StemCell Therapy

MORE people than ever are at risk of diabetes - and some may be developing it without a clue.

Charities have warned the UK is facing a diagnosis timebomb after many people missed vital GP appointments during the pandemic.

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Already some 4.9 million people in the UK are estimated to have diabetes, of which there are various forms.

But of those, some 850,000 people are living with type 2 diabetes but are yet to be diagnosed - a figure up 150,000 in the last year, according to Diabetes UK.

Staggering stats reveal people can live for up to 10 years with type 2 diabetes - the most common type - before being diagnosed.

On top of this, some 2.1 million people have a blood sugar level that is higher than normal, but not bad enough to be diagnosed with diabetes.

This is called prediabetes, or borderline diabetes, and means a person is on track to get a diagnosis if they dont act fast.

There are likely to be many more who are not aware they are in this category.

A further 13.6 million people in the UK are at risk of developing type 2 diabetes - but many will not know.

These people are overweight - the key driver of type 2 diabetes. Having a family member with the disease or being African-Carribean are also example of risk factors.

These people can start making changes, such as eating healthier, to prevent a diagnosis as early as possible.

Meanwhile, the pandemic has had a huge impact on people already living with a diagnosis.

Diabetes is a complex disease to manage. But concerning figures show nearly 2.5million people already with the condition missed vital checks over Covid.

GPs have performed 41 per cent fewer health checks in the last year, analysis by Diabetes UK found in June.

The backlog could be putting sufferers at risk of Covid death, heart attacks and strokes among other complications.

The total number of cases of diabetes is expected to reach 5.5 million people by 2030.

Diabetes UK chief executive Chris Askew said: We're sitting on a diabetes timebomb. Missed appointments and missed or delayed diagnoses can devastate lives.

Prediabetes is a grey area.

It is when someones blood glucose levels are higher than normal but not yet high enough to be classed as diabetes.

In the UK, around 7 million people are estimated to have prediabetes, according to Diabetes.co.uk.

People often dont notice the symptoms and put them down to something else, such as their stress levels or their age

Experts say prediabetes is a critical stage in the development of the disease because this is when people still have the ability to slow down, or even halt, the condition.

But prediabetes has no symptoms, Dr Prash Vas, consultant in Diabetes at London Bridge Hospital, told The Telegraph.

He said: [Prediabetes] has no symptoms. As your blood sugar levels go higher, the body will mount symptoms.

Even this group of individuals can have complications, such as a three times higher risk of developing eye problems such as diabetic retinopathy. There is also an increased chance of developing kidney problems and early nerve damage.

According to Dan Howarth, head of care at Diabetes UK, symptoms of diabetes wont kick in till blood sugar levels are around 11mmol/L, even though anything above 7.8mmol/L after eating is considered too high.

Even then, people often dont notice the symptoms and put them down to something else, such as their stress levels or their age, Dr Howarth said.

If your doctor is concerned you have pre-diabetes they will usually do either a HbA1c test, a fasting plasma glucose (FPG) test, or an OGTT test.

The NHS says type 2 diabetes is often diagnosed following blood or urine tests for something else.

Symptoms of diabetes can go completely missed because people think they are caused by something else.

Or their symptoms dont necessarily make them feel unwell, so they are not even acknowledged.

The most common early signs of type 2 diabetes are frequent urination, extreme thirst, and persistent hunger.

You should visit your GP if you are:

There are other symptoms that may alert you to this disease.

These include:

Factors such as age, family history and ethnicity can increase a persons likelihood of having diabetes.

The condition usually develops slowly when someone is over the age of 40 years old.

However, the risk starts increasing from the age of 25 if you are African-Caribbean, Black African, or South Asian.

Generally studies have found that people of African-Caribbean, black African or south Asian descent are two to four times more likely to develop type 2 diabetes than those from a white background.

Obesity is fuelling type 2 diabetes, accounting for 80 to 85 per cent of someones chances of developing the condition.

Just because you have one or more risk factors for diabetes, it doesnt mean you will get it.

However, its best to be wary so that you can prevent the condition now. Because the symptoms of type 2 diabetes are not always obvious, its really important to be aware of these risk factors, charities say.

Risk factors include if you:

You can take the "Know Your Risk" for type 2 diabetes quiz to find out your risk of getting type 2 diabetes.

The rapid quiz asks about age, weight, if someone in the family has diabetes and if you have been told you have high blood pressure, for example.

It will then give a score between zero and 47 points.

The higher the risk level, the more likely it is that person will develop type 2 diabetes in the next 10 years. For example, one out of four people with high risk will get type 2 diabetes in the next 10 years.

If someones score is moderate or high they can refer themselves to a local service for support remotely or online, without having to go through a healthcare professional.

Read the original post:
Do you have hidden diabetes? The 15 signs to watch out for... - The US Sun

Group of metabolic disorders

Medical condition

Diabetes mellitus (DM), commonly known as just diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time.[11] Symptoms often include frequent urination, increased thirst and increased appetite.[2] If left untreated, diabetes can cause many health complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves, damage to the eyes and cognitive impairment.[2][5]

Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.[12] There are three main types of diabetes mellitus:[2]

Type 1 diabetes must be managed with insulin injections.[2] Prevention and treatment of type 2 diabetes involves maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Type 2 diabetes may be treated with medications such as insulin sensitizers with or without insulin.[15] Control of blood pressure and maintaining proper foot and eye care are important for people with the disease.[2] Insulin and some oral medications can cause low blood sugar.[16] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes.[17] Gestational diabetes usually resolves after the birth of the baby.[18]

As of 2019[update], an estimated 463million people had diabetes worldwide (8.8% of the adult population), with type 2 diabetes making up about 90% of the cases.[10] Rates are similar in women and men.[19] Trends suggest that rates will continue to rise.[10] Diabetes at least doubles a person's risk of early death.[2] In 2019, diabetes resulted in approximately 4.2million deaths.[10] It is the 7th leading cause of death globally.[20][21] The global economic cost of diabetes-related health expenditure in 2017 was estimated at US$727 billion.[10] In the United States, diabetes cost nearly US$327billion in 2017.[22] Average medical expenditures among people with diabetes are about 2.3 times higher.[23]

The classic symptoms of untreated diabetes are unintended weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger).[24] Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes.[25]

Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known symptoms listed above, they include blurred vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Long-term vision loss can also be caused by diabetic retinopathy. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.[26]

People with diabetes (usually but not exclusively in type 1 diabetes) may also experience diabetic ketoacidosis (DKA), a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness. DKA requires emergency treatment in hospital.[27] A rarer but more dangerous condition is hyperosmolar hyperglycemic state (HHS), which is more common in type 2 diabetes and is mainly the result of dehydration caused by high blood sugars.[27]

Treatment-related low blood sugar (hypoglycemia) is common in people with type 1 and also type 2 diabetes depending on the medication being used. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and rarely permanent brain damage or death in severe cases.[28][29] Rapid breathing, sweating, and cold, pale skin are characteristic of low blood sugar but not definitive.[30] Mild to moderate cases are self-treated by eating or drinking something high in rapidly absorbed carbohydrates. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.[31]

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (1020) but may be the first symptom in those who have otherwise not received a diagnosis before that time.

The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease[32] and about 75% of deaths in people with diabetes are due to coronary artery disease.[33] Other macrovascular diseases include stroke, and peripheral artery disease.

The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves.[34] Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and eventual blindness.[34] Diabetes also increases the risk of having glaucoma, cataracts, and other eye problems. It is recommended that people with diabetes visit an eye doctor once a year.[35] Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplantation.[34] Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes.[34] The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle atrophy and weakness.

There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function.[36] Having diabetes, especially when on insulin, increases the risk of falls in older people.[37]

Diabetes mellitus is classified into six categories: type 1 diabetes, type 2 diabetes, hybrid forms of diabetes, hyperglycemia first detected during pregnancy, "unclassified diabetes", and "other specific types".[40] The "hybrid forms of diabetes" contains slowly evolving, immune-mediated diabetes of adults and ketosis-prone type 2 diabetes. The "hyperglycemia first detected during pregnancy" contains gestational diabetes mellitus and diabetes mellitus in pregnancy (type 1 or type 2 diabetes first diagnosed during pregnancy). The "other specific types" are a collection of a few dozen individual causes. Diabetes is a more variable disease than once thought and people may have combinations of forms.[41] The term "diabetes", without qualification, refers to diabetes mellitus.[42]

Type1 diabetes is characterized by loss of the insulin-producing beta cells of the pancreatic islets, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type1 diabetes is of an immune-mediated nature, in which a T cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin.[43] It causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Although it has been called "juvenile diabetes" due to the frequent onset in children, the majority of individuals living with type 1 diabetes are now adults.[6]

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.[44] Still, type1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, and the potential for diabetic ketoacidosis or serious low blood sugar levels. Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).[44] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type1 diabetes.[45]

Type1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors,[46] such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans.[46][47] Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.[48][49]

Type 1 diabetes can occur at any age, and a significant proportion is diagnosed during adulthood. Latent autoimmune diabetes of adults (LADA) is the diagnostic term applied when type 1 diabetes develops in adults; it has a slower onset than the same condition in children. Given this difference, some use the unofficial term "type 1.5 diabetes" for this condition. Adults with LADA are frequently initially misdiagnosed as having type 2 diabetes, based on age rather than a cause.[50]

Type 2 diabetes is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.[12] The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 diabetes is the most common type of diabetes mellitus.[2] Many people with type 2 diabetes have evidence of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) before meeting the criteria for type 2 diabetes.[51] The progression of prediabetes to overt type 2 diabetes can be slowed or reversed by lifestyle changes or medications that improve insulin sensitivity or reduce the liver's glucose production.[52]

Type 2 diabetes is primarily due to lifestyle factors and genetics.[53] A number of lifestyle factors are known to be important to the development of type 2 diabetes, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization.[38] Excess body fat is associated with 30% of cases in people of Chinese and Japanese descent, 6080% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders.[12] Even those who are not obese may have a high waisthip ratio.[12]

Dietary factors such as sugar-sweetened drinks are associated with an increased risk.[54][55] The type of fats in the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk.[53] Eating white rice excessively may increase the risk of diabetes, especially in Chinese and Japanese people.[56] Lack of physical activity may increase the risk of diabetes in some people.[57]

Adverse childhood experiences (ACEs), including abuse, neglect, and household difficulties, increase the likelihood of type 2 diabetes later in life by 32%, with neglect having the strongest effect.[58]

Gestational diabetes resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 210% of all pregnancies and may improve or disappear after delivery.[59] It is recommended that all pregnant women get tested starting around 2428 weeks gestation.[60] It is most often diagnosed in the second or third trimester because of the increase in insulin-antagonist hormone levels that occurs at this time.[60] However, after pregnancy approximately 510% of women with gestational diabetes are found to have another form of diabetes, most commonly type 2.[59] Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.[61]

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause infant respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.[62]

Maturity onset diabetes of the young (MODY) is a rare autosomal dominant inherited form of diabetes, due to one of several single-gene mutations causing defects in insulin production.[63] It is significantly less common than the three main types, constituting 12% of all cases. The name of this disease refers to early hypotheses as to its nature. Being due to a defective gene, this disease varies in age at presentation and in severity according to the specific gene defect; thus there are at least 13 subtypes of MODY. People with MODY often can control it without using insulin.[64]

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells, whereas others increase insulin resistance (especially glucocorticoids which can provoke "steroid diabetes"). The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.[65]Yet another form of diabetes that people may develop is double diabetes. This is when a type 1 diabetic becomes insulin resistant, the hallmark for type 2 diabetes or has a family history for type 2 diabetes.[66] It was first discovered in 1990 or 1991.

The following is a list of disorders that may increase the risk of diabetes:[67]

Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, adipose tissue and muscle, except smooth muscle, in which insulin acts via the IGF-1.[citation needed] Therefore, deficiency of insulin or the insensitivity of its receptors play a central role in all forms of diabetes mellitus.[69]

The body obtains glucose from three main sources: the intestinal absorption of food; the breakdown of glycogen (glycogenolysis), the storage form of glucose found in the liver; and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body.[70] Insulin plays a critical role in regulating glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.[70]

Insulin is released into the blood by beta cells (-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.[71]

If the amount of insulin available is insufficient, or if cells respond poorly to the effects of insulin (insulin resistance), or if the insulin itself is defective, then glucose is not absorbed properly by the body cells that require it, and is not stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as metabolic acidosis in cases of complete insulin deficiency.[70]

When glucose concentration in the blood remains high over time, the kidneys reach a threshold of reabsorption, and the body excretes glucose in the urine (glycosuria).[72] This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume is replaced osmotically from water in body cells and other body compartments, causing dehydration and increased thirst (polydipsia).[70] In addition, intracellular glucose deficiency stimulates appetite leading to excessive food intake (polyphagia).[73]

Diabetes mellitus is diagnosed with a test for the glucose content in the blood, and is diagnosed by demonstrating any one of the following:[65]

A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[77] According to the current definition, two fasting glucose measurements above 7.0mmol/L (126mg/dL) is considered diagnostic for diabetes mellitus.

Per the WHO, people with fasting glucose levels from 6.1 to 6.9mmol/L (110 to 125mg/dL) are considered to have impaired fasting glucose.[78] People with plasma glucose at or above 7.8mmol/L (140mg/dL), but not over 11.1mmol/L (200mg/dL), two hours after a 75gram oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease.[79] The American Diabetes Association (ADA) since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9mmol/L (100 to 125mg/dL).[80]

Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.[81]

There is no known preventive measure for type1 diabetes.[2] Type2 diabeteswhich accounts for 8590% of all cases worldwidecan often be prevented or delayed[82] by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet.[2] Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%.[83] Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish.[84] Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes.[84] Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.[85]

The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.[86]

Diabetes management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with dietary changes, exercise, weight loss, and use of appropriate medications (insulin, oral medications).

Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels.[87][88] Per the American College of Physicians, the goal of treatment is an HbA1C level of 7-8%.[89] Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, high blood pressure, metabolic syndrome obesity, and lack of regular exercise.[90] Specialized footwear is widely used to reduce the risk of ulcers in at-risk diabetic feet although evidence for the efficacy of this remains equivocal.[91]

People with diabetes can benefit from education about the disease and treatment, dietary changes, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.[92][93]

Weight loss can prevent progression from prediabetes to diabetes type 2, decrease the risk of cardiovascular disease, or result in a partial remission in people with diabetes.[94][95] No single dietary pattern is best for all people with diabetes.[96] Healthy dietary patterns, such as the Mediterranean diet, low-carbohydrate diet, or DASH diet, are often recommended, although evidence does not support one over the others.[94][95] According to the ADA, "reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia", and for individuals with type 2 diabetes who cannot meet the glycemic targets or where reducing anti-glycemic medications is a priority, low or very-low carbohydrate diets are a viable approach.[95] For overweight people with type 2 diabetes, any diet that achieves weight loss is effective.[96][97]

Most medications used to treat diabetes act by lowering blood sugar levels through different mechanisms. There is broad consensus that when people with diabetes maintain tight glucose control keeping the glucose levels in their blood within normal ranges they experience fewer complications, such as kidney problems or eye problems.[98][99] There is however debate as to whether this is appropriate and cost effective for people later in life in whom the risk of hypoglycemia may be more significant.[100]

There are a number of different classes of anti-diabetic medications. Type1 diabetes requires treatment with insulin, ideally using a "basal bolus" regimen that most closely matches normal insulin release: long-acting insulin for the basal rate and short-acting insulin with meals.[101] Type 2 diabetes is generally taken with medication that is taken by mouth (e.g. metformin) although some eventually require injectable treatment with insulin or GLP-1 agonists.[102]

Metformin is generally recommended as a first-line treatment for type2 diabetes, as there is good evidence that it decreases mortality.[8] It works by decreasing the liver's production of glucose.[103] Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type 2 diabetes. These include agents that increase insulin release (sulfonylureas), agents that decrease absorption of sugar from the intestines (acarbose), agents that inhibit the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretins such as GLP-1 and GIP (sitagliptin), agents that make the body more sensitive to insulin (thiazolidinedione) and agents that increase the excretion of glucose in the urine (SGLT2 inhibitors).[103] When insulin is used in type2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.[8] Doses of insulin are then increased until glucose targets are reached.[8][104]

Cardiovascular disease is a serious complication associated with diabetes, and many international guidelines recommend blood pressure treatment targets that are lower than 140/90mmHg for people with diabetes.[105] However, there is only limited evidence regarding what the lower targets should be. A 2016 systematic review found potential harm to treating to targets lower than 140 mmHg,[106] and a subsequent systematic review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130 - 140mmHg, although there was an increased risk of adverse events.[107]

2015 American Diabetes Association recommendations are that people with diabetes and albuminuria should receive an inhibitor of the renin-angiotensin system to reduce the risks of progression to end-stage renal disease, cardiovascular events, and death.[108] There is some evidence that angiotensin converting enzyme inhibitors (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as angiotensin receptor blockers (ARBs),[109] or aliskiren in preventing cardiovascular disease.[110] Although a more recent review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes.[111] There is no evidence that combining ACEIs and ARBs provides additional benefits.[111]

The use of aspirin to prevent cardiovascular disease in diabetes is controversial.[108] Aspirin is recommended by some in people at high risk of cardiovascular disease, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.[112] 2015 American Diabetes Association recommendations for aspirin use (based on expert consensus or clinical experience) are that low-dose aspirin use is reasonable in adults with diabetes who are at intermediate risk of cardiovascular disease (10-year cardiovascular disease risk, 510%).[108] National guidelines for England and Wales by the National Institute for Health and Care Excellence (NICE) recommend against the use of aspirin in people with type 1 or type 2 diabetes who do not have confirmed cardiovascular disease.[101][102]

Weight loss surgery in those with obesity and type 2 diabetes is often an effective measure.[17] Many are able to maintain normal blood sugar levels with little or no medications following surgery[113] and long-term mortality is decreased.[114] There is, however, a short-term mortality risk of less than 1% from the surgery.[115] The body mass index cutoffs for when surgery is appropriate are not yet clear.[114] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[116]

A pancreas transplant is occasionally considered for people with type1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.[117]

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.[118]

2891

92114

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142163

164184

185209

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248309

310404

4051879

In 2017, 425million people had diabetes worldwide,[119] up from an estimated 382million people in 2013[120] and from 108million in 1980.[121] Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.8% among adults, nearly double the rate of 4.7% in 1980.[119][121] Type2 makes up about 90% of the cases.[19][38] Some data indicate rates are roughly equal in women and men,[19] but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.[122][123]

The WHO estimates that diabetes resulted in 1.5million deaths in 2012, making it the 8th leading cause of death.[15][121] However another 2.2million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes.[121][124] For example, in 2017, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.0million deaths worldwide,[119] using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes.[119]

Diabetes occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[121] where more than 80% of diabetic deaths occur.[125] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[126] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[121][126] The global number of diabetes cases might increase by 48% between 2017 and 2045.[119]

Diabetes was one of the first diseases described,[127] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[128] The Ebers papyrus includes a recommendation for a drink to take in such cases.[129] The first described cases are believed to have been type1 diabetes.[128] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[128][129]

The term "diabetes" or "to pass through" was first used in 230BCE by the Greek Apollonius of Memphis.[128] The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.[128] This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa).[130]

The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rdcentury CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation between diabetes and other diseases, and he discussed differential diagnosis from the snakebite, which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[130]

Two types of diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400500CE with one type being associated with youth and another type with being overweight.[128] Effective treatment was not developed until the early part of the 20th century when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922.[128] This was followed by the development of the long-acting insulin NPH in the 1940s.[128]

The word diabetes ( or ) comes from Latin diabts, which in turn comes from Ancient Greek (diabts), which literally means "a passer through; a siphon".[131] Ancient Greek physician Aretaeus of Cappadocia (fl. 1stcentury CE) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease.[132][133] Ultimately, the word comes from Greek (diabainein), meaning "to pass through,"[131] which is composed of - (dia-), meaning "through" and (bainein), meaning "to go".[132] The word "diabetes" is first recorded in English, in the form diabete, in a medical text written around 1425.

The word mellitus ( or ) comes from the classical Latin word melltus, meaning "mellite"[134] (i.e. sweetened with honey;[134] honey-sweet[135]). The Latin word comes from mell-, which comes from mel, meaning "honey";[134][135] sweetness;[135] pleasant thing,[135] and the suffix -tus,[134] whose meaning is the same as that of the English suffix "-ite".[136] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a person with diabetes had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.

The 1989 "St. Vincent Declaration"[137][138] was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy but also economically expenses due to diabetes have been shown to be a major drain on health and productivity-related resources for healthcare systems and governments.

Several countries established more and less successful national diabetes programmes to improve treatment of the disease.[139]

People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be unemployed as those without the symptoms.[140]

In 2010, diabetes-related emergency room (ER) visit rates in the United States were higher among people from the lowest income communities (526 per 10,000 population) than from the highest income communities (236 per 10,000 population). Approximately 9.4% of diabetes-related ER visits were for the uninsured.[141]

The term "type1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.[142]

Diabetes mellitus is also occasionally known as "sugar diabetes" to differentiate it from diabetes insipidus.[143]

In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles.[144]

Feline diabetes is strikingly similar to human type 2 diabetes. The Burmese, Russian Blue, Abyssinian, and Norwegian Forest cat breeds are at higher risk than other breeds. Overweight cats are also at higher risk.[145]

The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognized in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.[144]

Inhalable insulin has been developed.[146] The original products were withdrawn due to side effects.[citation needed] Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014.[147] An advantage to inhaled insulin is that it may be more convenient and easy to use.[148]

Transdermal insulin in the form of a cream has been developed and trials are being conducted on people with type2 diabetes.[149][150]

The Diabetes Control and Complications Trial (DCCT) was a clinical study conducted by the United States National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that was published in the New England Journal of Medicine in 1993. Test subjects all had type 1 diabetes and were randomized to a tight glycemic arm and a control arm with the standard of care at the time; people were followed for an average of seven years, and people in the treatment had dramatically lower rates of diabetic complications. It was as a landmark study at the time, and significantly changed the management of all forms of diabetes.[100][151][152]

The United Kingdom Prospective Diabetes Study (UKPDS) was a clinical study conducted by Z that was published in The Lancet in 1998. Around 3,800 people with type 2 diabetes were followed for an average of ten years, and were treated with tight glucose control or the standard of care, and again the treatment arm had far better outcomes. This confirmed the importance of tight glucose control, as well as blood pressure control, for people with this condition.[100][153][154]

Original post:
Diabetes - Wikipedia

Your metabolism refers to all the chemical reactions in your body. These chemical reactions require energy. The amount of energy they require differs between people based on factors such as your age, body weight, and body composition.

Diabetes disrupts your bodys use of the hormone called insulin. This hormone regulates your blood sugar by shuttling glucose from your bloodstream to your tissues. If left uncontrolled, diabetes causes chronically high blood sugar levels that can damage your organs and blood vessels.

Here, well cover how diabetes affects your metabolism and examine the relationship between diabetes and obesity.

Every second, billions of chemical reactions occur in your body. These chemical reactions are collectively known as your metabolism.

Each of these reactions requires energy. Even extracting useable energy from your food requires energy.

Metabolic rate is the amount of energy your body burns in a certain amount of time, usually measured in calories. Its made up of three main components: your basal metabolic rate, energy burned during digestion, and energy burned through physical activity.

Your basal metabolic rate is the amount of energy your body burns at rest. It varies between people based on factors such as:

A 2014 study reviewed the results of studies published from 1920 to 2011 and found the average metabolic rate was 0.392 calories per pound of body weight per hour. For a 150-pound person, this equates to 1,411 calories per day.

The researchers found basal metabolic rate was higher in men than women and was lowest in overweight adults.

People with and without diabetes have almost identical metabolisms except for one key difference: People with diabetes have dysfunction of the hormone insulin.

Normally, after you consume food, carbohydrates are broken down by your saliva and digestive system. Once carbohydrates are broken down, they enter your bloodstream in the form of a sugar called glucose. Your pancreas produces insulin, which sends glucose to your cells for energy.

People with diabetes either dont respond to insulin or dont produce enough, or both. This can lead to chronically high blood sugar levels.

Type 1 diabetes is an autoimmune disease that occurs when the body attacks and destroys cells in your pancreas called beta cells, which produce insulin. Its usually diagnosed between childhood and young adulthood.

People with type 1 diabetes need to take insulin through injections or an insulin pump to lower their blood sugar.

Without insulin, blood sugar levels remain elevated and can cause damage to your body, leading to complications such as:

Type 2 diabetes makes up 90 to 95 percent of diabetes cases. It occurs when your body becomes insulin resistant.

Insulin resistance is when your cells stop responding to insulin and your blood sugar remains elevated.

To compensate for insulin resistance, your pancreas produces more insulin. This overproduction can damage the beta cells in your pancreas. Eventually, your pancreas wont be able to produce enough insulin to lower your blood sugar efficiently.

When your blood sugar levels remain elevated but arent high enough for you to be diagnosed with type 2 diabetes, your condition is known as prediabetes. More than 1 in 3 American adults have prediabetes.

Having obesity is the leading risk factor for the development of type 2 diabetes. Its thought to increase your risk by at least 6 times, regardless of genetic predisposition.

People who are overweight or with obesity are more likely to develop metabolic syndrome. Metabolic syndrome is a collection of five risk factors that increase your risk of developing stroke, type 2 diabetes, and heart disease. The risk factors are:

Researchers are still investigating why people who have obesity are more likely to develop diabetes than people who do not have obesity. One theory is that people who have obesity have increased levels of free fatty acids in their blood, which may stimulate the release of insulin and contribute to the development of insulin resistance.

People with diabetes often need to take insulin to keep blood sugar levels at a normal level. Insulin is usually taken through injections via pens or syringes. You can also take insulin through an insulin pump inserted under your skin.

Another option is inhaled insulin that you breathe in through your lungs. This type of insulin is absorbed quickly and wears off quicker as well 1.5 to 2 hours compared to 4 hours with rapid-acting injectable insulin.

There are five main types of insulin that help keep blood sugar levels stable. A doctor can help you decide which is best for you.

Taking too much insulin can lead to low blood sugar, which can be potentially life-threatening in severe cases. Going a long time between meals, skipping meals, or exercising can contribute to low blood sugar.

Monitoring your blood sugar level regularly can help you make an informed decision about food and medications. Over time, youll develop a better understanding of how your body responds to certain foods or exercise.

To make taking the right amount of insulin easier, many people count carbohydrates. Eating a high-carb meal, especially one filled with simple carbohydrates, will cause your blood sugar levels to rise more than eating a lower carbohydrate meal, and more insulin is needed to keep your blood sugar at a normal range.

Finding the right diabetes specialist gives you the best chance of keeping your diabetes under control.

A doctor likely has experience treating patients with diabetes and can walk you through your treatment. They can also refer you to a diabetes specialist. Most diabetes specialists are endocrinologists, who are doctors trained in glands and hormones.

A healthcare professional can also help you find a diabetes education program in your area to help you learn how to best manage your diabetes. Alternatively, you can visit the American Diabetes Associations website to enroll in their Living with Type 2 Diabetes Program, or to access their other resources.

You may benefit from seeing other specialists such as personal trainers or dieticians to help with weight management. The American Academy of Nutrition and Dietetics search tool allows you to search for dieticians in your area by postal code.

Diabetes care and education specialists are also a great resource to help you manage diabetes in your daily life, including nutrition, insulin injections, and learning how to use diabetes devices.

Diabetes causes dysfunction of the hormone insulin, which impairs your bodys ability to regulate blood sugar levels. People with type 1 diabetes dont produce enough or any insulin. People with type 2 diabetes dont respond efficiently to insulin, and often the beta cells stop being able to produce a sufficient amount of insulin.

If youre diagnosed with diabetes, its important to follow your doctors recommendation and take any medications prescribed to you. Consistent high blood sugar can lead to serious complications, such as nerve damage, an increased risk of infection, and cardiovascular disease.

View original post here:
Healthline Diabetes and Metabolism: What Are the Effects? - Healthline

SHREVEPORT, La. -- Diabetic retinopathy is a complication of diabetes that affects the eyes.

Diabetes mainly affects the retina by causing poor blood flow and damage to the tiny, tiny blood vessels that supply the retina, that inner lining of the eye to that allows us to see, said Dr. Ashley Sipes, an ophthalmologist with Willis Knighton Health System.

It causes leakage of fluid and bleeding.

Also swelling, especially in the area of central vision. And that's one of the major causes of blindness from diabetic problems, Sipes explained.

High, uncontrolled blood sugar levels are what trigger the condition.

Its the hyperglycemia that does the damage. It basically kills the retina cells, or damages them, mainly from lack of oxygen, she said.

Sipes said diabetic retinopathy can happen to patients with all types of diabetes.

We not only have to watch our Type 1 diabetics, and Type 2 diabetics, but our gestational diabetics, we often forget about, she explained. Their bodies in pregnancies are even sometimes more sensitive to this damage. So, they need to be screened as well.

But Type 1 diabetics are at highest risk.

The Type 1 diabetics tend to be the most at risk just because usually theyve had it the longest, Sipes said.

Initially, patients may not have noticeable symptoms.

Almost half of my diabetics have some form of diabetic retinopathy, and the damage is off in the peripheral retina. And when I say that, I just mean not in the center of vision, but in the periphery, Sipes said. They're not going to have any symptoms.

If it is not treated, it becomes even more dangerous.

When somebody has vision loss from diabetes, thats typically that area of sharpest central vision. Its called the macula. And if it gets swollen from diabetes, it swells up like a sponge and cant do its job properly," Sipes said.

Diabetic retinopathy is not curable. But it is treatable. One treatment is an injection into the eye.

Theres a medicine called anti-VEGF that they inject that has been, gosh, one of the biggest breakthroughs in my lifetime, Sipes said. Theyre able to use that for not only diabetes, but in some cases also macular degeneration. It has been remarkable.

Other treatments include laser surgery and vitrectomy surgery.

But the best treatment is prevention and keeping diabetes and blood sugar under control.

Those yearly exams really are important to diagnose not only the diabetic retinopathy, but all the things that can happen associated with blood sugar," Sipes said.

View post:
Diabetic retinopathy can happen to patients will all diabetes types - KTBS

Eden Internal Medicine in Eden, North Carolina, believed it could up its game on treating diabetes and hypertension patients.

THE PROBLEM

For diabetes patients, first there was diabetes control and monitoring in between visits. Patients with uncontrolled diabetes with elevated A1c did not have any close monitoringbetween visits to bring the sugars down.

For example, if the patient has extremely high blood sugar in the three-months-average A1c test during the visit today, staff will not have a way of closely monitoring the patient in between the visits until the patient comes for the next visit in three months.

That means the patient has been uncontrolled or partially controlled for three months. Uncontrolled diabetes leads to many complications for the patient. CMS and other HEDIS star rating and quality metrics require better A1c control.

"There are limitations with Bluetooth technology," said Dr. Dhruv B. Vyas, owner and partner at Eden Internal Medicine. "Bluetooth is not convenient for the patients who are not technologically savvy and do not have a smartphone, which makes it difficult to monitor them for glucose control in between the visits.

"Bluetooth devices lead to failure to transmit sometimes and a problem with syncing the devices that results with more time spent by the staff and the patient to fix the device connectivity issues," he continued. "Many patients do not have smartphones or have aversion to technology, which limits the use of such devices."

Then there is patient accountability and compliance monitoring. It was difficult to manage patients' accountability and compliance without having instant blood glucose monitoring between the visits while they were at home.

"Some patients may need close monitoring of the blood sugar readings and monitoring to follow the diet and exercise program," Vyas explained. "Without the instant access to the blood sugar readings daily for the doctor's office, it is difficult to advise such patients to improve their lifestyle and/or make medication changes."

Then comes hypertension. First, there was monitoring of blood pressure in between the visits.

"Monitoring blood pressure in between visits and adjusting the medication to get the blood pressure to the goal is key," said Vyas. "Patients with uncontrolled blood pressure and recent medication changes require frequent office visits, which is difficult for many patients.

"And then there is managing the patient with white coat hypertension," he continued. "It is difficult to treat the patient with labile hypertension or white coat hypertension based on the readings in the office. Patients may have extremely high blood pressure in the office, but reportedly normal blood pressure at home."

Treating such patients aggressively may lead to a hypotensive episode and syncope, he added. Monitoring such patients with reliable devices would give accurate data in their home settings when they are comfortable and not anxious, he said.

Lack of reliability of the current cellular blood pressure devices also was an issue. Some of the existing cellular blood pressure devices were not as accurate, and it was difficult to treat patients based on those numbers. There was a need for reliable cellular blood pressure monitor devices that produce consistent readings based on which medication could be adjusted.

And again, limitations with Bluetooth technology.

"Bluetooth BP devices work for people with smartphones and who are technologically savvy, but do not work for people with a regular phone in a rural area and who have a phobia of technology," Vyas said.

PROPOSAL

Eden Internal Medicine turned to technology from Smart Meter. The technology offers cellular-connected devices like blood sugar and blood pressure machines that would instantly transmit the readings to a patient's records or to a dashboard.

"By using cellular technology, the patient barriers of technology reliance are removed," said Vyas. "Diabetic supplies and test strips can be automatically shipped to the patient's home when they run out of the strips by the intuitive data platform on Smart Meter technology. Unlimited amounts of test strips are supplied with the Smart Start program. The technology has excellent support staff for troubleshooting, which reduces patient and staff time.

"Smart Meter devices are reliable and accurate, and produce consistent results of the blood pressure and blood sugar readings, which are in acceptable norms of standard deviation," he added. "The technology enables flexible device distribution, including direct-to-patient delivery, and manages all device and data logistics. It also provides training and support for providers, patients and caregivers."

MARKETPLACE

There are numerous vendors of remote patient monitoring technology on the health IT market today. Healthcare IT News recently published a special report on RPM vendors. To read the detailed listings, click here.

MEETING THE CHALLENGE

Eden Internal Medicine integrated the Smart Meter technology with its AstuteDoc care management platform.

"The intuitive software from AstuteDoc provides dashboards, care plans, interventions, data graphs, time management, billing exports and many more features, along with dedicated care team members embedded in the medical practice," Vyas explained.

"AstuteDoc's complete care management solutions include chronic care management, remote patient monitoring, transition-to-care management, annual wellness, ACO quality metrics, incident-to-visit, and principal care management.

"This platform has been used by many ACO medical practices, PharmD, physicians, cardiologists, endocrinologists, primary care practices, nurse practitioners, care coordinators and medical assistants," he continued. "AstuteDoc embeds the PharmD or medical assistant into the doctor's offices to achieve care management goals and quality metrics."

Implementing the Smart Meter technology resulted in better workflow, seamless integration, and staff and patient satisfaction, Vyas reported.

"AstuteDoc's care management providers, staff and PharmD were able to deliver better outcomes for the patients' blood pressure and blood sugar control," he said. "This has translated into better HEDIS Star rating quality metrics.

"And patient compliance has significantly improved," he continued. "Care coordinators' intervention in between visits led to improvement in the patient lifestyle and accountability toward exercise and dietary choices. Patients were more knowledgeable about their health issues and more motivated to take care of their health."

Enrolling patients in remote monitoring was much easier for care coordinators using Smart Meter devices, he added. Instant transmission of the data and integration to the software was seamless and reduced enrollment time, he said.

"Monitoring of data was much easier for staff via specific alerts for each patient to achieve their goals," said Vyas. "During the pandemic, tele-visits were surging, and use of the Smart Meter devices nicely complemented with such visits to provide more data to the providers for the meaningful disease management. Home BP readings transmitted were used for certain visits like annual wellness, which is a required element for CMS."

RESULTS

On the diabetes metrics front, Eden Internal Medicine saw improvement in A1c readings, reducing hospitalizations via improved patient compliance.

"Improvement in A1c was noted on an average of 1.6 with patients at the next visit in three months," Vyas reported. "And there was significant improvement in postprandial hyperglycemia due to close monitoring and intervention between visits. This has translated into weight loss due to patient accountability and lifestyle change.

"By creating critical alert triggers for different glucose readings, we were able to reduce the hospitalizations for hypoglycemia and diabetic ketoacidosis," he continued. "In the long run, we expect this A1c control to reduce diabetes-induced complications."

Eden Internal Medicine achieved a 4.95 HEDIS Star Rating for United Healthcare Medicare.

On the hypertension metrics front, patients' blood pressure was reduced by intervention in between visits.

"Patients with labile hypertension or white coat hypertension had somewhat normal readings at home, which has been documented in the EHR," Vyas explained. "Remote patient monitoring blood pressure readings can be used one time a year during in-office visits for the CMS quality metrics goal of BP Control.

"There were two patients with syncopal episodes, which appeared to be due to low blood pressure readings at home with the same medications, while these patients were showing high BP readings in the office," he continued. "The number of medications was reduced now based on the home blood pressure readings to correct the problems of overmedication. Patients started having more energy, and had no syncopal episode and less medication expense."

ADVICE FOR OTHERS

"Any healthcare provider organization considering using similar technology needs to investigate cellular technology platforms that integrate with the care management software or EHR," Vyas advised. "Reliability of the device and consistent support from the vendor will be equally important for this program to be successful."

Vyas strongly advises against using Bluetooth technology unless patients are technologically savvy and have a smartphone. Providers should use remote patient monitoring technology for high-risk patients, set specific critical alerts and decide intervention/care plans to bring them to the desired goals, he added.

"For better implementation of the remote monitoring program, it needs to be intertwined with the other care management programslike CCM, TCM, AWV, PCM, etc., to maximize the benefit for the value-based patient care, which translates into better quality scores and outcomes," he said.

"Implementation for such programs is extremely difficult if you do not have dedicated staff or a care management company handling day-to-day needs of the program and critical alerts interventions as providers will not have time to handle the workload.

"And having a PharmD-supported program also provides significant value to the practice, patient, ACO and Medicare advantage plans," he concluded. "The highest performing practices achieve their goals from the most coordinated care team efforts, workflows and smart technology."

Twitter:@SiwickiHealthITEmail the writer:bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.

Link:
Eden Internal Medicine reaps big rewards with RPM for diabetes and hypertension - Healthcare IT News

The Boston-based nonprofit T1D Exchange has been posing a Question of the Day to thousands of people living with type 1 diabetes (T1D) for nearly 10 years now. Questions run the gamut from How do you [dose insulin] for pizza? to Do you own a breath keytone meter? to Do you expect to take a device vacation for at least a few days this summer?

What a treasure trove of information the T1D Exchange must have amassed by now!

On first glance, this Question of the Day program looks to be a seamless and effective way for people who care about diabetes to ponder questions, share answers, see statistics, and interact with other like-minded folks all worthy and valuable functions.

But if you take a deeper dive into the T1D Exchange and this nearly decade-year old program, youll find much more than that.

The questions, answers, and much of the community that takes part in it constitute a living, breathing, thinking, and sharing database, helping not just one another, but to drive research to improve the lives of those with T1D across the board.

David Panzirer, trustee of The Leona M. and Harry B. Helmsley Charitable Trust funders of the T1D Exchange explained that those were their exact hopes for the Question of the Day program when it launched a decade ago. He worked on it with Dana Ball, program director of the T1D Program at the Helmsley Trust and former executive director of the Iacocca Foundation.

The real impetus was [when we looked around the diabetes research landscape] and thought, wheres the data? Panzirer told DiabetesMine.

The truth is, it did not exist in places most could access. It was off in vaulted places that no one else was willing to share, he said.

That meant researchers working on diabetes theories and treatments often had to add months, or even years, to their research timeline while they hunted down needed data. This contributed to why progress in the diabetes landscape seemed to come at a crawl, he said.

Today, the T1D Exchange, through both those Questions of the Day and their patient Registry that sprouted from that, now has treatment data and lifestyle information of about 30,000 people with diabetes. Of those, about 15,000 have opted to be part of their Registry, which seeks annual medical and other data and often asks members to participate in studies.

The T1D Exchange data culled from both of those sources has been presented in studies and programs around the world and continues to inform researchers, product manufacturers, and more on what the diabetes community needs.

All that data exists in one easy-to-access place, and is helping, many say, to speed up the process of research and bring new deliverables to market. Otherwise known as: improving the lives of people with diabetes.

And while doing all that heavy lifting, it also still continues to provide people with diabetes and those who care about them a place to chat, learn, vent, and adapt.

We use it as a platform to engage but also to share, T1D Exchange CEO David Walton told DiabetesMine. Its a great way to get [a large group of people] to respond.

Questions of the Day come from a variety of sources. The T1D Exchange team holds monthly brainstorming sessions, Walton said, to hone in on both what they may be wondering, what has bubbled up in the community at large, what companies and researchers may be curious about, and some staples, like the quarterly What is your A1C? question.

Anyone can opt in to respond, and much of the conversation, including tip sharing and support, happens online as each question is released.

That, Walton said, is where the support and sharing they know the community appreciates takes place.

Panzirer said it took them a solid 2 years and $20 million to get to the point of being a strong data collection program. From there, they both made that data accessible to researchers and other stakeholders and used it to begin what they really hoped to do: Push for faster, smarter and more impactful research and breakthroughs.

Their first step came when theyd only gathered about 10 percent of the group of respondents they have now.

With data from about 4,000 people, he said, they went before the Food and Drug Administration (FDA) and showed them two things: that the average A1C among their base was at 8.4 percent, and that 10 percent of the participants had experienced a severe diabetes event [blood sugar either low or high enough to require assistance, hospitalization, or both] in the past year.

I can tell you, their jaws were on the floor, Panzirer remembered of the FDA team. They had no idea. Now, we had clinical proof that the perception many had that insulin works fine and people with diabetes can easily do well with it wasnt a reality.

Without a doubt, he said, we were able to open their eyes and shine a light. It shined a light on just how poorly people were doing. We had the data to prove it.

To illustrate how this can culminate in helping people in real life and pushing research and industry to create life-bettering deliverables, Panzirer points to the success of Locemia Solutions.

Robert Oringer, an innovative businessman and the father of two sons with T1D, had an idea: What if emergency glucagon could be easier in every way: to carry, to administer, to store and more? After all, as the father of two sons with T1D, he knew well how bulky, stressful, confusing and even frightening the classic red case emergency glucagon rescue kits could feel.

He approached the T1D Exchange, who asked their community via Questions of the Day all about their feelings around rescue glucagon to confirm what Oringer saw. They jumped on board gathering data.

With that data and confidence in his product, they formed a committee of key opinion leaders like leading diabetes educator and author Hope Warshaw and well-known Yale endocrinologist Dr. William Tamborlane, and then went on to run clinical trials.

That data and study result information gave Locemia the platform to reach out to bigger names. Soon, the pharma giant Eli Lilly and Company took over the project.

Today, the product they created, the first-ever nasal glucagon Baqsimi, is available on the market, making carrying and using emergency glucagon a tremendously simpler, less stressful and more palatable option.

In other words, the data improved lives.

The timing of their first FDA meeting lines up, too, with the period of time when the FDA agreed to streamline the review process for continuous glucose monitors and after that, smarter insulin pumps and hybrid closed loop systems.

Today, just a decade past all of that seeming like a pipedream, new products are coming faster and faster.

The data that so many can access, Panzirer said, is a key reason why.

We forced a whole field to accelerate faster, he said. We forced the competition, and thats fueling more and more improvements.

While all this is going on, the questions continue to offer moral and educational support to thousands on a near daily basis, something Walton says they see as vitally important as well.

An example of how a question can help the community while informing researchers, T1D Exchange marketing manager Sarah Tackett told DiabetesMine, works like this:

They decided to ask the question, Do you brush your teeth after you treat a low?, after a dentist with a newly diagnosed child brought it up as a suggestion. This is an issue especially around nighttime lows, when people just want to go back to sleep after treating with sugar, but worry about damage to their teeth. Parents of children with T1D tend to be particularly worried.

The responses came in fast: 85 percent of respondents said they do not brush their teeth after treating a low.

From that came a hearty, helpful, and interesting discussion among respondents on the Question of the Day page on their website. People shared feelings on the topic, and asked for advice: Phew! Im not the only one! and Is there a better way?

It can be a very special thing to see folks connecting and helping one another around the questions, Tackett said.

They dont stop there, though.

We then send [the info] on to the research team, she said, so they can consider if there is anything to dig deeper into.

So, while the data may someday be important to a study, it becomes important the moment it sparks discussion, she said.

Questions can also give respondents a sense of power and input, she said. They may ask things like What features on a pump are most important to you? to help guide inventors and manufacturers toward what people want, an empowering experience for most.

Its a great springboard, Walton agreed.

The data also does another important thing, he said: It inspires bloggers and reporters to dig into topics that the public wants to learn more about or needs to hear more about.

In other words, increased education around diabetes is a byproduct as well.

As it celebrates 10 years, the T1D Exchange and its Registry and Question of the Day are far from done, said Walton.

They continue to collect data and welcome new people into their Registry with the goal of pushing things forward.

For Panzirer, who saw a second daughter diagnosed with T1D in 2017, it must and it shall move forward. He sees the same power today as he saw back when Ball suggested this to him long ago.

We are fortunate, Panzirer said. Dana was a visionary who got this whole thing rolling. I will be forever grateful to him.

Ball, who has retired from the role since, was the right person to partner with him to make this happen, he said.

Ive been a bull in a china shop. I told Dana Im not here to make friends. Im here to bring change. Are we successful in that? No, not until we dont have to use any of these [diabetes tools] anymore. And we will keep pushing until we are there, Panzirer said.

Go here to read the rest:
A Decade of Type 1 Diabetes 'Questions of the Day': What Have We Learned? - Healthline

A new study shows that among older adults with non-valvular atrial fibrillation (NVAF), those with diabetes mellitus (DM) and osteoarthritis (OA) incur a higher risk of heart failure (HF) and other cardiovascular diseases (CVDs). The findings were published in BMC Public Health.

In this retrospective observational cohort study, researchers examined data of Hawaii Medicare inpatient, outpatient, and carrier claim files and beneficiary summary files from 20092017.

Overall, 19,588 patients were included in analysis; the population were divided into four mutually exclusive cohorts of DM/OA status: with both DM and OA (n=1,230), with DM only (n=4,659), with OA only (n=1,978), or without DM and OA (n=11,721), based on their diagnoses before baseline.

Among the population, patients with cardiovascular diseases (CVDs) were identified (stroke: diabetes n=837, osteoarthritis n=315, diabetes and osteoarthritisn=184, without diabetes and osteoarthritis n=1630)(AMI: diabetes n=438, osteoarthritis n=128, diabetes and osteoarthritisn=118, without diabetes and osteoarthritisn=603)(HF: diabetes n=2,254, osteoarthritis n=764, diabetes and osteoarthritis n=581, without diabetes and osteoarthritis n=4,272).

According to the results, after adjusting for age, sex, race/ethnicity, and other confounders, patients with both DM and OA had a higher risk for HF (HR=1.21 95% CI, 1.101.33) than those without DM and OA. Patients with both diseases also had a higher risk of HF than those with just OA. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups.

The study did have its limitations; one being that the severity of the CVDs and types of diabetes were not taken into account. Moreover, the CVD risks were analyzed without adjusting for biomarkers and other potential risk factors such as smoking and physical inactivity. Also, while diseases were identified from large data sets of patients with Medicare Part A & B, Part C claims were not included, thus, some misidentifications could exist, the researchers noted.

The researchers wrote that despite these limitations, the current study has several strengths. The use of a nine-year longitudinal dataset allowed more accurate CVD risk estimation compared with studies with cross-sectional data. Our data included a high proportion of non-White individuals, which also allowed the risk estimations for those minority groups that have been often overlooked in the past. Additionally, the use of Hawaii Medicare data enabled us to compare the variations in hazard ratios by DM/OA status based on all non-Health Maintenance Organization Medicare beneficiaries aged 65years or older with NVAF in Hawaii.

They added that the finding that older diabetic patients with NVAF would have additional risks for the CVDs will provide a new and useful public health perspective. Healthcare professionals may need to consider developing multifactorial interventions for older adults with NVAF tailored to different DM/OA statuses.

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Older AFib Patients with Diabetes and Osteoarthritis at Higher Risk of Cardiovascular Diseases - DocWire News

Telehealth provider Teladoc Health is teaming up with The Ohio State University Wexner Medical Center to improve remote disease management for people with Type 2 diabetes.

Starting July 1, Wexner patients can enroll in Teladoc's Livongo for Diabetes Program, a patient-centric customized wellness program designed to improve hemoglobin A1c and other metabolic markers that reduce diabetes complications and ultimately reducing the use of healthcare resources.

The Livongo program focuses on sustainable behavioral changes that improve glycemic and HbA1c levels for patients. The program relies on real-time feedback, live coaching, curated educational content, health nudges, and five-day mini challenges for patients. The system eases data sharing with patients' physicians, allowing them to monitor their patients' progress.

Livongo patients will get a cellular-connected blood glucose meter, unlimited test strips, 24/7 interventional support, and ongoing access to Teladoc clinicians.

"With the prevalence of diabetes growing nationwide and in Ohio, patients are faced with ever-increasing challenges to manage this disease," Hal Paz, MD, executive vice president and chancellor for Health Affairs at The Ohio State University and CEO of the Ohio State Wexner Medical Center, said in a media release.

"This partnership with Teladoc Health's Livongo disease management and chronic care unit is a complementary platform to deliver high quality care to our patients living with diabetes while advancing our commitment to digital health and innovation," Paz said.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

See more here:
Teladoc, OSU Wexner, Tag-team on Diabetes Care Initiative - HealthLeaders Media

Managing type 2 diabetes typically involves losing weight, exercise and medication, but new research by Dr. Makoto Fukuda and colleagues at Baylor College of Medicine and other institutions suggests that there may be other ways to control the condition through the brain. The researchers have discovered a mechanism in a small area of the brain that regulates whole-body glucose balance without affecting body weight, which suggests the possibility that modulating the mechanism might help keep blood sugar levels in a healthy range.

A growing body of evidence strongly suggests that the brain is a promising yet unrealized therapeutic target for type 2 diabetes, as it has been shown that it can regulate glucose metabolism, said Fukuda, assistant professor of pediatrics-nutrition at Baylor. To further materialize this concept, it is of great interest to identify potentially druggable molecular targets mediating the brains antidiabetic effects.

Research has shown that within the hypothalamic region of the brain, a small area known as the ventromedial nucleus of the hypothalamus (VMH) contains glucose-sensing neurons and regulates glucose metabolism in peripheral tissues.

VMH neurons are thought to be crucial mediators of the neural glucoregulatory mechanism, Fukuda said. However, the signaling mechanisms within VMH neurons that mediate whole-body sugar control remain elusive. In this study, we identified a molecular pathway in the VMH that mediates whole-body glucose balance and involves Rap1, an enzyme known to mediate overnutrition-associated disorders.

The researchers worked with a diabetes model of high-fat diet-induced obesity in mice, in which they either activated or eliminated Rap1 specifically in VMH neurons by using either genetic or pharmacological techniques.

They discovered that activation of Rap1 in the hypothalamus exaggerated the high blood sugar levels or hyperglycemia in the diet-induced obesity mouse model. In contrast, genetic loss of hypothalamic Rap1 decreased hyperglycemia in dietary obesity.

Interestingly, the changes in glucose levels were observed without alterations in body weight, suggesting a primary role of Rap1 in glucoregulatory function, Fukuda said.

Our findings that Rap1 activity can be regulated via pharmacological intervention provide proof-of-concept for the potential of targeting Rap1 signaling within the brain to improve glucose imbalance and induce antidiabetic effects.

While having no effect on body weight regardless of sex, diet and age, Rap1 deficiency in VMH neurons markedly lowered blood glucose and insulin levels and improved glucose and insulin tolerance.

Taken together, the data suggest that hypothalamic Rap1 is a molecular pathway for the control of glucose metabolism and mediates high-fat diet-induced glucose imbalance, thereby making it a potential target for therapeutics.

If we gain weight, blood glucose seems to be disturbed. Thats why obese people may have diabetes, Fukuda said. But in this mouse model we discovered that by modulating the activity of Rap1 in a small brain area we could regulate whole-body glucose metabolism without body weight change. There is still much work to do, but our findings suggest that maybe in the future obese people with diabetes could lower blood sugar levels by manipulating this mechanism of Rap1 in the brain without having to lose weight.

Find all the details of this study in JCI Insight.

Other contributors to this work include Kentaro Kaneko, Hsiao-Yun Lin, Yukiko Fu, Pradip K. Saha, Ana B. De la Puente-Gomez, Yong Xu, Kousaku Ohinata, Peter Chen and Alexei Morozov. The authors are affiliated with one or more of the following institutions: Baylor College of Medicine, Kyoto University, Nagoya University, Cedars Sinai Medical Center, National Institute of Mental Health and Fralin Biomedical Research Institute at Virginia Tech Carilion.

Financial support for this project was provided by U.S. Department of Agriculture Current Research Information System 6250-51000-055, AHA-14BGIA20460080, NIH-P30-DK079638, NIH R01DK104901, and NIH R01DK126655; NIH awards R01DK093587 and R01DK101379; AHA-15POST22500012, the Uehara Memorial Foundation, Takeda Science Foundation and Japan Foundation for Applied Enzymology. Further support was provided by NIH awards R01MH120290, R01HL103868 and R01HL120947. This project was also supported in part by the Mouse Metabolic and Phenotyping Core at Baylor College of Medicine with funding from NIH UM1HG006348 and NIH R01DK114356.

By Ana Mara Rodrguez, Ph.D.

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Rap1 controls the body's sugar levels from the brain, regulating it may help manage diabetes - Baylor College of Medicine News

Rich in fiber, vitamins, minerals, and antioxidants, fresh fruit can be an excellent addition to a well-rounded diet (1).

However, certain types of fruit contain more sugar and calories than others. Furthermore, some fruits can cause side effects for people with health conditions like diabetes and acid reflux. These fruits can still be enjoyed, but in smaller serving sizes.

This article takes a closer look at the fruits highest in sugar and calories, plus the ones you may need to limit if you have diabetes or acid reflux.

Some types of fruit, both fresh and dried, are high in natural sugar. If youre aiming to reduce your intake of carbs or sugar, stick to small amounts when enjoying these.

Dates are known for their sweet, almost caramel-like flavor. Their dried versions are often enjoyed as-is for a handy snack or used as a natural sweetener in recipes.

Although theyre rich in antioxidants and micronutrients like potassium, copper, and magnesium, theyre also high in sugar and carbs (2, 3).

One cup (160 grams) of dried dates contains (3):

Some of the most common varieties of dried fruit include apples, raisins, apricots, figs, mangoes, pineapples, and cranberries.

Compared with their fresh counterparts, they generally contain more calories, carbs, and sugar per serving. Most varieties are also rich in fiber, potassium, and vitamin C (4).

Because of the high sugar content, its best to enjoy dried fruits in moderation, especially if youre looking to decrease your sugar intake.

A 1-cup (160-gram) serving of a dried fruit mixture contains (4):

Native to southeastern China, this tropical fruit is known for its unique taste and appearance.

It contains many key micronutrients, including vitamin C, copper, and potassium. Its also relatively high in sugar, which may be an issue if youre on a low carb or low sugar diet. (5).

One cup (190 grams) of raw lychees contains (5):

This delicious stone fruit is popular for its sweet flavor and soft, creamy texture.

Mangoes are also brimming with a variety of nutrients, including vitamin C, folate, and copper. On the other hand, they contain a high amount of natural sugar in each serving (6).

One cup (165 grams) of mangoes contains (6):

Many types of fruit are high in calories. While they can be enjoyed as part of a nutrient-dense, well-rounded diet, you may want to keep an eye on your portion sizes if youre trying to cut your calorie intake or lose weight.

Avocados are high in calories, thanks to their content of heart-healthy monounsaturated fats. Theyre also a good source of important vitamins and minerals like potassium, vitamin C, and B vitamins (7).

Plus, theyre loaded with fiber, an essential nutrient that can support regularity and digestive health (8).

One cup (150 grams) of avocado contains (7):

Shredded coconut is a common ingredient in baked goods, smoothie bowls, and breakfast dishes.

Although its rich in nutrients like manganese, copper, and selenium, its also high in fat and calories (9).

In particular, coconuts are high in medium-chain triglycerides (MCTs), a type of fat that is readily absorbed by your body. MCTs have been associated with several health benefits, including improved body composition and heart health (10).

One cup (93 grams) of dried unsweetened coconut contains (11):

Prunes are a type of dried fruit made from plums.

Because of their fiber content and laxative effects, theyre sometimes used as a natural remedy for constipation. However, like other types of dried fruit, theyre also relatively high in calories, carbs, and sugar. (12).

One cup (174 grams) of pitted prunes contains (13):

If you have diabetes, its important to eat plenty of nutrient-dense foods rich in fiber to support healthy blood sugar levels (14).

Meanwhile, foods that are low in fiber and high in added sugar should be limited, including certain forms of fruit (14).

Candied fruit is a type of fruit made by soaking and heating fruit in sugar syrup, resulting in a product with a sweet flavor and long shelf-life.

Not only is candied fruit high in calories and low in fiber, but it also packs a lot of sugar and carbohydrates into each serving. This may not be ideal for those with diabetes.

3.5 ounces (100 grams) of candied fruit contains (15):

Fruit juice offers a concentrated amount of carbs and sugar without any of the fiber found in fresh fruit. Many types also contain added sugar, which can negate many of the potential health benefits that the fresh versions otherwise provide.

In a review of four studies, increased intake of sugar-sweetened fruit juice was linked to a higher risk of type 2 diabetes (16).

Another study in 8,492 women found that drinking fruit juice was tied to increased levels of hemoglobin A1C, a marker that is used to measure long-term blood sugar control (17).

An 8-ounce (240-mL) serving of orange juice contains (18):

While canned fruit can be a quick and convenient way to squeeze a few servings of fruit into your diet, it may not be the best choice for those with diabetes.

This is because its generally higher in carbs and sugar and lower in fiber, compared with other types of fruit (19).

In particular, fruit canned in heavy syrup or juice is typically much higher in sugar than fruit canned in water. Thus, the water-canned version may be a better option when aiming to keep your blood sugar levels in check.

A 1-cup (214-gram) serving of fruit cocktail canned in heavy syrup contains (19):

Certain fruits may worsen symptoms for those with gastroesophageal reflux disease (GERD), also known as acid reflux (20).

Although these fruits are highly nutritious and can fit into a balanced diet, you may want to limit your intake if you find that they trigger symptoms of acid reflux.

Citrus fruits like oranges are loaded with essential nutrients like fiber, vitamin C, and potassium (21).

Unfortunately, theyre also highly acidic and may worsen heartburn for people with GERD.

One navel orange contains (21):

Although theyre often used as a vegetable in many recipes, tomatoes are technically classified as fruit.

This nutritious ingredient is rich in vitamin C, fiber, and lycopene a carotenoid that has been well studied for its antioxidant effects (22, 23).

However, like citrus fruits, the acidity of tomatoes and tomato-based products may trigger symptoms in people with GERD (24).

One cup (180 grams) of chopped tomatoes contains (22):

Grapefruit is a type of citrus fruit known for its tasty, tart, and slightly bitter flavor.

Its low in calories and rich in vitamins and minerals like vitamins A and C, potassium, and thiamine (25).

Unfortunately, grapefruit and grapefruit juice are also common symptom triggers for people with GERD (26).

A 1-cup (230-gram) serving of grapefruit contains (25):

Although fruit is highly nutritious and associated with many health benefits, some types especially dried, juiced, and canned versions may be high in sugar and calories.

Not only that, but certain kinds of fruit can increase blood sugar levels in people with diabetes or trigger symptoms in people with GERD.

Still, keep in mind that most fresh, minimally processed varieties of fruit can be enjoyed in moderation as part of a nutrient-dense, well-rounded diet.

The rest is here:
What Are the Most Unhealthy Fruits? Sugar, Calories, and More - Healthline

Five cancer cell therapies are approved in the U.S. Scores more are in clinical testing as drugmakers work to repurpose human cells as a platform for new medicines, many of which are similarly targeted at different types of cancer.

But more and more biotechnology companies aim to use cell therapy for diseases that turn the body's immune system against itself.

"We're in the era of engineering cells to do our bidding," said Samantha Singer, the CEO of a new startup launching Wednesday with $95 million in venture capital funding. "We should do this in autoimmune disease."

Over the past three years, Singer and scientists from Third Rock Ventures, the company's principal venture backer, Harvard Medical School, Massachusetts Institute of Technology and the National Institutes of Health have been studying that idea, work that led to the creation of the newly debuted company.

Called Abata Therapeutics, the startup plans to genetically engineer a type of regulatory immune cell to treat multiple sclerosis, Type 1 diabetes and an inflammatory disease called inclusion body myositis. If all goes well, Abata expects to have early clinical trial data on its lead therapy for MS by 2024 and to start clinical testing of treatments for the other two diseases by the end of 2025.

"Now is the time for Abata because the technology has evolved to a point where we can actually do some of the things that we were dreaming of two or three years ago," said Diane Mathis, a professor of immunology at Harvard Medical School and a co-founder of Abata, in a video announcing the company's launch.

The cells Abata chose to work with, called regulatory T cells, or Tregs, are a core part of the body's immune system. Crucially, they also possess many of the attributes Singer and the Abata team were looking for in a therapy.

"The ideal therapy would be something that acts locally, only in tissue that has an autoimmune pathology," said Singer, in an interview. "You'd want something that could counter multiple mechanisms of inflammation and promote repair. You'd want something that's durable. That's what a Treg does in your immune system."

Abata plans to engineer these Tregs with a cell receptor specifically designed to recognize antigens protein flags that act as triggers for an immune response associated with inflamed tissue.

"I like to think that we are simply taking advantage of this powerful, wise immune system that nature gave us," said Richard Ransohoff, a neurologist and partner at Third Rock who co-founded Abata, in an interview.

Abata plans to first target a progressive form of MS, a disease in which the immune system attacks the protective covering of nerve cells. There are many drugs now approved for relapsing forms of MS and one, Roche's Ocrevus, cleared for the primary progressive stage of the disease.

But for patients with progressive MS who no longer experience active relapses, there's no treatment option, according to Abata.

"Nodules of immune active cells have become lodged in corrugations of the brain and spinal space," said Ransohoff, who described the brain as a walnut, with alleys that can harbor those nodules.

"Ocrelizumab doesn't touch these nodules of inflammation that live in the central nervous system and are going to stay there after all the peripheral inflammation is removed," he added, using Ocrevus' scientific name.

Abata estimates there are about 45,000 patients in the U.S. who have progressive MS with non-relapsing disease and ongoing inflammatory tissue injury. The company plans to identify these patients using an MRI biomarker developed by NIH researcher Daniel Reich, who is a scientific adviser for Abata.

Along with Third Rock, Abata is also backed by ElevateBio, a richly funded and unusual biotech that mixes in-house research with a partnering business helping other companies manufacture complex cell therapies.

Lightspeed Venture Partners, Invus, Samsara BioCapital and the JDRF T1D Fund also invested in Abata through the Series A funding round led by Third Rock and ElevateBio.

Abata is not alone in attempting to build cell therapies around Tregs, but it appears to be one of the most well-funded. GentiBio, Quell Therapeutics, Sonoma Biotherapeutics, Coya Therapeutics and, most recently, TRexBio, have all launched in recent years with plans to use Tregs to treat autoimmune diseases.

Originally posted here:
Third Rock-backed startup launches to develop cell therapies for MS, diabetes - BioPharma Dive

As we reach what seems to be the end of the deadly second wave of Covid-19 in India, several recovering patients stare at a long haul of dealing with persisting symptoms now being defined as long Covid by doctors. In light of the situation, News18 will run a 15-day series Decoding Long Covid where doctors with different specialisations will address concerns, recommend ways to deal with them, and suggest when to seek help.

In todays column, Dr Sweta Budyal, senior consultant endocrinologist at Fortis Hospital Mulund in Mumbai, explains why recovering patients may experience a new onset of diabetes, viral thyroiditis and a flare-up of autoimmune diseases.

In an interview with News18, Dr Budyal said, By now, it is common knowledge that diabetes increases the risk of Covid-19. But, in terms of long Covid, what we have been seeing is that it becomes considerably difficult to manage pre-existing diabetes in patients, during the recovery phase.

More importantly, patients who have never had diabetes, or do not have the risk factors associated with the disease, also turn diabetic post-Covid. So, Covid induces diabetes in some cases, and it can happen long after the use of steroids have stopped, she added.

Apart from diabetes, one of the symptoms of Covid patients is sick euthyroid, which is abnormalities in the development of thyroid hormones during any acute illness. It has been observed that during the recovery phase, too, several thyroid-related issues crop up. Some patients experience subacute thyroiditis or viral thyroiditis, which are characterised by more pronounced symptoms like fever, throat or neck pain. Such conditions can last from anywhere between eight to twelve weeks and may even require supportive treatment, said the doctor.

Thirdly, many patients also face autoimmune issues during the recovery phase. We have seen a trend in the increase of type 1 diabetes following covid in children. I have also come across a rare case of insulin autoimmune hypoglycemia syndrome, said Budyal. The doctor said that while there are also reports that the virus has been extracted from testicles and other endocrine organs, in those cases, longer implications post-recovery is yet to be studied.

As far as metabolism is concerned, most covid patients generally tend to lose weight, which they regain after the infection. Covid causes poor health which may also require a step down in the Blood Pressure medication doses in some cases, she explained.

The doctor said every physical change needs to be monitored closely while dealing with long Covid, and there is a need to stay in touch with a physician who will help you navigate this phase.

Read all the Latest News, Breaking News and Coronavirus News here

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Decoding Long Covid: Viral Thyroiditis, Covid Induced Diabetes are Real Threats - News18

Bachem, a supplier to pharmaceutical and biotechnology companies worldwide, is celebrating its 50th anniversary this month. We take a look at the Swiss company'shistory.

Bachem is founded by entrepreneur Peter Grogg in Liestal, a small town near Basel in Switzerland. Grogg started the firm with just two employees, and with a focus on peptide synthesis - peptides are composed of amino acids that have a variety of functions treating health conditions such as cancer and diabetes.

Bachem moves its headquarters to the Swiss town of Bubendorf,with eight employees. In 1978 the company produces peptides for use in medicines for the first time. In 1981 production capacity triples and the workforce grows to 150.

The company expands into the US with Bachem Bioscience, Inc. in Philadelphia. To strengthen its presence in Europe, Bachem opens sales and marketing centres in Germany in 1988.

Further sales centres open in France in 1993. By 1995 the company employs 190 people. In 1996 it acquires the second largest manufacturer of peptides in the world and forms Bachem California with a site in Torrance.

Bachem company goes public and lists shares on the Swiss Stock Exchange. Further acquisitions include Peninsula Laboratories, Inc, based in California, and Sochinaz SA, a Swiss-based manufacturer of active pharmaceutical ingredients. By 2001, the company has 500 employees and sales reach 141 million CHF.

In 2003 the organisation is given a new legal holding structure to support its continued growth, which remains in place to this day.

Bachem acquires a brand by Merck Biosciences for ready-to-use clinical trial materials and related services.

In 2013, together with GlyTech, Inc. Bachem announces the development of a new amino acid that can help to treat multiple sclerosis, with a world market of more than $4 billion.

In 2015 it acquires the American Peptide Company (APC), which becomes integrated into Bachem Americas.

In 2016 the group opens a new building dedicated to R&D projects and small series production in Bubendorf. With a total of 1,022 employees, the workforce exceeds the 1,000 mark for the first time in the companys history. Sales are over the 200 million mark for the first time at 236.5 million CHF.Bachem expands into Asia with the establishment of a new company in Tokyo called Bachem Japan K.K.

By 2019 Bachem has a growing oligonucleotide portfolio - these are DNA molecules used in genetic testing, research, and forensics. It is hoped this will become a significant product range in the future.

Despite the COVID-19 pandemic, Bachem secures its supply of active ingredients, and even increases it in critical areas. Sales exceed the 400 million Swiss franc mark for the first time, and 272 new employees are hired.

Bachem celebrates its 50th anniversary and position as a global leader in the manufacture of peptides. While it remains headquartered in Bubendorf, the company employs 1,500 people at six locations worldwide. In the next five years there are plans to continue expanding.

Commemorating the company's anniversary, Kuno Sommer, Chairman of the Board of Directors, said: "Bachem's exceptional success story from a small laboratory to a global market leader is closely linked to Peter Grogg's values, and has been shaped by innovation, consistent quality and cost awareness, as well as by entrepreneurial vision."

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Dexcom: changing the lives of people with type 1 diabetes | Medical Devices & Pharma - Healthcare Global - Healthcare News, Magazine and Website

FOR IMMEDIATE RELEASE:June 22, 2021

MEDIA CONTACTS:Dan Tierney: 614-644-0957 Breann Almos: 614-644-0957

Governor DeWine Signs Bills Into Law

(COLUMBUS, Ohio)Ohio Governor Mike DeWine today was joined by Senate Bill 21 sponsors and several stakeholders for a bill signing at the Ohio Statehouse.

Senate Bill 21, sponsored by Senator Nickie Antonio and Senator Nathan Manning, requires the Board of Emergency Medical, Fire, and Transportation Services to adopt guidelines for the assessment, triage, and transport of stroke patients to hospitals. The bill requires emergency service organizations to establish stroke protocols and provide training based on the boards guidelines.

Following the ceremony in private, Governor DeWine signed Senate Bill 42, sponsored by Senator Tim Schaffer, into law. The bill establishes the second week of November as Ohio Diabetes Awareness-Heart Connection Week to raise public awareness about the connection between diabetes and cardiovascular disease.

30

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Governor DeWine signs bills for stroke protocols, public awareness for diabetes and cardiovascular disease - Ohio Department of Health

In his recently-published memoir, Making Excellence a Habit, Dr V Mohan recalls his experience of setting up one of the worlds largest chains of diabetes centres, Dr Mohans Group of Diabetes Institutions that began as a single clinic in 1991 and now has over 52 branches across 32 cities.

Dr V Mohan began researching on diabetes with his father, Prof. M. Viswanathan, when he was just 18.

India is home to 77 million people with diabetes and 80 million people with prediabetes. By 2030, the diabetic population in the country is close to hitting the mark of 101 million. Studies show that almost every Indian past the age of 50 is a diabetic unless proven otherwise, and at this rate it could become the next diabetes capital of the world soon, overtaking China. Dr V Mohan, who has done some stellar work over the last five decades in

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'In India, 50% people with diabetes are not even aware they have the condition' - Economic Times

Photo: Photo of Artem Podrez in Pexels / Pexels

Diabetes is an issue that will never go unnoticed. Especially in recent years that we have had the opportunity to have more information and thus worry more about our health. The truth is that it is one of the most alarming chronic diseases today: it contributes to 10-15% of deaths in the United States. In addition, there are updated data from the World Health Organization (WHO), in which it is confirmed that in 2019 diabetes was the direct cause of 1.5 million deaths.Also the total of cases is increasing, it is estimated that almost 1.6 million Americans are diagnosed with diabetes each year. As if that werent enough, recent research led by the Johns Hopkins Bloomberg School of Public Health found disappointing data: the percentage of American adults with diabetes who achieved glycemic control it worsened between 2007 and 2010, and again between 2015 and 2018.

As expected, these findings come to emphasize even more (especially after a year of pandemic), the continuing challenges that arise in the control of diabetes. According to the study authors, it is time to take more control of the situation, it is no joke to say that diabetes is one of the most prevalent health conditions and in many cases it is directly related to controllable factors. The team used data from an annual government-sponsored health study to assess trends in blood sugar control among adults with diabetes, as well as the control of blood pressure and cholesterol.

It is well known that type 2 diabetes is the most common form of the disease and is strongly related to diet and lifestyle factors. According to the study, it is estimated that affects more than 13% of the adult population in the United States and it increases the risks of other serious diseases, especially cardiovascular ones. Based on this, traditional approaches to diabetes care are aspects focused on reducing chronic high blood sugar / glucose, maintaining blood pressure below levels considered hypertension and good cholesterol control. . In addition to aspects related to lifestyle; Unfortunately the study shows that most people do not have this disease under control.

According to information released in the study: the proportion of adults with glycemic control improved between 1999 and 2007, but then it fell from 57.4% to 50.5% between 2007 and 2018. In addition, the study authors also observed a decrease in the proportion of people who achieved blood pressure control. It is worth mentioning that the proportion that achieved adequate cholesterol control stabilized.

Elizabeth Selvin, lead author of the study and professor in the Department of Epidemiology at the Bloomberg School, stated in the press release that it is rather disturbing findings. There has been a real decline in glycemic control over the past decade, and overall, only a small proportion of people with diabetes are simultaneously meeting the key goals of glycemic control, blood pressure control, and high cholesterol control.

The researchers had access to data including interviews and clinical examinations of approximately 5000 people nationwide. The sample consisted of 6,653 survey participants from 1999 to 2018 who were at least 20 years old, not pregnant, and reported having been diagnosed with diabetes outside of pregnancy.

Among the most relevant data that occurred between 1999 and 2010: the percentage of respondents who achieved glycemic control, defined as HbA1c levels below 7.0%, increased from 44% to 57.4%. However, it dropped dramatically between 2015 and 2018. Something similar happened with blood pressure: it rose steadily from 64% between 1999 and 2002 to 74.2% between 2011 and 2014, then fell to 70.4% between 2015 and 2018. Finally, the percentage of people with diabetes who controlled their lipoprotein cholesterol high-density (non-HDL) increased from 25.3% between 1999 and 2002 to 52.3% between 2007 and 2010, but then reached only 55.7% between 2015 and 2018.

In conclusion, the researchers discovered that the proportion of people who managed to control the 3 risk factors increased from 9% between 1999 and 2002, to 24.9% between 2007-2010. And then it was reduced to 22.2% between 2015 and 2018. Another of the authors who led the study Michael Fang spoke about it, who stated that the trends uncovered in the study are a wake-up call. Well, they point out that millions of Americans with diabetes have a higher risk of serious complications, that is, the study suggests that the worsening of diabetes control may already be having a detrimental effect at the national level.

Another highly relevant aspect suggested by the studys findings is that something changed since 2010 and that it had an influence by delaying progress in controlling diabetes risk factors. Based on this, the researchers undertook the task of analyzing two large clinical trials, published in 2008. In which they found that the intensive reduction of HbA1c to very low levels did not lead to the cardiovascular benefits that people expected, and some trial participants saw a increased risk of hypoglycemia. It is worth mentioning that to date things have changed, that is, it was in 2008 when the results of these trials were published; today the market offers numerous new and improved diabetes medications. Which if they allow reducing HbA1c (glycosylated hemoglobin test, a blood test for type 2 diabetes and prediabetes) and without causing hypoglycemia.

Although much research work remains to be done, these types of studies come to give greater clarity to medical personnel and enrich strategies in the management of diabetes. Which should not only be focused solely on one optimal glycemic control of patients with diabetes, it is necessary to integrate the good management of risk factors, make adjustments in lifestyle, diet, stress levels and sleep cycles.

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Diabetes: why Americans have such a hard time controlling blood sugar - The Saxon

Lille, France; Cambridge, MA; June 23, 2021 - GENFIT (Nasdaq and Euronext: GNFT), a late-stage biopharmaceutical company dedicated to improving the lives of patients with metabolic and liver diseases, today announced it will be making two poster presentations at two internationally-renown scientific and medical events in June 2021, including a thought-leadership documentary featuring Key Opinion Leaders (KOLs).

A poster presentation looking at the effects of age on the clinical performance of GENFITs proprietary diagnostic technology NIS4 in diagnosing at-risk NASH in patients with type 2 diabetes in comparison to a number of non-invasive tests, will be presented at the International Liver Congress 2021 on June 23-26, 2021, organized by the European Association for the Study of the Liver (EASL).

A poster presentation providing key insights into the performance of NIS4 technology either alone or in combination with other blood-based non-invasive tests in identifying at-risk NASH and advanced fibrosis in patients with and without type 2 diabetes, will be presented at the 81st Scientific Sessions of the American Diabetes Association (ADA) on June 25-29, 2021.

In addition, GENFIT is a key contributor to a thought-leadership documentary for ADA TV discussing, alongside KOLs, the link between NASH and patients with type 2 diabetes and how access to non-invasive diagnostic test kits to diagnose NASH, such as NASHnext, powered by GENFITs NIS4 technology, could provide an alternative to costly and invasive procedures and potentially benefit millions of patients. Featured KOLs include:

To view the 5-minute thought-leadership documentary, please click on the following link: https://www.youtube.com/watch?v=MlBoAG5tFMEv

Both events will be held virtually and the full programs can be found on the American Diabetes Association website and on the International Liver Congress website.

POSTER PRESENTATIONS

International Liver Congress June 23-26, 2021

Title: In Type 2 Diabetic Patients, the Identification of At-risk Nash is Impacted by Age: A Comparison of Serum-Based NITS Including NIS4

Abstract number: 2739

Poster identifier: PO-2739

Authors: Vlad Ratziu, Jeremy Magnanensi, Sylvie Deledicque, Elodie Delecroix, Yacine Hajji, Christian Rosenquist, Suneil Hosmane and Arun Sanyal.

81st Scientific Sessions of the ADA

Title: Application of NIS4 Technology for Stand-alone and Sequential Identification of At-risk NASH or Advanced Fibrosis in Non-Diabetic and Type 2 Diabetic Patients

Abstract number: #2021-A-5594-Diabetes

Poster number: 1174-P (Category 21-C Integrated PhysiologyLiver)

Authors: Christian Rosenquist, Yacine Hajji, Jrmy Magnanensi, Nicolas Stankovic-Valentin, Suneil Hosmane and Arun J. Sanyal

ABOUT THE INTERNATIONAL LIVER CONGRESS

The International Liver Congress is an annual congress and EASLs flagship event, attracting scientific and medical experts from around the world to learn about the latest in liver research.

ABOUT THE ADA

The ADA is the US leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. It holds annual scientific sessions to bring together the latest, cutting-edge advances in diabetes research, prevention and care.

ABOUT NIS4

NIS4 is GENFITs non-invasive, blood-based diagnostic technology, which was developed to identify patients with non-alcoholic steatohepatitis (NASH) and significant to advanced fibrosis (F>2), also referred to as at-risk NASH. In January 2019, GENFIT signed a licensing agreement with Labcorp to make NIS4 technology available for use in clinical research through their drug development subsidiary, Covance. In September 2020, GENFIT signed another licensing agreement with Labcorp to commercialize NIS4 in the US and Canada as a Laboratory Developed Test. Since April 2021, Labcorp has made NASHnext, powered by NIS4, available for use in the clinic. GENFIT also continues to explore opportunities to obtain formal marketing authorization of an in vitro diagnostic (IVD) test supported by NIS4 technology in both the U.S. and European markets. For more information, please visit: https://nis4.com.

ABOUT NASH

NASH is a liver disease characterized by an accumulation of fat (lipid droplets), along with inflammation and degeneration of hepatocytes. The disease is associated with an increased risk of cardiovascular disease along with long-term risk for progression to cirrhosis, leading to liver insufficiency and potential progression to liver cancer. NASH is a serious disease that often carries no symptoms in its early stages, but if left untreated can result in cirrhosis, cancer, and the need for liver transplant. The prevalence of NASH is rapidly increasing as a result of the growing obesity and diabetes epidemics and is believed to affect as much as 12 percent of people in the U.S. and six percent worldwide.

ABOUT GENFIT

GENFIT is a late-stage biopharmaceutical company dedicated to improving the lives of patients with cholestatic and metabolic chronic liver diseases. GENFIT is a pioneer in the field of nuclear receptor-based drug discovery, with a rich history and strong scientific heritage spanning more than two decades. GENFIT is currently enrolling in ELATIVE, a Phase 3 clinical trial evaluating elafibranor in patients with Primary Biliary Cholangitis (PBC). Elafibranor is an investigational compound that has not been reviewed and has not received approval by any regulatory authority. As part of GENFITs comprehensive approach to clinical management of patients with liver disease, the Company is also developing NIS4, a new, non-invasive blood-based diagnostic technology which could enable easier identification of patients with at-risk NASH. GENFIT has facilities in Lille and Paris, France, and Cambridge, MA, USA. GENFIT is a publicly traded company listed on the Nasdaq Global Select Market and on compartment B of Euronexts regulated market in Paris (Nasdaq and Euronext: GNFT). http://www.genfit.com

GENFIT FORWARD LOOKING STATEMENTS

This press release contains certain forward-looking statements with respect to GENFIT, including those within the meaning of the Private Securities Litigation Reform Act of 1995, including statements regarding the performance of NIS4 technology in the detection of NASH and at-risk NASH in non-diabetic and type 2 diabetic patients, the performance of NIS4 technology relative to other technologies, the potential for diagnostic tests powered by NIS4 technology to play a critical role in the diagnosis and management of patients with NASH, the potential for non-invasive testing to gain importance and the capability of NIS4 technology to identify patients who may require medical intervention, the development plans for NIS4 in the U.S. and in Europe and timing of such development plans, and the potential to obtain formal marketing authorization of an IVD test supported by NIS4 technology in the U.S. and/or European markets. The use of certain words, including consider, contemplate, think, aim, expect, understand, should, aspire, estimate, believe, wish, may, could, allow, seek, encourage or have confidence or (as the case may be) the negative forms of such terms or any other variant of such terms or other terms similar to them in meaning is intended to identify forward-looking statements. Although the Company believes its projections are based on reasonable expectations and assumptions of the Companys management, these forward-looking statements are subject to numerous known and unknown risks and uncertainties, which could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. These risks and uncertainties include, among other things, the uncertainties inherent in research and development, including in relation to safety, biomarkers, progression of, and results from, its ongoing and planned clinical trials, review and approvals by regulatory authorities of its drug and diagnostic candidates, exchange rate fluctuations and the Companys continued ability to raise capital to fund its development, as well as those risks and uncertainties discussed or identified in the Companys public filings with the French Autorit des Marchs Financiers (AMF), including those listed in Chapter 2 Main Risks and Uncertainties of the Companys 2020 Universal Registration Document filed with the AMF on 23 April 2021 under n D.21-0350, which is available on the Companys website (www.genfit.com) and on the website of the AMF (www.amf-france.org) and public filings and reports filed with the U.S. Securities and Exchange Commission (SEC) including the Companys 2020 Annual Report on Form 20-F filed with the SEC on April 23, 2021. In addition, even if the Companys results, performance, financial condition and liquidity, and the development of the industry in which it operates are consistent with such forward-looking statements, they may not be predictive of results or developments in future periods. These forward-looking statements speak only as of the date of publication of this document. Other than as required by applicable law, the Company does not undertake any obligation to update or revise any forward-looking information or statements, whether as a result of new information, future events or otherwise.

CONTACT

GENFIT | Investors

Tel: +1 (617) 714 5252 | investors@genfit.com

PRESS RELATIONS | Media

Stephanie Boyer Press relations | Tel: +333 2016 4000 | stephanie.boyer@genfit.com

GENFIT | 885 Avenue Eugne Avine, 59120 Loos - FRANCE | +333 2016 4000 | http://www.genfit.com

Excerpt from:
GENFIT presents new NIS4 data in NASH at the International Liver Congress and the 81st Scientific - GlobeNewswire

Led by John Buse, MD, PhD, and Anna Kahkoska, MD, PhD, this analysis showed that GLP1-RA and SGLT2i medication use for type 2 diabetes of hospitalized COVID-19 patients was associated with lower odds of mortality and other adverse outcomes.

CHAPEL HILL, NC Diabetes is one of the comorbidities most strongly associated with severe coronavirus disease 2019 (COVID-19) in the United States, and data from early in the pandemic suggested individuals with type 2 diabetes faced twice the risk of death from COVID-19, as well as a greater risk of requiring hospitalization and intensive care.

The National COVID Collaborative (N3C), a partnership of NIH Clinical and Translational Science Award Program hubs, conducted a study of data from 12,446 individuals with type 2 diabetes who had a positive test for COVID-19 in 2020. These scientists found that individuals who had been treated with certain kinds of diabetes medications fared better than those who were treated with a different type of medication.

This research was published in Diabetes Care, the journal of the American Diabetes Association. The senior author is John Buse, MD, PhD, Co-Director of the North Carolina Translational and Clinical Sciences (NC TraCS) Institute at UNC and lead of the UNC Diabetes Research Center. The first author is Anna Kahkoska, MD, PhD, assistant professor in the UNC Department of Nutrition at the UNC Gillings School of Global Public Health and the UNC School of Medicine.

Two classes of medications that lower blood sugar glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodiumglucose cotransporter 2 inhibitors (SGLT2i) have been associated with a reduction of cardiorenal events and mortality in previous large trials of cardiovascular, heart failure, and renal outcomes, in populations at high risk of cardiorenal events. Benefits associated with these medications appear most pronounced among individuals with type 2 diabetes and comorbid cardiovascular disease, heart failure, chronic kidney disease, and obesity, conditions that also incur the highest risk for severe COVID-19.

Additionally, scientists have speculated about plausible mechanisms for the protective effects of GLP1-RA and SGLT2i in COVID-19, independent of their glycemic effects. Yet, it is not known how the use of new medications is associated with severity of COVID-19.

Our objective was to characterize the association of premorbid use of GLP1-RA and SGLT2i with COVID-19 outcomes, said Buse, who is the Verne S. Caviness Distinguished Professor of Medicine and endocrinology division chief at the UNC School of Medicine. The study hypothesis was that use of both classes of medications would be associated with improved outcomes in the setting of COVID-19 infection. And characterizing these associations could reveal treatment strategies to improve outcomes for a population at high risk for COVID-19associated mortality.

For the study, the researchers selected individuals using dipeptidyl peptidase 4 inhibitors (DPP4i) as a comparator group to individuals taking GLP1-RA or SGLT2i medications because DPP4i medications can also be considered for second-line use after the initiation of metformin and have been suggested to be safe or beneficial in COVID-times in other real-world analyses.

To determine the respective associations of premorbid glucagon-like peptide-1 receptor agonist (GLP1-RA) and sodiumglucose cotransporter 2 inhibitor (SGLT2i) use, compared with premorbid dipeptidyl peptidase 4 inhibitor (DPP4i) use, with severity of outcomes in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Of the 12,446 individuals, the 60-day mortality was 3.11%, with 2.06% for GLP1-RA use, 2.32% for SGLT2i use, and 5.67% for DPP4i use. Both GLP1-RA and SGLT2i use were associated with lower 60-day mortality compared with DPP4i use. Use of both GLP1-RA and SGLT2i medications was also associated with decreased total mortality, emergency room visits, and hospitalizations, though the individuals taking DPP4i medications were older and generally sicker.

N3C is a COVID research platform funded by the National Institute of Healths National Center for Advancing Translational Sciences (NCATS) including data on over 2 million people with a positive COVID test.The North Carolina Translational and Clinical Sciences (TraCS) Institute played an integral role in the development of N3C and supports efforts to use the data to develop better treatment and prevention programs for COVID.

Other authors of the Diabetes Care paper are Trine Julie Abrahamsen, G. Caleb Alexander, Tellen D. Bennett, Christopher G. Chute, Melissa A. Haendel, Klara R. Klein, Hemalkumar Mehta, Joshua D. Miller, Richard A. Moffitt, Til Strmer, and Kajsa Kvist.

Read the original post:
UNC Researchers Lead Study of Diabetes Treatment of Severely Ill COVID-19 Patients | Newsroom - UNC Health and UNC School of Medicine

By Ernie Mundell and Robert Preidt HealthDay Reporters

THURSDAY, Feb. 18, 2021 (HealthDay News) -- Diabetes is a big risk factor for a severe bout of COVID-19, and a new European study bears that out: It finds that 1 in every 5 hospitalized COVID-19 patients with diabetes die within 28 days of admission.

One U.S. expert wasn't surprised by that grim finding.

"Diabetic patients are clearly in a very high-risk category and should be among the first groups of people to get the vaccine," advised Dr. Mangala Narasimhan, who directs critical care services at Northwell Health in New Hyde Park, N.Y. She also advises people with diabetes to make sure they are taking control of their blood sugar levels and avoiding any complications of the disease.

Such steps "seem to really make a difference in terms of survival from COVID infection," said Narasimhan, who wasn't involved in the new study.

The research was led by Bertrand Cariou and Samy Hadjadj, diabetologists at University Hospital Nantes in France. In May of last year they had released preliminary findings that showed that 10% of COVID-19 patients with diabetes died within seven days of hospital admission.

The newer, updated results are from a larger number of patients -- close to 2,800 -- treated for COVID-19 at 68 hospitals across France. Their mean age was 70, nearly two-thirds were men, and many were overweight. About 40% were also experiencing various forms of complications from their diabetes.

During the 28 days after their admission to a hospital, 21% of patients died, the French team reported Feb. 17 in the journal Diabetologia.

Of those patients who survived at least one month, 50% were discharged from the hospital with a median stay of nine days; 12% were still hospitalized at day 28, and 17% had been transferred from their first hospital to another facility.

Younger age, routine diabetes therapy using the drug metformin, and having had symptoms longer prior to hospital admission were key factors associated with a higher likelihood of being discharged from the hospital, the researchers said.

Patients who regularly took insulin -- possibly indicating more advanced diabetes -- had a 44% higher risk of death than those who didn't take insulin, the investigators said. Long-term blood sugar control wasn't associated with patient outcomes, but a higher level of blood sugar at the time of hospital admission was a strong predictor of death and of a lower chance of discharge.

Dr. Barbara Keber directs family medicine at Glen Cove Hospital in Glen Cove, N.Y. Reading over the findings, she said they show "diabetes is clearly a significant risk factor for both need for ICU/ventilator care in the hospital as well as for death" within a month of admission.

Keber said it "makes sense" that people with complications from poorly controlled diabetes are at higher risk, since this creates a "pro-inflammatory state" that is similar to that seen in advanced COVID-19.

But Keber also cautioned that death rates may have improved for COVID-19 patients, including those with diabetes, over the past year.

"This study was done in the first wave of the pandemic, and many of the current treatment regimens and medications that were tried in the early phase have been found to not be beneficial and other treatment regimens have taken their place," she noted.

For example, "the current use of steroids for treatment may play a role in the [improved] prognosis of patients overall and especially for those with diabetes," Keber said.

More information

The American Diabetes Association has more on COVID-19.

SOURCES: Mangala Narasimhan, DO, director, critical care services, Northwell Health, New Hyde Park, N.Y.; Barbara Keber, MD, chair, family medicine, Glen Cove Hospital, Glen Cove, N.Y.; Diabetologia, news release, Feb. 17, 2021

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COVID Deaths High When Hospitalized With Diabetes - WebMD

Diabetic retinopathy is an eye disease that affects people living with diabetes. It develops when high blood sugar damages the tiny blood vessels in the retina. This causes a variety of symptoms like blurry vision and vision loss.

This progressive disease may lead to irreversible vision loss, so its important to have regular eye exams. A doctor can then diagnose the condition early and slow its progression.

Glucose, or blood sugar, is a main source of energy yet too much circulating in the blood can be harmful to the body.

Typically, the pancreas releases the hormone insulin, which helps cells absorb glucose for energy. In the case of diabetes, though, the body doesnt make enough insulin or doesnt use it properly. This causes glucose to accumulate in the blood.

Consistent levels of high blood sugar can affect different parts of the body, including the eyes.

Diabetic retinopathy doesnt only weaken or damage the blood vessels in the eye. It can also cause the development of new abnormal blood vessels in the retina.

Diabetic retinopathy is a progressive eye disease classified by two types and four stages.

The two types are nonproliferative and proliferative. Nonproliferative refers to early stages of the disease, while proliferative is an advanced form of the disease.

This is the earliest stage of diabetic retinopathy, characterized by tiny areas of swelling in the blood vessels of the retina. These areas of swelling are known as micro aneurysms.

Small amounts of fluid can leak into the retina at the stage, triggering swelling of the macula. This is an area near the center of the retina.

Increased swelling of tiny blood vessels starts to interfere with blood flow to the retina, preventing proper nourishment. This causes an accumulation of blood and other fluids in the macula.

A larger section of blood vessels in the retina become blocked, causing a significant decrease in blood flow to this area. At this point, the body receives signals to start growing new blood vessels in the retina.

This is an advanced stage of the disease, in which new blood vessels form in the retina. Since these blood vessels are often fragile, theres a higher risk of fluid leakage. This triggers different vision problems such as blurriness, reduced field of vision, and even blindness.

Diabetic retinopathy doesnt usually cause symptoms during the nonproliferative stages, so its possible to have it and not know it. This is because blood vessels dont always leak in these stages.

Many people dont have symptoms until the disease progresses to proliferative diabetic retinopathy.

However, an eye examination by an eye care specialist or ophthalmologist can detect diabetic retinopathy in its earlier stages, before symptoms become apparent.

Symptoms of proliferative diabetic retinopathy include:

Be mindful, too, that diabetic retinopathy symptoms usually affect both eyes at the same time.

To diagnose diabetic retinopathy, your doctor may complete a comprehensive eye examination. This involves measuring:

Your doctor will likely also dilate your eye to examine your optic nerve and retina using special eye drops.

Doctors can also diagnose diabetic retinopathy with fluorescein angiography, which checks for abnormal blood vessel growth or leakage.

Theyll inject a yellow dye into a vein in your arm, allowing the dye to travel through your blood vessels. A special camera takes images of the dye as it travels through the blood vessels in your retina.

Diabetic retinopathy may lead to irreversible vision loss, but it is treatable. Treatment starts with managing blood sugar and diabetes. This includes taking diabetes medication as directed, watching your diet, and increasing physical activity.

Keeping blood sugar within a healthy range can slow the progression of vision loss.

Other treatments will depend on the stage or extent of the disease. If caught very early before damage to the retina occurs blood sugar management might be the only necessary treatment. Your doctor will continue to monitor your eyes, though, to ensure the disease doesnt progress.

If youre in a nonproliferative stage but experience some eye damage, treatment options might include:

Preventing diabetic retinopathy starts with managing blood sugar.

This involves managing diabetes with medication, balanced eating habits, and regular physical activity. You should also monitor your blood sugar on a regular basis and speak with your doctor if your levels are difficult to manage.

A healthy diet consists of:

Diabetes management may also involve other changes. This can include managing your blood pressure and cholesterol and avoiding tobacco.

Diabetic retinopathy isnt the only complication of diabetes. Blood sugar levels outside of a healthy range can cause other long-term issues, such as:

It may also lead to other conditions involving significant vision loss or blindness, such as:

If you have diabetes, make an appointment to see an eye care specialist such as an ophthalmologist at least once a year, or as often as your doctor recommends.

You should also see your doctor if your glucose level remains high despite medication and other changes, or if you notice any changes in vision, even if they are subtle.

Diabetic retinopathy is a potentially serious eye disease that can result in permanent distorted vision or loss of vision. Any changes in vision, such as blurriness, poor night vision, and an increase of eye floaters, should prompt a trip to the eye doctor.

Speak with your eye care specialist to diagnose any possible eye conditions. Although diabetic retinopathy isnt reversible, it is treatable.

Read more:
Diabetic Retinopathy Stages: The 4 Stages and What to Do - Healthline