Posts Tagged ‘diabetes’

Combo Diet-Exercise Programs Trim Diabetes Risk

A combination of diet and physical activity programs offered in the community reduce the risk of type 2 diabetes in patients who are at increased risk, according to new federal data.

Programs Help Patients Revert to Normal Glycemic Levels

• Strong evidence suggests that a combination of diet and physical activity programs can reduce new-onset diabetes for persons at increased risk for type 2 diabetes.

• These programs also increase the likelihood of reversion to normal glycemic levels and improve diabetes and cardiovascular disease risk factors, including weight, blood glucose levels, blood pressure, and lipid levels.

• The US Community Preventive Services Task Force recommends the use of combined diet and physical activity promotion programs to reduce progression to type 2 diabetes in those at increased risk.

Combined Program’s Critical Components

• Critical components of a combined diet and physical activity program include trained providers in clinical or community settings who work directly with program participants for at least 3 months; some combination of counseling, coaching, and extended support; and multiple sessions related to diet and physical activity, delivered in person or by other methods.

• Programs also may use 1 or more of the following: diet counselors in various specialties (eg, nutritionists, dietitians, and diabetes educators); exercise counselors in various specialties (eg, physical educators, physiotherapists, and trainers); physicians, nurses, and trained laypersons; a range of intensity of counseling, with many or few sessions, longer- or shorter-duration sessions, and individual or group sessions; and individually tailored or generic diet or physical activity programs.

• Programs should include specific weight-loss or exercise goals and a period of maintenance sessions after the primary core period of the program.

US Task Force Conducts Systematic Review

• The task force recommendation is based on evidence from a systematic review of 53 studies that described 66 programs.

• Most programs used a combination of in-person individual and group sessions.

• Almost all programs led to weight loss, reduced risk of diabetes, or both.

• More intensive programs led to more weight loss and less development of diabetes.

Group Programs More Cost-effective

• These diet-exercise programs were cost-effective; group-based programs were the most cost-effective.

• Health care providers usually are the primary resource for patients at increased risk for type 2 diabetes.

• The task force suggests that health care providers keep informed about local prevention programs offered by community centers or run by insurers or nonprofit or other private contractors.

Take-home Message:

• A federal task force’s systematic review found combined diet and physical activity programs can help prevent or delay the development of diabetes.

High Blood Sugar Elevates Breast Cancer Risks

Higher blood sugar levels that reflect prediabetes or undiagnosed diabetes lead to poorer outcomes in patients with breast cancer, particularly in young women, according to the results of a new study.

“In younger patients, doctors need to be aggressive in controlling blood sugar levels to improve their breast cancer-related outcomes,” said lead author Varinder Kaur, MD, a Fellow in Hematology/Oncology at the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas in Little Rock.

Multiple studies indicate that type 2 diabetes is associated with an increase in mortality in breast cancer.

However, the class of anti-diabetic therapy remains an obvious confounding factor in these studies.

Higher mortality rates have been reported in patients with breast cancer who are treated with insulin than in those treated with metformin.

Choosing a population of patients with breast cancer who have prediabetes and are not receiving anti-diabetic therapy could overcome such confounders.

RANDOM BLOOD SUGAR LEVELS RELATE TO BREAST CANCER

“We conducted a retrospective cohort study to evaluate the relationship between elevated random blood sugar (RBS) levels and breast cancer outcomes,” Dr. Kaur said.

The study included 234 patients, median age 53 years, who had no previous history of diabetes and who were not receiving any anti-diabetic therapy.

Some 159 patients had a documented RBS level.

The patients had stage I-III breast cancer, mostly stage II disease (177 patients); 72 patients had elevated RBS levels (higher than 120 mg/dL) and 87 had RBS levels lower than 120 mg/dL.

The effect of elevated RBS levels on overall survival, event-free survival, and time to tumor recurrence were analyzed.

“We observed that patients with elevated random blood sugar levels experienced significantly shorter overall survival, shorter event-free survival, and shorter time to tumor recurrence,” Dr. Kaur said.

“After adjusting for age, obesity, and race, elevated random blood sugar levels continued to display a high and statistically significant association with shorter survival and time to tumor recurrence.”

In addition, among patients younger than 50 years, elevated RBS levels were associated with a significantly greater frequency of high-grade tumors (80%) compared with RBS levels below 120 mg/dL (45%), suggesting that “elevated random blood sugar levels may have more impact in younger patients,” she noted.

Metformin may help reduce the risk of breast cancer and more tightly control blood sugar levels, Dr. Kaur said.

This may improve outcomes more than if patients are receiving insulin.

YOUNGER PATIENTS NEED BETTER BLOOD SUGAR CONTROL

Metformin may be even more effective in younger patients.

The risk of shorter survival and shorter time to tumor recurrence was more than twice as high in the 97 patients who were younger than 50 years than in the patients older than 50 years, she stated.

In conclusion, Dr. Kaur said, “High random blood sugar levels, reflective of a prediabetic state or undiagnosed diabetic state, are associated with shorter overall survival and time to tumor recurrence in early-stage breast cancer patients. It makes sense to be aggressive and control their blood sugar.”

The researchers presented the results of the study (Abstract 1584) at the American Society of Clinical Oncology annual meeting in Chicago.

Young Diabetes Patients Less Likely to Take Their Medicine

Patients with diabetes who are younger, new to the disease, and receiving few other medications may be at risk for nonadherence to therapy, according to a new study.

Medication nonadherence is fairly common, in about 30% of patients.

There are ‘non-modifiable’ factors associated with lower adherence, such as younger age, being female, and lower income level.

We think it’s helpful to be aware of these factors to increase awareness of risks and also to target programs or interventions to improve adherence,” said M. Sue Kirkman, MD, from the University of North Carolina School of Medicine, Chapel Hill, NC.

“There also are potentially modifiable factors that health care providers could target, such as getting more patients to use mail-order pharmacies or doing more to lower patients’ out-of-pocket costs,” she added.

WHO ADHERES TO MEDICATION

Many prior studies have shown that nonadherence to anti-diabetic medications is associated with many adverse outcomes, including hospitalizations, higher costs, and increased mortality.

Dr. Kirkman and colleagues conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to anti-diabetic medications.

They extracted data on a cohort of more than 200,000 patients who were treated for diabetes with non-insulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011.

They used the medication possession ratio, a fairly standard way to assess adherence.

“We pre-specified a number of variables related to patient factors, provider factors, and prescription factors and looked at their association with adherence,” Dr. Kirkman said.

“We then did a multivariate model to look at the independent effects of each variable, since many of them are correlated with one another.”

WHY THEY DON’T TAKE THEIR MEDS

Overall, 69% of patients were adherent.

Nonadherence was associated with a number of factors, including younger age, being female, being new to diabetes therapy, and receiving few other medications.

Nonadherence also was associated with higher out-of-pocket costs and use of retail pharmacies vs mail order.

“We speculate that nonadherent patients may not view themselves as ‘ill’ and may be less likely to take medications for an essentially asymptomatic disease, while older patients who have more comorbidities and are more used to taking medications might be more likely to stay on their diabetes medications,” Dr. Kirkman said, noting that the researchers did not talk to patients directly.

“This suggests that acceptance of a chronic illness diagnosis and the potential consequences may be an important, but perhaps overlooked, determinant of medication-taking behavior,” she noted.

The researchers published their results online January 8, 2015, in Diabetes Care.

Just Eating Healthier Trims Diabetes Risk

Improve your overall diet quality and you will lower your risk of type 2 diabetes mellitus, independent of adopting other healthful behaviors, including increased physical activity and body weight loss, according to the results of a new study.

In an analysis of 3 large cohort studies of men and women by researchers at the Harvard School of Public Health, those who improved their diet quality index scores by 10 percent over 4 years reduced their risk for type 2 diabetes by about 20% compared to those who made no changes to their diets.

“We found that diet was indeed associated with diabetes independent of weight loss and increased physical activity,” said lead author Sylvia Ley, PhD, RD, a post-doctoral fellow at the Harvard School of Public Health, at the American Diabetes Association’s 74th Scientific Sessions®.

“If you improve other lifestyle factors you reduce your risk for type 2 diabetes even more, but improving diet quality alone has significant benefits.”

She noted that it is often difficult for people to maintain a calorie-restricted diet for a long time.

“We want them to know that if they can improve the overall quality of what they eat – consume less red meat and sugar-sweetened beverages, and more fruits, vegetables and whole grains – they are going to improve their health and reduce their risk for diabetes,” Dr Ley said.

Lifestyle changes, including individually tailored, macronutrient composition focused, calorie-restricted interventions, can prevent or delay type 2 diabetes among those at high risk, according to randomized controlled trials.

However, it is unclear whether improving overall diet quality by itself is associated with reduced risk of diabetes among healthy adults.

DIET QUALITY CHANGES LOWER RISK

Dr. Ley and colleagues investigated the association between diet quality changes during a 4-year period and subsequent 4-year type 2 diabetes risk, and simultaneous changes in multiple lifestyle factors on that risk (Abstract 74-OR).

They prospectively followed more than 148,000 participants without diabetes at baseline in the Nurses’ Health Study (1986-2006), Nurses’ Health Study II (1991-2011), and Health Professionals Follow-up Study (1986-2010).

The Alternative Healthy Eating Index score was used to assess diet quality.

Associations between changes in diet quality, physical activity, and body weight and diabetes risk were evaluated simultaneously.

The researchers documented more than 9,000 incident cases of type 2 diabetes during the more than 2.3 million person-year follow-up.

Greater than 10% decrease in diet quality scores over 4 years was associated with higher subsequent diabetes risk with multiple adjustments, while at least 10% improvement in dietary scores was associated with lower risk, Dr Ley said during her presentation at the ADA meeting.

When simultaneous relationships among 4-year changes in diet quality, physical activity, and body weight were assessed, improvement in each behavioral factor was independently associated with lower incident diabetes.

“Regardless of where participants started, improving diet quality was beneficial for all,” she noted.

Diabetes in Men Often Goes Under the Radar

Men are more than twice as likely to have undiagnosed diabetes as women, despite the fact that their overall risk for diabetes is similar.

That’s one of the messages of a new campaign by the American Diabetes Association to raise health awareness among men when it comes to conditions like diabetes, sexual dysfunction, and sleep apnea as the Association celebrates Men’s Health Month this June.

“When it comes to men and diabetes management, the main barriers to good health are often a lack of understanding and education of the disease, as well as a fear of having to change their current lifestyle,” said Robert E. Ratner, MD, FACP, FACE, Chief Scientific & Medical Officer, American Diabetes Association.

“During Men’s Health Month, the American Diabetes Association is encouraging all men to get out, get active, and get informed to help Stop Diabetes®.”

Nearly 1 in 8 American men has diabetes, and 1 in 3 has pre-diabetes.

The complications of diabetes are well known and serious, and those risk factors can be significantly controlled through control of the ABCs: A1C (as a measure of glucose control), blood pressure, and cholesterol, particularly low-density lipoprotein.

The health risks for men with diabetes who smoke are even greater than the risks for men who don’t have diabetes, so smoking cessation is even more important.

Studies show an increased risk for heart disease for men both with and without diabetes.

An easy-to-implement diabetes screening score for undiagnosed diabetes, defined as fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or greater without known diabetes, developed from National Health and Nutrition Examination Survey data, has been demonstrated to be an improvement over existing methods.

Historically, men are not as comfortable as women when it comes to discussing health issues, which can result in shorter and less healthy lives for men in the US compared to women, says the Association.

SLEEP APNEA

Being male also means being more likely to suffer from obstructive sleep apnea (OSA).

Cross-sectional studies have documented the co-occurrence of OSA with glucose intolerance, insulin resistance, and type 2 diabetes mellitus.

OSA is linked to an increased risk for diabetes and can also make diabetes harder to control.

Studies show that sleep apnea increases the risk of developing diabetes, independent of other risk factors.

Among patients with more severe sleep apnea, regular positive airway pressure use may attenuate this risk.

SEXUAL DYSFUNCTION

In addition, diabetes can often have sexual implications for males, including erectile dysfunction.

However, there are many steps men can do to take better care of their diabetes and general health.

The Association recommends finding a family doctor the patient can trust and to discussion health issues.

In addition, the Association recommends enlisting a friend or family member to help the patient adopt healthy behaviors, such as an exercise partner, to increase the level of physical activity and modify eating habits and portion control.

Also, the Association notes that regular professional care is crucial for keeping diabetes management on track.

Lifestyle Measures Cut Cardiovascular Deaths in Prediabetes

Weight loss and other lifestyle interventions can reduce the risk of long-term cardiovascular consequences of diabetes, according to the results of a clinical trial.

This is the first randomized clinical trial to show that lifestyle intervention in those with impaired glucose tolerance reduces all-cause and cardiovascular disease mortality.

Lifestyle intervention delays the onset of diabetes and reduces the incidence of diabetes.

We had assessed how mortality was affected by the time free from diabetes, which was defined as the time between randomization and onset of diabetes.

We found that the increased delay in the onset of diabetes was associated with significantly lower all-cause and cardiovascular disease mortality,” said lead author Professor Guangwei Li of the China-Japan Friendship Hospital, Beijing, China.

“After inclusion of time to onset of diabetes in the multivariable models the intervention variable was no longer statistically significant, suggesting that the reduction in mortality associated with the intervention is mediated by its effect in delaying the onset of diabetes,” he noted.

The researchers published their results online on April 3, 2014 in The Lancet Diabetes & Endocrinology.

LIFESTYLE INTERVENTIONS PREVENT DEATHS

Many research studies have shown that lifestyle interventions, such as exercise programs or weight loss, in persons with impaired glucose tolerance can prevent progression to overt type 2 diabetes.

However, until now, there has been a lack of high-quality, randomized controlled trial evidence to prove that lifestyle interventions prevent deaths from cardiovascular disease, such as heart attacks and stroke, in these patients.

Dr. Li and colleagues enrolled 438 patients assigned to the intervention arm and 138 patients who were assigned to the control arm.

The study intervention lasted for 6 years, and patients were then monitored for 23 years.

At the end of the follow-up period, cumulative incidence of death from cardiovascular disease was 11.9% in the lifestyle intervention group versus 19.6% in the control group.

Death from all causes was 28.1% in the lifestyle group versus 38.4% in the control group.

The difference between groups for both outcomes was statistically significant.

“Although the association between duration of diabetes and mortality is well established, serious chronic complications and excess mortality typically only occur after at least 10 years of having diabetes,” Dr. Li said.

“In the present study, a difference in mortality between the intervention and control group started to emerge 12 years after the study began, slowly increased to a 17% difference by the 20-year follow-up, but became statistically significant only after 23 years.”

“TYPE 2 DIABETES CAN BE PREVENTED”

Dr. Li noted that a key difference between previous other studies and the Da Qing Diabetes Prevention Study is the length of follow-up.

In previous studies, the length of follow-up might have been insufficient to detect an effect of intervention on mortality.

Dr. Li’s bottom-line message: “Type 2 diabetes can be prevented.

Group-based lifestyle interventions over a 6-year period have long-term effects on prevention of diabetes beyond the period of active intervention.

The benefits of the intervention extended to a significantly favorable reduction of mortality.

These results emphasize the long-term benefits of the intervention and reinforce the overall value and importance of lifestyle interventions as public health strategies to prevent diabetes.”

Mediterranean Diet Reduces Diabetes, Inflammation

Two new studies show the heart-healthy benefits of eating a Mediterranean diet.

One study linked the diet to a lower risk of diabetes, especially among those at high risk for cardiovascular disease.

The other study tied the eating plan to lower levels of platelets and white blood cells, 2 markers of inflammation, which has been associated with a greater risk of heart attack and stroke.

The Mediterranean diet frequently emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil, and even a glass of red wine.the_mediterranean_diet_

Eating an anti-inflammatory, Mediterranean style diet has been shown to not only be a delicious and enjoyable way to eat, but also is wonderful for your health.

Earlier research has shown that following the traditional Mediterranean diet also is linked to weight loss, a reduced risk of heart disease and related death, and lower blood pressure and blood cholesterol levels.

Mediterranean Diet Reduces Risk of Diabetes

In the first pooled analysis of studies evaluating the possible role of the Mediterranean diet in diabetes development, adherence to this diet was associated with a 21% reduced risk of diabetes compared with the control dietary groups.

The likelihood of developing diabetes was almost 27% less in those at high risk for cardiovascular disease than in controls.

“Adherence to the Mediterranean diet may prevent the development of diabetes irrespective of age, sex, race, or culture,” said lead investigator Demosthenes Panagiotakos, PhD, professor at Harokopio University, Athens, Greece.

“This diet has a beneficial effect, even in high risk groups, and speaks to the fact that it is never too late to start eating a healthy diet.”

Dr. Panagiotakos and colleagues systematically reviewed 19 original research studies that followed more than 162,000 participants for an average of 5.5 years.

These studies spanned European and non-European populations, which is important because most of the published studies have been European-based and there has been some question of possible confounding factors in these regions, including genetics, the environment, lifestyle, and lower stress levels.

Dr. Panagiotakos said he believes the Mediterranean diet lowers the risk of diabetes by helping guard against obesity.

He presented his study on March 27, 2014 at the American College of Cardiology’s 63rd Annual Scientific Session in Washington, DC.

Mediterranean Diet Lowers Inflammation

To understand whether a Mediterranean diet might favorably influence platelet and white blood cell levels, Italian researchers conducted an analysis of the eating habits of nearly 15,000 healthy Italian men and women aged 35 years or older as part of a large epidemiological study.

The investigators observed that consumption of the Mediterranean diet was directly related to lower levels of platelets and white blood cells, which in turn correlated to lower levels of inflammation.

Those who strictly followed a traditional Mediterranean diet were less likely to belong to study cohorts with relatively high platelet counts and were more likely to belong to cohorts with relatively low white blood cell counts.

“Because the study included healthy participants, the lower levels of platelets and white blood cells in those who were more strictly consuming a Mediterranean diet indicate that this eating plan could account for substantial changes within normal ranges of variability,” said lead author Marialaura Bonaccio, PhD.

“This is an important finding that has implications for how these anti-inflammatory markers are tracked among the general population.”

Dr Bonaccio is with the Department of Epidemiology and Prevention at the IRCCS Istituto Neurologico Mediterraneo NEUROMED in Italy.

The results of her study were published online in the March 31, 2014 issue of Blood.