A “Cure” for Type 2 Diabetes

In case you haven’t already heard, researchers are now reporting that Type 2 Diabetes may (possibly) be reversed by a restricted low-calorie diet:

Adhering to the strict 600 calorie-a-day diet causes fat levels in the pancreas to plummet, restoring normal function, found Prof Roy Taylor of Newcastle University.

The discovery, a “radical change” in understanding of the condition, holds out the possibility that sufferers could cure themselves – if they have the willpower.

Until recently received medical wisdom was that Type 2 diabetes was largely irreversible.

But this small-scale study indicates that defeating it could be easier than commonly thought.

Prof Taylor asked 11 volunteers, all recently diagnosed, to go on what he admitted was an “extreme diet” of specially formulated drinks and non-starchy vegetables, for eight weeks.

Hyscience comments:

As the article goes on to point out, the trial study involved only 11 patients that ate a “meal-replacement” milkshake of 150 calories three times a day. This was supplemented with three portions of non-starchy vegetables including cabbage, broccoli, peppers, tomatoes, cucumber and lettuce. After one week, their pre-breakfast blood sugar levels had returned to normal and an MRI scan revealed that the fat levels in the pancreas were also normal, down from around eight per cent to six per cent.

Notes to self:

  • Great news – perhaps (I think)
  • “small-scale study” –  The smaller the study the less likely the results will be supported over time, esp. considering all of the potential influential factors.  Something like 33% of all reported major medical studies is contradicted within five years.
  • Radical change in management – pharma and device companies may need to revisit their strategic roadmap if this research is supported by larger scale studies

 

Eat Whole Grain – the glycemic index is back, again

low-glycemic index

Some things seem to be reported in never-ending cyclic patterns.  This might be one of them but I tend to think that it is actually the journalists interpretation that brings about the feeling of deja vu rather than the researcher’s investigation.

It’s not necessarily the amount of carbohydrates you consume as it is the type (or the glycemic load), so says a “new study” recently reported by Reuters after being published in the American Journal of Clinical Nutrition:

How many carbs you eat might be less important for your blood sugar than your food’s glycemic load, a measure that also takes into account how quickly you absorb those carbs.

That’s the conclusion of a new study of healthy adults, which questions the way people with type 1 diabetes determine how much insulin they should take before meals.

Well, measuring how fast carbohydrate is absorbed has been around for a long time and we’ve been avoiding simple carbohydrates in preference to whole grain cereals and complex carbs as long as I can remember.  Perhaps I’m missing something or the actual research was under-reported but there is a reason I’m eating the 7-grain cooked cereal in the image above rather than corn flakes – the difference in glycemic index!

Never-the-less, any study that can help educate us on the damaging impact of post-prandial variability has value and perhaps a read of the research as reported rather than interpreted will add additional insight.

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Why do we continually hear that diabetes diagnoses and treatment are ineffective?

We continue to hear year after year that both diagnosis and treatment of diabetes is inadequaete.  For example:

Nearly 90 percent of U.S. adult diabetics — more than 16 million adults aged 35 and older — have ineffective treatment of blood sugar, blood pressure, and cholesterol. That percentage is 99 percent in Mexico, said the researchers at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

Frankly, I don’t know why a problem that is this often researched, reported and editorialized is not acted upon in an effective manner.  Here are a few guesses regarding why our progress in this area has been slow:

  1. Diabetes is a challenging disease to identify because is exists in a continuum of states begining with insulin resistance and hyperinsulemia.
  2. Finding an alternate or suplimentary tool for diagnosis faces stiff resistance among the medical community if it is not fully vetted with a large, mult-center and internationally approved clinical study.  After all, “new” mean changing the practice of medicine which requires significant proof. 
  3. The cost of (2) may be an large impediment
  4. Our society tends to rely too heavily on doctors and/or medications to cure with a sliver bullet.  Effective treatment of diabetes requires change in one’s lifestyle, expectations and resource allocation.  The disease is not life threatening (generally) on a day-to-day basis which makes it difficult for many to “sacrifice” their present desires for the future.

These were off the top of my head … I’ll add more as I think of them.

Thanks for reading.

Diabulimia Triples Your Risk

The term for withholding insulin to lose weight is “Diabulimia” – there’s a medical term for everything. It turns out that …

Women with type 1 diabetes who take less insulin than they should to try to lose weight triple their risk of dying compared to women who do not skip insulin doses, a new study finds.

more

Do you test frequently enough?

Testing blood sugar levels is one of the most important things that people with diabetes can do to help manage their disease and live a healthy lifestyle. However, an Omnibus survey of 1,002 adults with type 1 and type 2 diabetes indicates that almost 4 out of 10 do not test as often as their doctors recommend. – more
The top reasons for not testing:

  1. Having to reprick (48%)
  2. painful testing (43%)

It seems that having to reprick might be related to (2) and the results conveniently correspond to the marketed strengths of the ACCU-CHEK Aviva system.

Studies Support Intensive Therapy

Two decent studies were reported in the Annals of Internal Medicine that concluded treatment with inhaled insulin or exenatide, an injectable drug, can improve diabetes management in individuals with Type 2 diabetes.

In one study, Dr. Julio Rosenstock, from the Dallas Diabetes and Endocrine Center in Texas, and colleagues assessed the effect of inhaled insulin on sugar control in 309 patients when substituted for or added to standard oral medications. The subjects were followed for 12 weeks.
Compared with continued oral therapy alone, a significant improvement in sugar control was achieved by substituting or adding inhaled insulin therapy, the investigators report.
Inhaled insulin therapy was more likely than oral therapy alone to produce excessively low sugar levels. Treatment was also associated with mild weight gain and mild cough.
In the second study, Dr. Robert J. Heine, from VU University Medical Center in the Netherlands, compared the sugar-lowering effects of exenatide and insulin glargine in 551 patients with type 2 diabetes who had poor sugar control with oral medications.
At 26-week follow-up, exenatide and insulin glargine were associated with similar improvements in sugar control.
Treatment with exenatide was tied to a drop in body weight of 5 lbs., while insulin glargine was linked to 4 lbs. of weight gain. Gastrointestinal side effects, such as nausea, vomiting, and diarrhea, were much more common with exenatide than with insulin glargine.

Text Messaging Diabetes

Mobile text messaging by families throughout the US has been used to close the gap when their kids with diabetes are at school or anytime they are away from home … more here.

‘Landmark’ Study Points to the Importance of Diabetes Management

In 1993, the decade long Diabetes Control and Complications Trial (DCCT) showed that individuals with diabetes who aggressively manage their blood glucose levels delay or even avoid the onset and progression of diabetes related complications such as eye, kidney, and nerve diseases.
A new study released by Canadian researchers this week examined 2,473 diabetics “to gain a better understanding of how type 2 diabetes is being treated in Canada in the family practice setting and to explore the level of disease management among Canadian patients.”

The Diabetes in Canada Evaluation study, released Tuesday, has found that one out of two Canadians who have Type 2 diabetes do not have their blood-sugar levels and their disease under control, leaving them increasingly susceptible to such complications as heart attacks, strokes, kidney disease and blindness.

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Seven Principles for Managing Diabetes

From the NIH here are seven principles for managing your diabetes for life:

PRINCIPLE 1 Learn as Much as You Can About Diabetes
PRINCIPLE 2 Get Regular Care for Your Diabetes
PRINCIPLE 3 Learn How to Control Your Diabetes
PRINCIPLE 4 Take Care of Your Diabetes ABCs
PRINCIPLE 5 Monitor Your Diabetes ABCs
PRINCIPLE 6 Prevent Long-Term Diabetes Problems
PRINCIPLE 7 Get Checked for Long-Term Problems and Treat Them

The NIH website is very well-done and worth a visit.

Average HbA1c Levels are Over Nine (9) Percent

At the 2004 Diabetes Technology Meeting, Dr. Statish Garg of the Barbara Davis Center for Childhood Diabetes, began a presentation on Rapid Acting Insulin Analogs by informing the audience that the average HbA1c for diabetic patients seeing primary care physicians is 9.7%.

For those under the care of endocrinologists HbA1c levels are not much better, averaging 9.3%.

Both levels are significantly higher than accepted guidelines and reflect a high risk for complications.

For example, a normal non-diabetic HbA1C is 3.5-5.5% with less than 6% being acceptable. The The Diabetes Control and Complications Trial (DCCT) found that an average HbA1c level of 7.2% resulted in a 76% reduction in retinopathy, a 60% reduction in neuropathy, a 50% reduction in kidney disease and a 35% reduction in cardiovascular disease.

The remarkably high average HbA1c level indicates that most individuals with diabetes are not able to manage their glucose levels acceptably. The solution? It’s not simple but involves each person taking control of their diabetes management.

Most People With Diabetes Do Not Meet Treatment Goals

The question is why less than 12 percent of people diagnosed with diabetes meet the recommended goals for blood glucose, blood pressure, and cholesterol. Substantial evidence exists showing that controlling these factors delays or prevents diabetes complications.
In addition, the percentage of people who achieve these targets has changed little in the past decade, according to a study published in the January 21, 2004, issue of the Journal of the American Medical Association.

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Simple Actions Wipe Out Huge Higher Heart Risks For Asian Diabetics

New research, not yet fully disclosed, has shown that very simple interventions to target the health care of UK Asian diabetics can almost wipe out the 40% higher risks of heart disease linked to diabetes in that community. [University of Warwick]
Very simply, it appears that researchers examined the effect of better communication and contact with health care workers and documented a resulting drop in blood pressure. The anticipated outcome is that the “drop in blood pressure [will lead] to a 35% reduction in the risk of heart disease.”

Diabetes Management Program Billed a Success

JEFFERSON CITY, Mo., April 12 /U.S. Newswire/ — A chronic disease management pilot project launched last year by the Missouri Department of Health and Senior Services (DHSS) and Primaris, the Medicare Quality Improvement Organization for Missouri, dramatically improved the quality of care given to Missourians with diabetes, prompting officials to extend the initiative for another year.

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