue signal, though the smaller human study had. He said the results of the intervention in the present study were more impressive than expected.

The magnitude and character (fat loss and muscle gain) of this effect is unprecedented, he said. One learning: the best model to study these effects is in humans; typically drug developers can project efficacy from animal models to humans.

The study also raises bigger questions about the extent to which this type of pharmacologic approach could be used more broadly to counter obesity and related conditions. Heymsfield said the results could spark a push to develop a pill form of the drug, as the formulation in the study was an intravenous infusion.

Another outcome, already being realized, is a stimulus for basic scientists to unravel the mechanisms of these effects.something that could potentially lead to important new discoveries and drugs, he said.

In the meantime, Heymsfield said bimagrumabs IV formulation and the relatively high cost of monoclonal antibodies mean the drug would probably be best suited for people with high-risk obesity-related comorbidities, possibly as an alternative to bariatric surgery.

The study, Effect of Bimagrumab vs Placebo on Body Fat Mass Among Adults With Type 2 Diabetes and Obesity, was published online in JAMA Network Open.

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Bimagrumab Linked to Dramatic Weight Loss in Patients with Diabetes and Obesity - MD Magazine

Kidney Week 2020

Researchers, led by Patrick D. Walker, MD, conducted an analysis designed to determine the renal biopsy incidence of a second kidney disease in patients with diabetic nephropathy who were biopsied for various clinical indications. Results of the analysis were reported during a virtual poster session at ASN Kidney Week 2020. The poster was titled In Patients with Biopsy-Proven Diabetic Nephropathy, 38% Have a Second Significant Diagnosis.

Of a cohort of 45,422 non-transplant patients from 2001-2014 (2222 nephrologists in 39 states), 7746 with diabetic nephropathy were identified. Of those 1749 cases were excluded for insufficient data, and 1398 cases with focal segmental glomerulosclerosis were excluded, resulting an analysis cohort of 4599 cases. Patient age ranged from 8 to 89 years and 53.5% were male.

Indications for renal biopsy were acute kidney injury (AKI), acute nephritic syndrome (ANS), rapidly progressive renal failure (RPRF), hematuria, suspected non-diabetic nephropathy renal disease, sudden increase in proteinuria, or chronic kidney disease (CKD).

In 38% of the cases (n=1750), a second kidney disease was diagnosed. The highest odds ratio (OR) of a second diagnosis was in patients with AKI (OR, 3.25; 95% confidence interval [CI], 2.91-3.63; P<.001). ORs in other clinical indications were: ANS, 2.32; 95% CI, 1.59-3.37; P<.001; RPRF, 1.43; 95% CI, 0.93-2.20; P=.099; hematuria, 0.71; 95% CI, 0.54-0.93; P=.012; non-diabetic nephropathy, 0.64; 95% CI, 0.45-0.90; P=.01; proteinuria, 0.36; 95% CI, 0.32-0.40; P<.001; and CKD, 0.03; 95% CI, 0.01-0.08; P<.001.

There was a correlation between age and a second diagnosis (P<.001); the incidence ranged from 29% in patients <30 years of age to 56% in patients 80 years of age.

In 1589 patients, a specific second kidney disease was to be ruled out. A second kidney disease was found in 48% of renal biopsies with a rule-out diagnosis versus 33% when no rule-out second disease was given (OR, 1.83; 95% CI, 1.62-2.08; P<.001). There was significant correlation of grades of diabetic nephropathy and a second kidney disease diagnosis: I-75%, II-64%, III-38%, IV-20% (P<.001).

In biopsy-proven diabetic nephropathy, a significant second kidney disease was found in 38%, with AKI and ASN most likely to yield a second kidney disease. Age and a rule-out second kidney disease can further differentiate patient groups most likely to have a second kidney disease. Given the worldwide toll of diabetes, the finding of a potentially treatable second kidney disease in diabetics already at high risk of end-stage kidney disease should provide significant savings in morbidity, mortality, and healthcare expenses, the researchers said.

Source: Walker PD, Charu V, Dai D-F. In patients with biopsy-proven diabetic nephropathy, 38% have a second significant diagnosis. Abstract of a poser presented at the American Society of Nephrology virtual Kidney Week 2020 (Abstract PO0955), October 22, 2020.

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Diagnosis of Second Kidney Disease in Patients with Diabetic Nephropathy - DocWire News

The study, published in the journal Microbiome, was supported by institutional funds fromThe National Institutes of Health, the National Institute of Food and Agriculture, and Advent-Health.

Saccharin (one of the six artificial sweeteners approved by the FDA) is a zero-calorie, high-intensity, artificial sweetener 200 to 700 times sweeter than table sugar (sucrose) and has been used in formulations to sweeten beverages, jams, and baked goods. Its brand names includeSweet and Low, Sweet Twin, Sweet'N Low, and Necta Sweet.

While approved and deemed safe by the FDA, saccharin has been a subject of controversary in the public health community. Past studies have linked the consumption of saccharin to serious negative health outcomes such as the development of diabetes.

"Previous studies elsewhere have suggested that consuming artificial sweeteners is associated with metabolic syndrome, weight gain, obesity, and non-alcoholic fatty liver disease. These findings have raised concerns that consuming them may lead to adverse public health outcomes, and a lack of well-controlled interventional studies contributed to the confusion," said study author Joan Serrano, a researcher in the department of biological chemistry and pharmacology at Ohio State.

"It's not that the findings of previous studies are wrong, they just didn't adequately control for things like underlying health conditions, diet choices and lifestyle habits,"added George Kyriazis, assistant professor of biological chemistry and pharmacology at Ohio State and senior author of the study.

"By studying the artificial sweetener saccharin in healthy adults, we've isolated its effects and found no change in participants' gut microbiome or their metabolic profiles, as was previously suggested."

For their study, researchers collaborated with Ohio State's College of Food, Agricultural & Environmental Sciences, Ohio State's College of Arts and Sciences, Sanford Burnham Prebys Medical Discovery Institute in California and the Translational Research Institute for Metabolism and Diabetes at Advent-Health in Florida.

A total of 46 healthy adults ages 18-45 with a body mass index of 25 or less completed therandomized, double-blind, placebo-controlled study.

Participants ingested capsules that contained the maximum acceptable daily amount of either saccharin (400 mg per day), or lactisole (a sweet taste receptor inhibitor), or saccharin with lactisole or a placeboevery day for two weeks.

At the end of the two weeks researchers found that the artificial sweetener did not affect glucose tolerance or confer other apparent adverse health effects.

"Sugar, on the other hand, is well-documented to contribute to obesity, heart disease and diabetes," Kyriazis said.

"So when given the choice, artificial sweeteners such as saccharin are the clear winner based on all of the scientific information we currently have."

Researchers also tested for 10 weeks the effects of even higher doses of saccharin in mice that genetically lack sweet taste receptors, and came to similar results: the artificial sweetener did not affect glucose tolerance, or cause any significant gut microbiota changes or apparent adverse health effects.

Researchers added that more research over a longer period of time is needed to draw further conclusions about the consumption of saccharin on health outcomes.

Despite these findings, it appears that artificial sweeteners still face consumer perception challenges and a shrinking market.

According to Mintel research,the market for naturally sweetened low-sugar products (expected to reach $36bn over the next three years) is nearly four times larger than the artificially sweetened low-sugar market.

Additionally, Mintel found that more than two-thirds of consumers agree it is essential that sugar or sweetness comes from natural sources.

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Researchers find no short-term link between saccharin and development of diabetes - FoodNavigator-USA.com

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.

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

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

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