Probiotic foods

 

Best probiotic foods for diabetes

Diabetes and exercise: When to monitor your blood sugar

 

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise. By Mayo Clinic Staff Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and stroke. But diabetes and exercise pose unique challenges, too. Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations. Before exercise: Check your blood sugar before your workout Before jumping into a fitness program, get your doctor's OK to exercise — especially if you've been inactive. Discuss with your doctor which activities you're contemplating and the best time to exercise, as well as the potential impact of medications on your blood sugar as you become more active. For the best health benefits, experts recommend 150 minutes a week of moderately intense physical activities such as: Fast walking Lap swimming Bicycling If you're taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and approximately every 30 minutes during exercise. This will help you determine if your blood sugar level is stable, rising or falling and if it's safe to keep exercising.   Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Lower than 100 mg/dL (5.6 mmol/L). Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout. 100 to 250 mg/dL (5.6 to 13.9 mmol/L). You're good to go. For most people, this is a safe pre-exercise blood sugar range. 250 mg/dL (13.9 mmol/L) or higher. This is a caution zone. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate that your body doesn't have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your test kit indicates absence or a low level of ketones in your urine. 300 mg/dL (16.7 mmol/L) or higher. Your blood sugar may be too high to exercise safely, as these high glucose levels may increase your risk of dehydration and ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range. See more In-depth During exercise: Watch for symptoms of low blood sugar During exercise, low blood sugar is sometimes a concern. If you're planning a long workout, check your blood sugar every 30 minutes — especially if you're trying a new activity or increasing the intensity or duration of your workout. This may be difficult if you're participating in outdoor activities or sports. However, this precaution is necessary until you know how your blood sugar responds to changes in your exercise habits. Stop exercising if: Your blood sugar is 70 mg/dL (3.9 mmol/L) or lower You feel shaky, weak or confused Eat or drink something to raise your blood sugar level, such as: Three or four glucose tablets 1/2 cup (118 milliliters) of fruit juice 1/2 cup (118 milliliters) of regular (not diet) soda Five or six pieces of hard candy Recheck your blood sugar 15 minutes later. If it's still too low, have another serving and test again 15 minutes later. Repeat as needed until your blood sugar reaches at least 70 mg/dL (3.9 mmol/L). If you haven't finished your workout, continue once your blood sugar returns to a safe range. After exercise: Check your blood sugar again Check your blood sugar right away after exercise and again several times during the next few hours. Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood. The more strenuous your workout, the longer your blood sugar will be affected. Low blood sugar is possible even several hours after exercise. If you do have low blood sugar after exercise, eat a small carbohydrate-containing snack, such as fruit or crackers, or drink a small glass of fruit juice. Exercise can be beneficial to your health in many ways, but if you have diabetes, testing your blood sugar before, during and after exercise may be just as important as the exercise itself. Feb. 22, 2014 References See more In-depth   http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697

For diabetes in obesity, weight-loss surgery beats medication

 

Friday, September 4, 2015  By Anne Harding (Reuters Health) – Weight-loss surgery beats medication for controlling type 2 diabetes in obese people, according to the longest-term trial ever to compare the two approaches. Half of the patients treated with weight-loss surgery in the study were diabetes-free at five years, said Dr. Francesco Rubino of Kings College London in the UK and colleagues in a report in The Lancet. “The five-year mark is an important mark in many diseases,” Dr. Rubino told Reuters Health by phone. “The fact that some patients at five years are basically disease-free is a remarkable finding.” In 2009, he and his colleagues randomly assigned 20 obese patients with type 2 diabetes to receive medical treatment, 20 to receive a type of weight-loss surgery called a gastric bypass, and another 20 to undergo a weight-loss operation called a biliopancreatic diversion. Eighty percent of patients who had surgery had their blood sugar under good long-term control, versus about 25 percent of patients treated with drugs only. All of the study groups had a reduction in cardiovascular risk. But the surgery-treated patients had a 50 percent lower risk of heart and blood vessel disease than those treated with drugs only, and they needed fewer drugs for treating high blood pressure or high cholesterol. The improvements in blood sugar control and heart disease risk weren’t related to how much weight patients lost. “What really is causing the remission of diabetes after surgery remains mysterious,” Dr. Rubino said. What is known, he added, is that the intestines produce a host of hormones involved in regulating metabolism. Reconstructing the gastrointestinal tract so that food bypasses the stomach and small intestine may help restore normal metabolic control, he explained. Like any surgery, weight loss operations carry risks. An international study published earlier this, for example, found that after two years, people randomized to have gastric bypass surgery had better control of their type 2 diabetes than people assigned to a medication group, but they also had a higher risk for infections and bone fractures. (See Reuters Health story of May 21, 2015.) And some patients may gain back some of the weight they lost. Still, doctors are increasingly referring to this type of surgery as “diabetes surgery,” rather than obesity surgery, said Dr. Philip Schauer, the director of the Cleveland Clinic Bariatric and Metabolic Institute and a bariatric surgeon, in a telephone interview with Reuters Health. Dr. Schauer did not participate in the new study. “There are some people, this study shows, that can go into remission for up to five years or more,” he said. “We hesitate to use the word ‘cure,’ but it’s pretty darn close to a cure, about as close to a cure as you can get.’” Dr. Schauer pointed out that about half of patients with type 2 diabetes are unable to control their blood sugar with medication and lifestyle measures. Based on the new findings, he said, bariatric surgery should be offered to these patients if they are moderately obese, for example with a body mass index (BMI) of 35. (BMI is a measure of weight in relation to height.) Currently the National Institutes of Health states that patients should have a BMI of 40, or a BMI of 35 with obesity-related illness, such as type 2 diabetes, in order to be eligible for weight loss surgery. “There are still many insurance companies today that will not pay for this surgery for any reason, whether it’s for obesity or diabetes. It means that they are denying people effective treatment,” Dr. Schauer said. “This study is going to make insurance carriers and third party payers rethink their coverage policies regarding bariatric or diabetes surgery, as we prefer to call it.” SOURCE: http://bit.ly/1JTRaqX The Lancet, online September 3, 2015.

Diabetes symptoms: When diabetes symptoms are a concern

 

Diabetes symptoms are often subtle. Here's what to look for — and when to consult your doctor. By Mayo Clinic Staff Early symptoms of diabetes, especially type 2 diabetes, can be subtle or seemingly harmless — if you have symptoms at all. Over time, however, you may develop diabetes complications, even if you haven't had diabetes symptoms. In the United States alone, nearly 7 million people have undiagnosed diabetes, according to the American Diabetes Association. But you don't need to become a statistic. Understanding possible diabetes symptoms can lead to early diagnosis and treatment — and a lifetime of better health. If you're experiencing any of the following diabetes signs and symptoms, see your doctor. Excessive thirst and increased urination Excessive thirst and increased urination are classic diabetes symptoms. When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine along with fluids drawn from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more Fatigue You may feel fatigued. Many factors can contribute to this. They include dehydration from increased urination and your body's inability to function properly, since it's less able to use sugar for energy needs. Weight loss Weight fluctuations also fall under the umbrella of possible diabetes signs and symptoms. When you lose sugar through frequent urination, you also lose calories. At the same time, diabetes may keep the sugar from your food from reaching your cells — leading to constant hunger. The combined effect is potentially rapid weight loss, especially if you have type 1 diabetes. Blurred vision Diabetes symptoms sometimes involve your vision. High levels of blood sugar pull fluid from your tissues, including the lenses of your eyes. This affects your ability to focus. Left untreated, diabetes can cause new blood vessels to form in your retina — the back part of your eye — and damage established vessels. For most people, these early changes do not cause vision problems. However, if these changes progress undetected, they can lead to vision loss and blindness. Next http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-symptoms/art-20044248

Coping with diabetes: Helping your loved one

 

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N. April 24, 2013 How do you help someone who won't help themself, especially when he or she is an adult? Let's face it, diabetes isn't an easy disease to have or manage. It can be frustrating and takes work. On top of that, everyone seems to have an opinion about diabetes, whether it's valid or not. As a family member or friend of someone with diabetes, you may see your loved one struggle with diabetes management. And some people with diabetes tend to minimize or ignore their diabetes. Burnout can occur from years of managing the condition. But, as William Polonsky, Ph.D., author of the book, Diabetes Burnout, says, "Ignoring something bad that is happening to you makes perfect sense only if there is really nothing you can do about it." That's part of why watching a family member or partner do little or nothing to keep his or her diabetes under control can be so heartbreaking. Still, if you're a family member, friend or partner of someone with diabetes, it's important to remember whose diabetes it is and respect boundaries. Nagging, being a watchdog, extracting promises and manipulating someone to do what you want them to do doesn't work. So what should you do? Dr. Polonsky offers the following advice: Don't assume you know what your loved one with diabetes is thinking. Do try and understand how your loved one's actions make sense from their perspective. Don't offer advice unless you're asked. Do offer to help if the individual is receptive. Remind your loved one that he or she is loved on a regular basis. Take care of yourself and seek education about diabetes. In addition, it may be useful to: Ask your partner, friend or family member to join you for a walk, bike ride or other activity (but accept "no" if that's the response). Offer healthy food options, but don't make demands. Ultimately, it's the other person's choice. Try not to nag. Don't let another person's diabetes take control of your life. Seek counseling if you feel overwhelmed. Try motivating yourself to make lifestyle changes if needed. Learn to set boundaries. The bottom line is to take care of yourself and find your own support system. Respect your loved one's wishes and show them you care. Hopefully your loved one will discover that he or she isn't powerless and can do something to cope with and control his or her diabetes. source: http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/coping-with-diabetes/bgp-20056490/?utm_source=newsletter&utm_medium=email&utm_campaign=controlling-diabetes

Genetics, Obesity, and More What Increases My Risk of Diabetes?

 

There are three major types of the disease: type 1, type 2, and gestational diabetes. With all three, your body can't make or use insulin.  One of every four people with diabetes doesn't know they have it. That amounts to about 7 million people living in the USA. Might you be one of them? Read on to see if your risk of having diabetes is high. Type 1 This type usually starts in childhood. Your pancreas stops making insulin. You have type 1 diabetes for life. The main things that lead to it are: Family history. If you have relatives with diabetes, chances are strong you’ll get it, too. Anyone who has a mother, father, sister, or brother with type 1 diabetes should get checked. A simple blood test can diagnose it. Diseases of the pancreas. They can slow its ability to make insulin. Infection or illness. Some infections and illnesses, mostly rare ones, can damage your pancreas. Type 2 If you have this kind, your body can't use the insulin it makes. This is called insulin resistance. Type 2 usually affects adults, but it can begin at any time in your life. The main things that lead to it are: Obesity or being overweight. Research shows this is a top reason for type 2 diabetes. Because of the rise in obesity among U.S. children, this type is affecting more teenagers. Impaired glucose tolerance. Prediabetes is a milder form of this condition. It can be diagnosed with a simple blood test. If you have it, there’s a strong chance you’ll get type 2 diabetes. Insulin resistance. Type 2 diabetes often starts with cells that are resistant to insulin. That means your pancreas has to work extra hard to make enough insulin to meet your body's needs. Ethnic background. Diabetes happens more often in Hispanic/Latino Americans, African-Americans, Native US citizens, Asian-Americans, Pacific Islanders, and Alaska natives. High blood pressure . That means blood pressure over 140/90. Low levels of HDL ("good") cholesterol and high levels of triglycerides. Gestational diabetes. If you had diabetes while you were pregnant, you had gestational diabetes. This raises your chances of getting type 2 diabetes later in life. Sedentary lifestyle. You exercise less than three times a week. Family history. You have a parent or sibling who has diabetes. Polycystic ovary syndrome. Women with polycystic ovary syndrome (PCOS) have a higher risk. Age. If you're over 45 and overweight or if you have symptoms of diabetes, talk to your doctor about a simple screening test.   What Increases My Risk of Diabetes? Gestational It's caused by hormones the placenta makes or by too little insulin. High blood sugar from the mother causes high blood sugar in the baby. That can lead to growth and development problems if left untreated. Things that can lead to gestational diabetes include: Obesity or being overweight. Extra pounds can lead to gestational diabetes. Glucose intolerance. Having glucose intolerance or gestational diabetes in the past makes you more likely to get it again. Family history. If a parent or sibling has had gestational diabetes, you're more likely to get it. Age. The older you are when you get pregnant, the higher your chances are. Steps to Take Whatever your risk are, there's a lot you can do to delay or prevent diabetes. Manage your blood pressure. Keep your weight within or near a healthy range. Get 30 minutes of exercise on most days. Eat a balanced diet.

12 Powerfoods to Beat Diabetes

 

Can controlling your blood sugar and preventing diabetes complications be as simple as eating the right foods? Yes. Certain foods are packed with nutrients that stabilize blood sugar levels, protect your heart, and even save your vision from the damaging effects of diabetes. These 12 foods can give you an extra edge against diabetes and its complications. 1. Apples In a Finnish study, men who ate the most apples and other foods high in quercetin had 20 percent less diabetes and heart disease deaths. Other good sources of quercetin are onions, tomatoes, leafy green vegetables, and berries. 2. Cinnamon A study at the Human Nutrition Research Center in Beltsville, Maryland, found that if you use ½ teaspoon of cinnamon daily, it can make cells more sensitive to insulin. Therefore, the study says, the cells convert blood sugar to energy. After 40 days of taking various amount of cinnamon extract, diabetics experienced not only lower blood sugar spikes after eating, but major improvements in signs of heart health. And you can sprinkle cinnamon on just about anything. 3. Citrus Fruit Studies show that people with diabetes tend to have lower levels of vitamin C in their bodies, so antioxidant-packed citrus fruit is a great snack choice. It may seem quicker to get your C from a pill, but since fruit is low in fat, high in fiber, and delivers lots of other healthy nutrients, it's a better choice. 4. Cold-Water Fish Heart disease strikes people with diabetes twice as often as it does people without the illness, according to the American Diabetes Association. Diets high in omega-3 fatty acids—the "good fat" in cold-water fish such as wild Alaskan salmon, sardines, and Atlantic mackerel—can help lower artery-clogging LDL cholesterol and triglycerides while raising levels of HDL (good) cholesterol. 5. Fiber-Rich Foods A study at the University of Texas Southwestern Medical Center found that people who increased their fiber intake from 24 to 50 g daily had dramatic improvements in blood sugar levels. In fact, the high-fiber diet was as effective as some diabetes medications. Rather than try to figure out exactly how much fiber is in different foods, focus on trying to get a total of 13 daily servings of a mixture of fruits, vegetables, beans, brown rice, and whole grain pastas, cereals, and breads. 6. Legumes Legumes of all sorts—chickpeas, cannelloni beans, kidney beans, and lentils—are a great addition to soups, salads, and a variety of ethnic dishes. And this low-fat, low-calorie, high-fiber, high-protein food helps to reduce risk of diabetes and heart disease. The fiber slows the release of glucose into your bloodstream, which prevents the blood sugar spikes that worsen diabetes blood sugar control and make you feel hungry. 7. Green Tea Studies show that chronic inflammation—caused by high-fat foods, lack of exercise, and eating too few fruits, vegetables, and good fats—can increase risk of hearts attacks and thwart the body's ability to absorb blood sugar. A simple solution: Drink green tea and orange or cranberry juice. They're all packed with flavonoids—powerful inflammation-fighters. Swap one in for one cup of coffee a day. 8. Nuts Studies show that people who eat nuts regularly have lower rates of heart disease than people who don't eat them. (People with diabetes are at increased risk of heart disease.) Even among the healthiest eaters, the ones who also eat nuts boast the best health record. Exactly why isn't known yet, but one reason could be compounds called tocotrienols. The key to eating nuts is not to eat too many; they're so high in calories that you could easily see the aftermath pouring over your pants. Either measure 2 tablespoons of nuts, count how many it is, and limit yourself to that number, or keep a jar of chopped nuts on hand. Sprinkle 2 tablespoons a day on cereal, yogurt, veggies, salads, or wherever the flavor appeals to you. 9. Spinach, Kale, and Collard Greens All of these green leafy vegetables are good sources of lutein, a carotenoid that's good for the eyes. That's especially important because people with diabetes may develop debilitating eye problems as complications of the disease. These foods are also great sources of fiber, B vitamins, iron, calcium, and vitamin C. 10. Chocolate Researchers at Tufts University discovered that dark chocolate improves insulin sensitivity, a crucial improvement in preventing or treating type 2 diabetes. What's more, dark—but not white—chocolate also produced a significant drop in blood pressure, reduced LDL (bad) cholesterol, and improved blood vessel function. Just don't overdo it. Dark chocolate is great for the occasional indulgence, but it still packs a lot of fat and calories. 11. Steak There's something in steak besides the protein, iron, and B vitamins that's good for us. It's a compound that's part of beef's fat profile called conjugated linoleic acid (CLA). Doctors Michael Murray and Michael Lyon point out in their book Beat Diabetes Naturally that experiments have shown that CLA works to correct impaired blood sugar metabolism and also appears to have significant anti-cancer properties. In the most recent research, scientists in Norway supplemented the diets of 180 people with a few grams of CLA and reported that they lost 9 percent of their body weight in one year. For a 200-pounder, that's an 18-pound weight loss! To get CLA from steak, choose meat from range-fed beef. Eating natural pasturage give these animals far more healthful CLA than the usual grain-rich diet. And keep portions to 3 or 4 ounces. 12. Vinegar Two tablespoons of vinegar taken before a meal can help your blood sugar go down. A study at Arizona State University East tested three different groups of people to see what the results would be in healthy people, those with prediabetes (they had signs diabetes was developing), and confirmed diabetics. Before each of two meals a day, the subjects were given 2 tablespoons of ordinary vinegar. The results: An hour after the vinegar treatment, the diabetics had blood sugar levels that were 25 percent lower than without vinegar. The prediabetics had an even better result: Their levels were lower by about half. Recipes>>   http://www.menshealth.com

Have Diabetes? Get Tips for Safe Travels

 

Plan ahead for diabetes care even when you’re on vacation and traveling. Getting out of your regular routine is part of the fun of vacation and traveling. But it's important to travel with your care routine, especially if you have diabetes. Meals away from home, changes in how much physical activity you get, and differences in time zones as you travel can affect how well you manage diabetes. Use this time to be refreshed, lose the stress, and continue healthy habits. Before you hit the road, review these tips for taking care of yourself. Don't Forget Your Medication Pack twice the amount of diabetes supplies you expect to need, in case of travel delays. Have all syringes and insulin delivery systems (including vials of insulin) clearly marked with the pharmaceutical preprinted label that identifies the medications. Take copies of prescriptions with you. If you use insulin, make sure you also pack a glucagon emergency kit. Carry a card in your wallet that says you have diabetes and tells if you use medicine to treat it. Plan ahead for stress-free travel and your health needs. Keep snacks, glucose gel, or glucose tablets with you in case your blood glucose drops. Make sure you keep your health insurance card and emergency phone numbers handy, including your doctor's name and phone number. Wear medical identification that says you have diabetes. Keep time zone changes in mind so you'll know when to take medication. Find out where to get medical care if needed when away from home. On the Road Pack a small cooler of foods that may be difficult to find while traveling, such as fresh fruit and sliced raw vegetables. You can also pack dried fruit, nuts, and seeds as snacks. Since these foods can be high in calories, measure out small portions (¼ cup) in advance. Bring a few bottles of water instead of sugar-sweetened soda or juice. If you're traveling with insulin, don't store it in direct sunlight or in a hot car. Keep it in a cooler, but do not place it directly on ice or on a gel pack. Reduce your risk for blood clots by moving around every hour or two. Stick with your exercise routine. Be sure to get at least 150 minutes of physical activity each week. Air Travel Plan ahead for both food and medical supplies on your flight. If a meal will be served during your flight, call ahead for a diabetic, low fat, or low cholesterol meal. If the airline doesn't offer a meal, bring a nutritious meal yourself. Place all diabetes supplies in carry-on luggage. Remember to pack snacks in case of flight delays. Keep medications and snacks at your seat for easy access: don't store them in overhead bins or checked luggage. If you're flying and don't want to walk through the metal detector with your insulin pump, tell a security officer that you are wearing an insulin pump and ask them to visually inspect the pump and do a security pat-down. When drawing up your dose of insulin, don't inject air into the bottle (the air on your plane will probably be pressurized). Reduce your risk for blood clots by moving around every hour or two. Staying Healthy Before you leave on your trip, make sure you are up-to-date on immunizations . Talk with your doctor before increasing physical activity, such as going on a trip that will involve more walking. Also, work with your doctor to plan your timing for medicine, food, and activity. Talk about what to do if you find changes in your glucose readings. Remember these healthy habits in your daily diabetes care routine Changes in what you eat, activity levels, and time zones can affect your blood glucose. Check levels often. Stick with your exercise routine. Be sure to get at least 150 minutes of physical activity each week. Wash your hands often with soap and water. Protect your feet. Be especially careful of hot pavement by pools and hot sand on beaches. Never go barefoot.   http://www.cdc.gov

'Crosstalk' gives clues to diabetes

 

Sugar levels are managed by interactions between cells of the Islets of Langerhans in the pancreas. The hormone urocortin (green) is produced and stored in the same cells as insulin in the islets. Cells that make glucagon, which works to raise blood sugar, are stained red. Credit: Mark Huising, UC Davis Sometimes, listening in on a conversation can tell you a lot. For Mark Huising, an assistant professor in the Department of Neurobiology, Physiology and Behavior at the UC Davis College of Biological Sciences, that crosstalk is between the cells that control your body's response to sugar, and understanding the conversation can help us understand, and perhaps ultimately treat, diabetes. Huising's lab has now identified a key part of the conversation going on between cells in the pancreas. A hormone called urocortin 3, they found, is released at the same time as insulin and acts to damp down insulin production. A paper describing the work appears online on June 15 in the journal Nature Medicine. "It's a beautiful system," Huising said. "It turns out that there is a lot of crosstalk going on in the islets to balance insulin and glucagon secretion. The negative feedback that urocortin 3 provides is necessary to tightly control blood sugar levels at all times." Both forms of the disease -- type 1, "juvenile" or "insulin-dependent" diabetes, and type 2 or "adult-onset" diabetes -- occur when the body fails to regulate the level of sugar properly. Diabetes is tied to structures called the Islets of Langerhans in the pancreas. Within the islets, beta cells make insulin. Increasing blood sugar stimulates insulin production, which causes the body's cells to pull sugar out of circulation. The islets also house alpha cells, which make another hormone, glucagon, which acts on the liver to release more glucose into the bloodstream. An islet of Langerhans with urocortin stained green in beta cells. Glucagon-making cells are stained red. Credit: Mark Huising. An islet of Langerhans with urocortin stained green in beta cells. Glucagon-making cells are stained red. Credit: Mark Huising. Urocortin 3 was originally identified as a hormone that is related to the signal in our brain that kick-starts our stress response. Instead, urocortin 3 is produced by islet beta cells and stored and released alongside insulin. In a series of experiments, Huising's group showed that urocortin 3 causes another cell type in the islets, delta cells, to release somatostatin, which turns down insulin production and acts as a natural brake on the release of insulin. Urocortin 3 is reduced in laboratory animal models of diabetes and in beta cells from diabetic patients. Without urocortin 3, islets produce more insulin, but at the same time lose control over how much insulin they release. By understanding how different cells and systems communicate to regulate blood sugar, Huising hopes to get a better understanding of what happens when this regulation goes wrong, leading to the different forms diabetes. Eventually this approach could lead to new ways to treat or prevent the disease. Story Source: The above post is reprinted from materials provided by University of California - Davis. Note: Materials may be edited for content and length. Journal Reference: Talitha van der Meulen, Cynthia J Donaldson, Elena Cáceres, Anna E Hunter, Christopher Cowing-Zitron, Lynley D Pound, Michael W Adams, Andreas Zembrzycki, Kevin L Grove, Mark O Huising. Urocortin3 mediates somatostatin-dependent negative feedback control of insulin secretion. Nature Medicine, 2015; DOI: 10.1038/nm.3872

Oral Medication & Non-Insulin Injectables

Knowing the type of medication you take, when to take it and what it does is really important to managing your diabetes. Arming yourself with this information can help you to manage your blood sugars and alert you to potential side effects.Because everyone with diabetes is so different, your prescription will take your individual differences into consideration. This includes your blood sugars, past medical history, age, cost, potential side effects, and the medication's effects on weight.
Before filling any prescription, you may want to confirm with your insurance provider or health care provider if this medicine is preferred by your plan – this will help to save you money. Remember, while medications are very important, they are always considered secondary to diet and exercise. If you are new to diabetes medicines and are not sure what your medicine does or when you should take it, find out now.

Table of Contents

1. Biguanides

• Metformin (Fortmate®, Glucophage®, Glucophage XR®, Glumetza®, Riomet®)

2. Thiazolidinediones (TZD’s)

• Pioglitazone (Actos®)

3. Sulfonylureas

• Glimepiride (Amaryl®)
• Glyburide (Diabeta®, Micronase®)
• Glipizide (Glucotrol®, GlucotrolXL®)

4. Meglitinides

• Repaglinide (Prandin®)
• Nateglinide (Starlix®)

5. DPP-4 Inhibitors

• Sitagliptin (Januvia®)
• Linagliptin (Trajenta®)
• Saxagliptin (Onglyza®)
• Alogliptin (Nesina®)

6. SLGT-2 Inhibitors

• Canagliflozin (Invokana®)
• Dapagliflozin (Farxiga®)
• Empagliflozin (Jardiance®)

7. Alpha Glucosidase Inhibitors

• Miglitol (Glyset®)
• Acarbose (Precose®)

8. Combination Oral Medicines
9. Injectable Non-Insulin Medicines
Learn About More Oral Diabetes Medications

source to this post - www.about.com

Individuals with type 2 diabetes should exercise after dinner

February 18, 2015 University of Missouri-Columbia Individuals with Type 2 diabetes have heightened amounts of sugars and fats in their blood, which increases their risks for cardiovascular diseases such as strokes and heart attacks. Exercise is a popular prescription for individuals suffering from the symptoms of Type 2 diabetes, but little research has explored whether these individuals receive more benefits from working out before or after dinner. Now, researchers at the University of Missouri have found that individuals with Type 2 diabetes can lower their risks of cardiovascular diseases more effectively by exercising after a meal. "This study shows that it is not just the intensity or duration of exercising that is important but also the timing of when it occurs," said Jill Kanaley, professor in the MU Department of Nutrition and Exercise Physiology. "Results from this study show that resistance exercise has its most powerful effect on reducing glucose and fat levels in one's blood when performed after dinner." Kanaley and her colleagues studied a group of obese individuals with Type 2 diabetes. On one occasion, participants performed resistance exercises before eating dinner. During another visit, participants exercised 45 minutes after eating dinner. Participants performed resistance exercises such as leg curls, seated calf raises and abdominal crunches. Compared to levels on a non-exercise day, Kanaley found that the participants who exercised before dinner were able to only reduce the sugar levels in their blood; however, participants who exercised after dinner were able to reduce both sugar and fat levels. Participants consumed a moderate carbohydrate dinner on the evenings of the study. Kanaley said her research is particularly helpful for health care providers who have patients who exercise every day but are not seeing benefits. "Knowing that the best time to exercise is after a meal could provide health care professionals with a better understanding of how to personalize exercise prescriptions to optimize health benefits," Kanaley said. Kanaley also found that improvements in participants' blood sugar and fat levels were short-lived and did not extend to the next day. She suggests individuals practice daily resistance exercise after dinner to maintain improvements. "Individuals who exercise in the morning have usually fasted for 10 hours beforehand," Kanaley said. "Also, it is natural for individuals' hormone levels to be different at different times of day, which is another factor to consider when determining the best time to exercise." In the future, Kanaley said she plans to research how exercising in the morning differs from exercising after dinner and how individuals' hormone levels also affect exercise results. The study, "Post-dinner resistance exercise improves postprandial risk factors more effectively than pre-dinner resistance exercise in patients with type 2 diabetes," was published in the Journal of Applied Physiology. Story Source: The above story is based on materials provided by University of Missouri-Columbia. The original article was written by Diamond Dixon. Note: Materials may be edited for content and length. Journal Reference: T. D. Heden, N. C. Winn, A. Mari, F. W. Booth, R. S. Rector, J. P. Thyfault, J. A. Kanaley. Post-dinner resistance exercise improves postprandial risk factors more effectively than pre-dinner resistance exercise in patients with type 2 diabetes. Journal of Applied Physiology, 2014; DOI: 10.1152/japplphysiol.00917.2014

Microbiome linked to type 1 diabetes: Shift in microbiome species diversity prior to disease onset

 

The human microbiome, which consists of the trillions of microorganisms (bacteria, viruses, and other assorted "bugs") that reside in our bodies, has become an area of growing interest to the medical community as researchers have begun to probe the role it plays in human health and disease. While most bugs in our microbiome are harmless, and even beneficial, changes in the microbiome (and in the interactions microbial species share with their human hosts) have been linked to various disease states, including diabetes and Inflammatory Bowel Disease (IBD). To explore the possible connection between changes in the microbiome and type 1 diabetes, a team led by Ramnik Xavier, an Institute Member of the Broad and Chief of Gastroenterology at MGH, followed 33 infants (out of a much larger cohort of Finnish and Estonian children) who were genetically predisposed to T1D. From birth to age 3, the team regularly analyzed the subjects' stool samples, collecting data on the composition of their gut microbiome. In the handful that developed T1D during this period, the team observed a 25% drop in community diversity (in other words, in the number of distinct species present in the microbiome) one year prior to the onset of the disease. They also noted that this population shift included a decrease in bacteria known to help regulate health in the gut, along with an increase in potentially harmful bacteria that are known to promote inflammation. The findings are further evidence of a previously identified link between inflammation of the gut and type 1 diabetes. "We know from previous human studies that changes in gut bacterial composition correlate with the early development of type 1 diabetes, and that the interactions between bacterial networks may be a contributing factor in why some people at risk for the disease develop type 1 diabetes and others don't," said Jessica Dunne, Director of Discovery Research at JDRF, which funded the study. "This is the first study to show how specific changes in the microbiome are affecting the progression to symptomatic T1D." Previous studies have shown that transferring microbiota from mice that were predisposed to autoimmune diabetes (the mouse equivalent of T1D) to mice that were not predisposed increased the prevalence of autoimmune diabetes in mice that were otherwise unlikely to develop the disease. Studies in humans have also shown an association between T1D and the bacterial composition of the gut. However, those studies were retrospective, meaning they were conducted after the patients developed the disease, making causality difficult to prove. "This study is unique because we have taken a cohort of children at high risk of developing type 1 diabetes and then followed what changes in the microbiome tip the balance toward progression to the disease," Xavier said. Aleksandar Kostic, a postdoctoral fellow in Xavier's lab and first author of the study, agreed, calling the study "a compelling piece of evidence pointing toward a direct role of the microbiome in type 1 diabetes." Since the study also followed infants who did not ultimately develop type 1 diabetes, the researchers were also able to gain insights into the normal development of the microbiome during infancy. They found that, while the species of bacteria present in the gut microbiome vary greatly between individuals, the composition of the microbiome is generally stable within the individual over time. Moreover, using metabolomic analysis (looking at the metabolites -- the tiny molecules produced during metabolism -- in subject stool samples), the researchers were also able to see that, while bacterial species varied between individuals, the biological functions served by the various species in the microbiome remained consistent over time, and from person to person. "Whether the bacterial community is very small, as it is in early infancy, or if it's larger as it is later in life, the community is always serving the same major functions regardless of its composition. No matter which species are present, they encode the same major metabolic pathways, indicating that they're doing the same jobs," Kostic said. By revealing patterns in the development of the microbiome in healthy individuals, and in those progressing toward T1D onset, the findings may ultimately have diagnostic or therapeutic implications. In terms of diagnostics, understanding how the microbiome shifts prior to the onset of disease could ultimately help clinicians spot early microbial features of T1D. As for therapeutics, Xavier, who is also the Kurt Isselbacher Chair in Medicine at Harvard Medical School and Co-Director of the Center for Microbiome Informatics and Therapeutics at MIT, says that knowing which species are absent and which are flourishing in the gastrointestinal tract of children with T1D may help make it possible to slow progression of the disease after onset by revealing ways to manipulate the microbiome and, in turn, microbiome-induced immunoregulation. The next step, he says, is to broaden the sample pool to determine what factors in the environment and in the microbiome might be making Finns -- who are at exceptionally high risk of T1D -- more predisposed to the disease than other populations. That includes revisiting the hygiene hypothesis, which holds that a lack of childhood exposure to microbiota and other potentially infectious agents may hinder the development of the immune system and increase susceptibility to immunological disorders. The researchers are also examining the metagenomic data gathered in the study to determine what biological pathways the microbiota are acting upon -- or what metabolites they may be producing -- that could be contributing to disease. The study was funded by JDRF and supported by the European Union Seventh Framework Programme and The Academy of Finland Centre of Excellence in Molecular Systems Immunology and Physiology Research. Other researchers who worked on the study include: Dirk Gevers, Heli Siljander, Tommi Vatanen, Tuulia Hyötyläinen, Anu-Maaria Hämäläinen, Aleksandr Peet, Vallo Tillmann, Päivi Pöhö, Ismo Mattila, Harri Lähdesmäki, Eric A. Franzosa, Outi Vaarala, Marcus de Goffau, Hermie Harmsen, Jorma Ilonen, Suvi M. Virtanen, Clary Clish, Matej Orešič, Curtis Huttenhower, and the DIABIMMUNE Study Group under the leadership of Mikael Knip.

Popular diabetes drug may be safe for patients with kidney disease

 

The most popular treatment for type 2 diabetes, metformin, may be safer for patients with mild to moderate kidney disease than guidelines suggest, according to a new, systematic review of the literature published by Yale investigators in the Journal of the American Medical Association (JAMA). For 20 years, metformin has been used in the United States to lower blood sugar in people with type 2 diabetes. Most experts consider it the best first agent to treat blood sugar increases in this disease. Despite its strong safety profile, the FDA has long recommended that metformin not be prescribed to patients with mild to moderate kidney disease due to the risk of lactic acidosis, a potentially serious condition. But those decades-old guidelines have recently been called into question. Yale professor of medicine Silvio E. Inzucchi, M.D., and colleagues at Yale, the University of Texas Southwestern Medical Center, and Aston University in the U.K. conducted a systematic review of published research to assess the risk of lactic acidosis with metformin in diabetes patients with mild to moderate kidney disease. They found that the risk in these patients is extremely low -- actually comparable to the risk in those who did not take metformin. "What we found is that there is essentially zero evidence that this is risky," said Inzucchi, who is also medical director of the Yale Diabetes Center. "The drug could be used safely, so long as kidney function is stable and not severely impaired." The finding is key because doctors often avoid or stop prescribing metformin to older patients with diabetes who need it. "They hit a certain age, their kidney function starts to decline, and the first thing most doctors do is to stop metformin," Inzucchi said. "What invariably happens next is their diabetes goes out of control. Other drugs may be substituted, but they are usually not generic products like metformin, and so more expensive and may also have more side effects." The JAMA review also noted that metformin is already being routinely prescribed to patients with type 2 diabetes and kidney disease despite the guidelines. "Many in the field know that metformin can be used cautiously in patients who have mild to moderate kidney problems," Inzucchi noted. "Most specialists do this all the time." He cautions that the review findings do not apply to individuals with severe kidney disease. Should the guidelines change, as many in the field have recommended, dosage of metformin would probably need to be reduced at a certain level of kidney function, and patients would need to be more closely monitored to make sure kidney function remains stable. If the FDA guidelines for metformin use are updated, as Dr. Inzucchi and colleagues have recommended, the drug could be made available to more than 2.5 million Americans living with type 2 diabetes. His group has assembled more than 100 signatures from diabetes experts throughout the country to petition the FDA to update its guidelines. Story Source: The above story is based on materials provided by Yale University. The original article was written by Ziba Kashef. Note: Materials may be edited for content and length. Journal Reference: Silvio E. Inzucchi, Kasia J. Lipska, Helen Mayo, Clifford J. Bailey, Darren K. McGuire. Metformin in Patients With Type 2 Diabetes and Kidney Disease. JAMA, 2014; 312 (24): 2668 DOI: 10.1001/jama.2014.15298

Technophobia may keep seniors from using apps to manage diabetes

 

December 19, 2014 University of Waterloo Despite showing interest in web or mobile apps to help manage their type 2 diabetes, only a small number of older adults actually use them, says a new study. Approximately 2.2 million Canadians are living with type 2 diabetes, 2 million of whom are age 50 or older. A study found that although more than 90 per cent of research participants owned a computer or had daily Internet access, just 18 per cent used applications on this technology to help manage their diabetes. While almost half owned smartphones, only 5 per cent used them to manage their disease. Despite showing interest in web or mobile apps to help manage their Type 2 diabetes, only a small number of older adults actually use them, says a new study from the University of Waterloo. Approximately 2.2 million Canadians are living with Type 2 diabetes, 2 million of whom are age 50 or older. The study, which appears in the online edition of the Journal of Diabetes Science and Technology, found that although more than 90 per cent of research participants owned a computer or had daily Internet access, just 18 per cent used applications on this technology to help manage their diabetes. While almost half owned smartphones, only 5 per cent used them to manage their disease. "There was a strong association between age and confidence -- confidence about technology use really dropped off in the oldest age groups," said Professor Peter Hall, of the Faculty of Applied Health Sciences at Waterloo and senior author of the paper. "This drop in confidence was mirrored by a corresponding drop in intentions to use the technology in the near future." Earlier research shows that people who use smartphone and web apps to manage chronic diseases follow their doctors' recommendations more closely and make positive changes in their health, at least among those already positively inclined toward such technology. In diabetes management, technology can provide platforms for glucose logs, dietary and physical activity journals, and create opportunities for scheduled prompting or interventions. "It may be that older adults are unaware of apps available, they had low confidence about using them regularly, or both," said Kathleen Dobson, a graduate student and lead author on the paper. Despite the low use of assistive technology among older adults, the majority of study participants felt that adopting Internet or smartphone applications to manage their diabetes was a good idea. More than two-thirds intended to adopt assistive technology moving forward. "Successful diabetes management improves quality of life, reduces risk of complications and generally extends life expectancy," said Professor Hall. "My hope is that we can find ways to encourage adoption of these new self-management tools, even among those older adults who don't consider themselves to be especially tech-savvy." The development of senior-friendly apps that are easier to see and use along with encouragement from health-care practitioners to use assistive technology could help increase the number of older adults who use their phones and computers as tools to better manage their diabetes. Raising awareness about existing applications and boosting confidence is also key in increasing the use of assistive technology among older adults. A future phase of this research will involve seniors who aren't tech-savvy to determine their receptivity to different types of applications. Story Source: The above story is based on materials provided by University of Waterloo. Note: Materials may be edited for content and length. Journal Reference: K. G. Dobson, P. Hall. A Pilot Study Examining Patient Attitudes and Intentions to Adopt Assistive Technologies Into Type 2 Diabetes Self-Management. Journal of Diabetes Science and Technology, 2014; DOI: 10.1177/1932296814560395

Research findings could pave way for a fructose tolerance test

 

October 13, 2014

Beth Israel Deaconess Medical Center

The FGF21 hormone may be a reliable predictor of altered fructose metabolism and provide the basis for a "fructose tolerance test," researchers report. Determining the body’s metabolic response to fructose has been a difficult task, researchers say and consequently, there is no equivalent test to warn of impaired or altered fructose metabolism. That may soon change, thanks to new research.

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Increased consumption of table sugar and high-fructose corn syrup has been linked to rising rates of obesity and type 2 diabetes in the United States and throughout the world. Both sweeteners are commonly found in processed foods and sugar-sweetened beverages, and both are made up of nearly equal amounts of two basic sugars, glucose and fructose.

The effects of glucose ingestion in humans are well understood, in part, because they are easily assessed by performing a Glucose Tolerance Test, which measures serum glucose levels after glucose ingestion and has become the diagnostic cornerstone for modern diabetes care. Furthermore, the hormone insulin can also be easily measured to assess the acute metabolic effects of glucose ingestion and evaluate a person's risk for developing diabetes and cardiovascular disease.

But determining the body's metabolic response to fructose has been much more difficult, and consequently, there is no equivalent test to warn of impaired or altered fructose metabolism.

That may soon change. A new study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) now finds that blood levels of the hormone Fibroblast Growth Factor 21 (FGF21) increases rapidly acutely and robustly after fructose ingestion. Reported online in Molecular Metabolism, the new findings suggest that FGF21 is a reliable predictor of altered fructose metabolism and, in essence, provides the basis for a "fructose tolerance test."

"Accumulating evidence suggests that the fructose component of sugar may have a particularly deleterious effect on health," explains co-senior author Mark Herman, MD, of the Division of Endocrinology, Diabetes and Metabolism at BIDMC and Assistant Professor of Medicine at Harvard Medical School (HMS). "If you feed animals or people higher-than-normal amounts of fructose, they become obese, less responsive to the key actions of insulin, and develop fatty liver disease and abnormal blood lipid levels. All of these increase the risk of developing diabetes and cardiovascular disease." Fructose is a pervasive presence throughout our foods: high fructose corn syrup, for example, can be found in everything from processed cookies and sweets to seemingly healthy foods, such as yogurt.

"Fructose is taken up by the liver as soon as it's ingested and very little of it makes it to peripheral blood where it might be sampled and measured," adds co-senior author Eleftheria Maratos-Flier, MD, HMS Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at BIDMC. "This makes it very hard to determine how an individual responds to fructose ingestion. Furthermore, there has, to date, been no known hormonal response to fructose in the way that the hormone insulin responds to glucose."

Maratos-Flier has been studying the FGF21 hormone for almost a decade and previously found that in both humans and animals, FGF21 levels are elevated in association with obesity, insulin resistance, and non-alcoholic fatty liver disease. Herman's work, meanwhile, had focused on a cellular factor, Carbohydrate Responsive-Element Binding Protein (ChREBP), which senses simple sugars and responds by activating cellular gene expression programs. Observations that fructose potently activates ChREBP in rodent livers and that ChREBP can regulate FGF21 expression suggested to Maratos-Flier and Herman the intriguing hypothesis that fructose ingestion might stimulate production of circulating FGF21 in people.

To test this hypothesis, the researchers, led by first author Jody Dushay, MD, HMS Instructor in Medicine, recruited 10 lean, healthy study subjects. They first tested the effect of glucose on FGF21 by giving volunteers a drink of 75 grams of glucose and measuring blood levels over the course of five hours. There was no immediate effect on FGF21 levels although modest changes in FGF21 were seen three to four hours later. In contrast, after ingesting 75 grams of fructose, FGF21 levels dramatically increased by an average of 400 percent -- within only two hours.

"This tells us that fructose actively regulates FGF21 in humans," says Maratos-Flier. "The hormone-like response of FGF21 to fructose ingestion suggests that FGF21 might play an unanticipated role in regulating fructose metabolism. We were totally surprised by this dramatic effect becausej, to date, there has been no way of assessing the body's acute metabolic response to fructose ingestion. We haven't had a simple quick test like we have for glucose."

Furthermore, she adds, the findings demonstrated that the FGF21 response was exaggerated in subjects with metabolic disease, suggesting that either some aspect of fructose metabolism changes during the development of metabolic syndrome and/or there are innate differences in fructose metabolism among individuals and those with an exaggerated FGF21 response to fructose are predisposed to developing disease.

"For the first time, this provides an avenue for labs everywhere to easily study fructose metabolism in people," adds Herman. "This study provides a foundational observation for further investigation into the genetic and environmental determinants of an individual's metabolic response to fructose and this type of knowledge will be essential to develop personalized dietary recommendations as well as pharmacological strategies to prevent and treat cardiometabolic disease."

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Story Source:

The above story is based on materials provided by Beth Israel Deaconess Medical Center. Note: Materials may be edited for content and length.

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Beth Israel Deaconess Medical Center. "Research findings could pave way for a fructose tolerance test." ScienceDaily. ScienceDaily, 13 October 2014. <www.sciencedaily.com/releases/2014/10/141013123018.htm>.

 

Gene responsible for traits involved in diabetes discovered

 

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A collaborative research team led by Medical College of Wisconsin (MCW) scientists has identified a new gene associated with fasting glucose and insulin levels in rats, mice and in humans. The findings are published in the September issue of Genetics.

Leah Solberg Woods, Ph.D., associate professor of pediatrics at MCW and a researcher in the Children's Hospital of Wisconsin Research Institute, led the study and is the corresponding author of the paper.

The authors of the paper identified a gene called Tpcn2 in which a variant was associated with fasting glucose levels in a rat model. Studies in Tpcn2 knockout mice also demonstrated the difference in fasting glucose levels as well as insulin response between the knockout animals and regular mice. Finally, Dr. Woods' team identified variants within Tpcn2 associated with fasting insulin in humans. Tpcn2 is a lysosomal calcium channel that likely plays a role in insulin signaling. Glucose tolerance, insulin resistance and beta cell dysfunction are key underlying causes of type 2 diabetes.

"Genome-wide association studies in humans have identified 60+ genes linked to type 2 diabetes; however, these genes explain only a small portion of heritability in diabetes studies. As we continue to identify genes and variants of interest, we will evaluate them in multiple models to understand the mechanism of disease," said Dr. Solberg Woods.

According to the American Diabetes Association, 29 million Americans have diabetes -- more than nine percent of the total population. It is the 7th leading cause of death, and experts estimate diabetes is an underreported cause of death because of the comorbidities and complications associated with the disease.

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Story Source:

The above story is based on materials provided by Medical College of Wisconsin. Note: Materials may be edited for content and length.

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Journal Reference:

1. S.-W. Tsaih, K. Holl, S. Jia, M. Kaldunski, M. Tschannen, H. He, J. W. Andrae, S.-H. Li, A. Stoddard, A. Wiederhold, J. Parrington, M. Ruas da Silva, A. Galione, J. Meigs, R. G. Hoffmann, P. Simpson, H. Jacob, M. Hessner, L. C. Solberg Woods. Identification of a Novel Gene for Diabetic Traits in Rats, Mice, and Humans. Genetics, 2014; 198 (1): 17 DOI: 10.1534/genetics.114.162982

Quarter of people with diabetes worldwide live in China, but new approach could help transform their care

 

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Diabetes has become a major public health crisis in China, with an annual projected cost of 360 billion RMB (nearly 35 billion British pounds) by 2030, but a new collaborative approach to care that uses registries and community support could help improve diabetes care, according to a new three-part Series about diabetes in China published in The Lancet Diabetes & Endocrinology.

China has the largest number of people with diabetes of any country in the world, and the disease has reached epidemic proportions in the adult population. In 1980, less than 1% of Chinese adults had diabetes, but this increased to almost 12% (113.9 million adults) by 2010. Latest estimates indicate that around half of Chinese adults have prediabetes, putting them at high risk of diabetes and multiple related illnesses.

"Especially alarming is that most adults with diabetes are undiagnosed (70% of all cases), only a quarter of people with diabetes have received treatment and that the disease is controlled in just 40% of those treated", says Professor Guang Ning, one of the Series authors, and immediate past president of the Chinese Endocrine Society, who led the Chinese national survey of diabetes in 2010.

Worryingly, say the authors, these figures herald a major epidemic of diabetes-related complications such as cardiovascular disease, chronic kidney disease, and cancer in the near future unless there is effective national intervention.

The epidemic is the result of rapid economic development and urbanisation that has culminated in an "obesogenic environment" characterised by food abundance, physical inactivity, and psychosocial stress. What is more, Chinese people are particularly susceptible to type 2 diabetes compared with white people, and they tend to develop the disease at a much lower body mass index (BMI). The average BMI of Chinese patients with diabetes is 25 kg/m2, compared with 30 kg/m2 in non-Asians.

Over the past 30 years, China's standard of living and life expectancy have improved for many, but the aging population, dietary changes, reduced physical activity, and exceptionally high rates of smoking have contributed to the diabetes epidemic. The health consequences of this epidemic threaten to overwhelm health-care systems and urgent action is needed, warn the authors.

In future decades, the double burden of an aging population and rising rates of young-onset diabetes will have an enormous toll on productivity and health-care systems. Series co-leader Professor Ronald Ma, from the Chinese University of Hong Kong, explains: "Given the increased long-term risk of complications in people with young-onset diabetes, the potential economic and health burden associated with this epidemic is very alarming. In 1993, the cost of diabetes treatment in China was 2.2 billion RMB, but the projected cost for 2030 is 360 billion RMB, which highlights the critical importance of prevention."

There is much to be done, says Professor Juliana Chan from the Chinese University of Hong Kong, who co-led the Series: "While we await the results of long-term strategies from the China National Plan for Non-Communicable Disease Prevention and Treatment (2012-15) including tobacco control and universal screening for gestational diabetes, we advocate the use of a targeted proactive approach to identify people at high risk of diabetes for prevention, and of private-public community partnerships that make care more accessible, sustainable, and affordable focusing on registry, empowerment, and community support."

For example, community-based coordinating centres and targeted screening programs in schools and workplaces, run by trained community health workers and graduate students under medical supervision, could identify high-risk individuals and provide education about the benefits of early intervention, treatment and continuing support. Additionally, more research is needed to identify the best drug treatments for Chinese people with type 2 diabetes, who have several unique clinical characteristics.

According to Professor Chan, "As this epidemic continues to unfold, every individual must join in the grand challenge of creating a multidimensional solution to minimise its effects on societal, family, and personal health."

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Story Source:

The above story is based on materials provided by The Lancet. Note: Materials may be edited for content and length.

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Journal References:

1. Wenying Yang, Jianping Weng. Early therapy for type 2 diabetes in China. The Lancet Diabetes & Endocrinology, 2014; DOI: 10.1016/S2213-8587(14)70136-6
2. Juliana C N Chan, Yuying Zhang, Guang Ning. Diabetes in China: a societal solution for a personal challenge. The Lancet Diabetes & Endocrinology, 2014; DOI: 10.1016/S2213-8587(14)70144-5
3. Ronald Ching Wan Ma, Xu Lin, Weiping Jia. Causes of type 2 diabetes in China. The Lancet Diabetes & Endocrinology, 2014; DOI: 10.1016/S2213-8587(14)70145-7

Global epidemic of diabetes threatens to jeopardize further progress in tuberculosis control

 

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A series of papers indicates that 15% of adult TB cases worldwide are already attributable to diabetes. These diabetes-associated cases correspond to over 1 million cases a year, with more than 40% occurring in India and China alone. If diabetes rates continue to rise out of control, the present downward trajectory in global TB cases could be offset by 8% (ie, 8% less reduction) or more by 2035, warn the authors.

Diabetes increases the risk of developing active TB, and is associated with a poorer TB prognosis. Conversely, TB infection worsens glucose control in patients with diabetes. Thus, as diabetes becomes more common in TB-endemic regions, health care systems will increasingly be faced with the challenge of this double disease burden.

Diabetes is making an increasingly important contribution to the TB epidemic [Paper 1]. A 52% increase in diabetes prevalence recorded over the last 3 years in the 22 highest TB burden countries is thought to be responsible for a rise in diabetes-associated TB cases from 10% in 2010 to 15% in 2013.

New estimates produced for the Series [Paper 1] reveal that the top 10 countries with the highest estimated number of adult TB cases associated with diabetes are India (302,000), China (156,000), South Africa (70,000), Indonesia (48,000), Pakistan (43,000), Bangladesh (36,000), Philippines (29,000), Russia (23,000), Burma (21,000), and the Democratic Republic of Congo (19,000) [see table 2, page 4].

"These findings highlight the growing impact of diabetes on TB control in regions of the world where both diseases are prevalent," says Series author Dr Knut Lönnroth from the Global TB Programme at WHO in Geneva. "TB control is being undermined by the growing number of people with diabetes, which is expected to reach an astounding 592 million worldwide by 2035."

This double disease burden creates obstacles for the prevention and care of both diseases [Paper 2]. Dr Reinout van Crevel, Series co-author and infectious disease specialist at Radboud University Medical Center in the Netherlands, explains, "People with diabetes have a three times greater risk of contracting TB than people without diabetes, are four times more likely to relapse following treatment for TB, and are at twice the risk of dying during treatment than those without diabetes. These figures suggest we need to improve care for these patients at multiple levels."

Worryingly, the impact of diabetes on TB rates could worsen in future decades [Paper 3]. Over the next 20 years, the International Diabetes Federation (IDF) estimates that the number of people with diabetes will rise by 21%, which corresponds to an overall diabetes prevalence in adults of more than 10%. Mathematical modelling conducted for the Series [Paper 3] estimates that as a result of diabetes on this scale, global tuberculosis incidence would be 3% higher than the projected downward trend by 2035, or even 8% higher in a pessimistic scenario (a large 25% increase in the number of people with diabetes) -- which might be the reality in regions where diabetes risk factors are increasing fastest.

However, the authors also calculate the maximum positive effect of public health efforts to prevent and improve care for diabetes globally (eg, improved case identification, glucose control in patients with diabetes, and chemoprophylaxis in people with latent TB infection). Such efforts could further reduce tuberculosis cases by 15% or more by 2035 compared with the present rate of decline.

According to Dr Lönnroth, "If we are to achieve the ambitious post-2015 global TB target to reduce TB incidence by 90% by 2035, increased efforts to diagnose and treat both TB and diabetes, especially in countries with a high burden of both diseases, will be crucial."

An Editorial accompanying the Series warns that, as papers from the Series clearly show, continued progress in reducing communicable diseases like TB cannot be made without adequate provision of resources to combat diabetes. According to the Editorial, this knowledge should be a wake-up call to the global community and local providers to invest further in the prevention and treatment of chronic diseases like obesity and diabetes, which continue to be relatively ignored when it comes to health care funding.

The series can be found online at: http://www.thelancet.com/series/tuberculosis-and-diabetes

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Story Source:

The above story is based on materials provided by The Lancet. Note: Materials may be edited for content and length.

Do 'walkable' neighborhoods reduce obesity, diabetes? Yes, research suggests

 

June 17, 2014

People who live in neighborhoods that are conducive to walking experienced a substantially lower rate of obesity, overweight and diabetes than those who lived in more auto-dependent neighborhoods, according to a pair of studies. Specifically, the studies found that people living in neighborhoods with greater walkability saw on average a 13 percent lower development of diabetes incidence over 10 years than those that were less walkable.

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People who live in neighborhoods that are conducive to walking experienced a substantially lower rate of obesity, overweight and diabetes than those who lived in more auto-dependent neighborhoods.

Researchers in Canada compared adults living in the most and least "walkable" metropolitan areas in southern Ontario and found a lower risk of developing diabetes over a 10-year period for those who lived in neighborhoods with less sprawl, more interconnectivity among streets, and more local stores and services within walking distance, among other measures used to determine a neighborhood's "walkability." The researchers controlled for variables, such as health at baseline, in order to rule out the probability that healthier people were choosing more walkable neighborhoods to begin with. A second study that compared neighborhoods, not individuals, found that the most walkable neighborhoods had the lowest incidence of obesity, overweight and diabetes.

"How we build our cities matters in terms of our overall health," said lead researcher Gillian Booth, MD, Endocrinologist and Research Scientist at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto. "This is one piece of a puzzle that we can potentially do something about. As a society, we have engineered physical activity out of our lives. Every opportunity to walk, to get outside, to go to the corner store or walk our children to school can have a big impact on our risk for diabetes and becoming overweight."

Marisa Creatore, Epidemiologist with the Centre for Research on Inner City Health at St. Michael's Hospital, Toronto, added that the studies revealed the degree to which "your environment can influence your decisions about physical activity. When you live in a neighborhood designed to encourage people to be more active, you are in fact more likely to be more active."

Specifically, the studies found that people living in neighborhoods with greater walkability saw on average a 13 percent lower development of diabetes incidence over 10 years than those that were less walkable. However, walkability was only protective in those who were younger and middle aged; those who were age 65 or older saw no benefit from living in a walkable neighborhood.

Diabetes was lowest in the most walkable neighborhoods, where incidence fell 7 percent over 10 years, whereas neighborhoods rated least walkable saw a 6 percent rise in diabetes over the same time period. Overweight and obesity, as well, was lowest in the most walkable neighborhoods and fell by 9 percent over 10 years, whereas it rose 13 percent in neighborhoods with the least walkability during that time.

The researchers also noted that people who lived in the most walkable neighborhoods were three times more likely to walk or bicycle and half as likely to drive as a means of transportation.

Solving the obesity pandemic, concluded Booth, "will require both policy changes as well as individual strategies. We have to take a more population-based approach to the problem, given the environment we live in."