topic Re: winter diabetes thread in Wellness

winter diabetes thread

cherry — Tue, 15 Jan 2019 10:27:39 GMT

Gut microbiome may affect some anti-diabetes drugs Date: December 11, 2018 Source: Wake Forest Baptist Medical Center Summary: Why do orally-administered drugs for diabetes work for some people but not others? According to researchers, bacteria that make up the gut microbiome may be the culprit. Share:

FULL STORY

Why do orally-administered drugs for diabetes work for some people but not others?

According to researchers at Wake Forest School of Medicine, bacteria that make up the gut microbiome may be the culprit.

In a review of more than 100 current published studies in humans and rodents, the School of Medicine team examined how gut bacteria either enhanced or inhibited a drug's effectiveness. The review is published in the Dec.11 edition of the journal EBioMedicine.

"For example, certain drugs work fine when given intravenously and go directly to the circulation, but when they are taken orally and pass through the gut, they don't work," said Hariom Yadav, Ph.D., assistant professor of molecular medicine at the School of Medicine, a part of Wake Forest Baptist Medical Center.

"Conversely, metformin, a commonly used anti-diabetes drug, works best when given orally but does not work when given through an IV."

The review examined interactions between the most commonly prescribed anti-diabetic drugs with the microbiome. Before being absorbed into the bloodstream, many orally-administered drugs are processed by intestinal microbial enzymes. As a result, the gut microbiome influences the metabolism of the drugs, thereby affecting patients' responses, Yadav said.

Type-2 diabetes, a disease characterized by carbohydrate and fat metabolism abnormalities, has recently become a global pandemic. One main function of gut microbiota is to metabolize non-digestive carbohydrates and regulate a person's metabolism.

"Our review showed that the metabolic capacity of a patient's microbiome could influence the absorption and function of these drugs by making them pharmacologically active, inactive or even toxic," he said. "We believe that differences in an individual's microbiome help explain why drugs will show a 90 or 50 percent optimum efficacy, but never 100 percent."

The researchers concluded that modulation of the gut microbiome by drugs may represent a target to improve, modify or reverse the effectiveness of current medications for type-2 diabetes.

"This field is only a decade old, and the possibility of developing treatments derived from bacteria related to or involved in specific diseases is tantalizing," Yadav said.

Story Source:

Materials provided by Wake Forest Baptist Medical Center. Note: Content may be edited for style and length.

Re: winter diabetes thread

cherry — Tue, 15 Jan 2019 10:36:55 GMT

In July 2017, the Centers for Disease Control and Prevention reported that 30.3 million adults, or 9.4 percent of the U.S. population, have diabetes. "Another 84.1 million have prediabetes, a condition that if not treated often leads to Type 2 diabetes within five years," according to the agency.

These figures are alarming because diabetes is a progressive disease that takes a massive toll on patients, their families and the U.S. economy. A 2018 report from the American Diabetes Association found that "the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined." In addition, the report noted that more than 300 million work days are lost to the economy because of diabetes and a quarter of all health care dollars spent in 2017 went toward care of diabetic patients.

Re: winter diabetes thread

Teddie — Tue, 15 Jan 2019 12:43:00 GMT

I appreciate you taking the time to share these, @cherry. Diabetes is a progressive disease and affects every part of our body. Ugh, how depressing to know it’s probably going to get worse before it gets better.

Re: winter diabetes thread

cherry — Tue, 15 Jan 2019 12:32:46 GMT

@Teddie you know, sometimes it seems, we are fighting a giant, but, we still need to do the best we can ,to stay healthy

They are finding new information everyday, and the entire world is working on a solution. The glass is really half full. Don't lose heart

Re: winter diabetes thread

Teddie — Tue, 15 Jan 2019 12:40:28 GMT

If you ask anyone in my family, I was always the one who leaned toward the healthy lifestyle and took certain vitamins. I’ve just improved on that as I’ve learned more. But I’m the one who has diabetes, no one else in my family does. It’s just discouraging to know as I get older things can start to get worse.

Thank you, dear @cherry, for your kind, encouraging words. We will hang in there.

Re: winter diabetes thread

cherry — Tue, 15 Jan 2019 19:44:38 GMT

“I didn’t listen to any of the pre-diabetes signs,” Randy Jackson said. (Randy Jackson)

Randy Jackson says he shouldn’t have been surprised when he was diagnosed with Type-2 diabetes years ago. All the signs were there: His body often felt hot; he was lethargic; he couldn’t quite quench his thirst.

“I didn’t listen to any of the pre-diabetes signs,” he said. “You’d think that with all the knowledge out there you would heed those warnings. It runs in my family and I should have been more careful.”

Instead, Jackson’s first inkling that something was awry came from a visit to his dentist, who told Jackson that, based on the health of his gums, he might have high blood sugar. A month later, Jackson ended up in a hospital emergency room, and was diagnosed with Type-2 diabetes.

That was 18 years ago. Shortly afterward, the music producer and then-“American Idol” judge began working with a behavior modification therapist to help him understand why he ate the way he did. He underwent gastric bypass surgery and lost 120 pounds. He has kept the diabetes in check with a mix of medication, healthful eating and regular exercise. Nor has Jackson forgotten that visit to his dentist; he’s partnered with Colgate Total and the American Diabetes Assn. on a campaign to spotlight the connection between gum disease and diabetes, a condition which is diagnosed on average once every 21 seconds in the U.S.

Here, he shares his six tips for keeping off the weight and staying healthy — and why he models his meals after airline food.

1. You don’t have to hit the gym

I don’t go to the gym. I hate the idea of a trainer barking at me. Let me do my own thing. I love tennis. I started walking more every day. I like yoga and Pilates. Pilates is the best exercise ever invented because it strengthens your whole core.

2. Embrace drastic changes

My diet before diabetes was horrific. It was basically anything I wanted. If someone threw a doughnut party I’d have 14 doughnuts. Landing in the ER was a huge rude awakening but it had a silver lining because it forced me to get my life together. You have a choice — do you want to feel good or do you want to feel bad?

3. Do a deep dive into “why?”

Behavior modification therapy really helped me. I’m one of those addictive personalities that has to completely change the way I look at something to have it sit well in my life. I began to look at food as the nourishment I needed, not as a party.

4. Learn from airplane food

I’ve been vegan and vegetarian and tried all sorts of diets. To me, the airplane meal is the perfect meal because of the portion. You have a piece of meat the size of your palm. Everything is portioned out, and it’s a little bit of everything. You shouldn’t be eating more than that.

5. Aim for balanced meals

For breakfast, I try to get in some protein — maybe eggs with bacon. Lunch is salad and fish. I snack throughout the day on Vega protein bars and crisps, which are all plant-based.

6. Before you eat, stop and think

Ask yourself, “Why am I eating this bucket of ice cream?” We eat our feelings. We eat because we are anxious or disappointed or emotional. I had to learn to deal with feelings without using food.

Re: winter diabetes thread

cherry — Wed, 16 Jan 2019 10:36:41 GMT

UM study testing whether Omega 3 and vitamin D can halt progression of Type 1 diabetes

By Julie Landry Laviolette Special to the Miami Herald

November 21, 2018 01:04 PM,

Updated November 21, 2018 01:04 PM

Dr. Camillo Ricordi, of the University of Miami Miller School of Medicine, is working on islet cell transplantation. Diabetes patients who have had the cell transplants are now living without insulin. Ricordi is director of the Diabetes Research Institute, which is currently seeking Type 1 diabetes patients for a clinical trial to test if high doses of omega-3 and vitamin D can halt progression of the disease. Al Diaz Miami Herald file

Adult and pediatric Type 1 diabetes patients are being sought for a clinical trial to test if high doses of omega-3 and vitamin D can halt the progression of the disease.

The Diabetes Research Institute at the University of Miami Miller School of Medicine is conducting the trial.

The Poseidon Trial will study the safety and effectiveness of the two oral medications, with the hope that it may slow or stop the progression of the autoimmune process and preserve insulin-producing cells, essentially halting Type 1 diabetes from developing further.

In type 1 diabetes, the body does not produce insulin, which the body needs to get glucose from the bloodstream into the cells.

Scientific reports have suggested that high-dose omega-3 and vitamin D supplementation may improve autoimmune conditions like Type 1 diabetes.

“What has been found is that omega-3 and vitamin D, above a certain dose, become both anti-inflammatory and immunomodulatory,” meaning that they can change and regulate the body’s immune system, said Dr. Camillo Ricordi, director of the Diabetes Research Institute at the University of Miami.

Inflammation may be one of the triggers for autoimmunity that leads to the onset of the disease. It also may also affect insulin resistance, Ricordi said in a statement announcing the trial.

Results from a recent case study examining the role of omega-3 and vitamin D in preserving beta cell function (to store and release insulin) in three pediatric patients with Type 1 diabetes warranted further investigation of the therapeutic strategy, he said.

“The combination of the two are safe and very inexpensive compared to other expensive biologic drugs that are being tested, so I think it is a safe, affordable alternative that can have a profound impact on not just Type 1 diabetes, but autoimmune conditions in general,” Ricordi said.

At center, Dr. Camillo Ricordi from University of Miami’s medical school is working on islet cell transplantation. Diabetes patients who have had the cell transplants are now living without insulin.

Al Diaz Miami Herald file

The Diabetes Research Institute is enrolling 56 adults and children ages 6 to 65 with Type 1 diabetes, both newly diagnosed and those who were diagnosed more than six months ago. Study participants will take either vitamin D alone or in combination with omega-3 for one year, followed by a one-year observation period.

“We are at the very beginning…and I am very excited to able to test this hypothesis,” Ricordi said.

But he is cautious about creating hype about the therapy before it is tested.

“One of our problems is once you explain the trial, it’s so simple people are trying it on their own,” he said. In fact, there are tests that can be secured online to monitor omega-3 and vitamin D levels by doing a simple finger stick and mailing off a blood sample.

“But it should be done under medical supervision. I cannot recommend that anyone do a trial that is not proven yet,” Ricordi said. “I recommend enroll in the trial and get validation of the hypothesis or discuss this with your physician.”

It is also important to use a highly purified form of omega-3.

“You don’t want to get a cheap product that may have contaminants like mercury, especially if you are taking them at a higher dose,” he said.

Studying the effects of omega-3 and vitamin D could change health care as we know it, Ricordi said.

“There are trials studying the effects of the combination of omega-3 and vitamin D to prevent cardiovascular disease, stroke and cancer,” he said. “You’ll see many more trials coming up on this topic.”

Re: winter diabetes thread

cherry — Wed, 16 Jan 2019 10:55:15 GMT

Exercise Must Be a Prescription for Those With Type 2 Diabetes, European Cardiologists Say

Mary Caffrey

Keeping patients with diabetes motivated is the most challenging part of exercise, the authors say, as they call for psychologists and counselors to be part of the care team.

People with type 2 diabetes (T2D) need individual prescriptions for exercise, not finger-wagging from their doctors, according to a new position paper from the European Association of Preventive Cardiology.

The group is a branch of the European Society of Cardiology (ESC), which publishes the European Journal of Preventive Cardiology, where the paper appears Tuesday. “Just advising patients to exercise, which is what doctors typically do, is not enough,” first author Hareld Kemps, MD, a cardiologist with Maxima Medical Centre in the Netherlands, said in a statement. An actual prescription for exercise is needed, the authors say.

Kemps said that physicians must “take the lead” in calling for programs to be reimbursed by insurers.

Making movement a daily habit seriously lowers the risks associated with heart disease, which is the leading cause of death among people with T2D. It’s also the most cost-effective way to treat the disease, but it’s also the most difficult because so many people stumble when trying to stick with a fitness plan.

To address this, the paper encourages physicians to integrate exercise in a patient’s daily routine and increase their cardiorespiratory fitness over time. Showing the patient how measurable improvements are improving their health beyond what they see on the scale can keep patients motivated. The paper points out the need to work with a team of professionals, involving specialists such as psychologists and counselors, to help T2D patients achieve their goals.

Among the report’s recommendations and findings:

A patient’s cardiorespiratory fitness should be assessed with cardiopulmonary testing before an exercise program begins. Getting low-density lipoprotein cholesterol under control is important for patients who have not been active.
Each patient’s exercise plan should be customized, and doctors should increase goals as the patient hits fitness milestones.
Where possible, combining aerobic training and resistance training is the best way to improve glycemic control and muscle mass and function.
Both glycated hemoglobin (A1C) and cardiorespiratory fitness are important measures of the success of a training program.
Current evidence does not support or refute that exercise that that exercise reduces death rates in T2D patients, but there is evidence that exercise reduces microvascular complications that lead to disability, such as the loss of kidney function or nerve damage.
Improving vascular function is a good reason to exercise; it reduces the chance of a heart attack and eases symptoms such as erectile dysfunction, apart from the benefits for improving A1C.
Exercise can help control of lipids, but it does not replace medication like statins.

What kind of exercise is best?

While the report generally recommends a combination of aerobic activity, such as running, cycling, or swimming, to improve cardiovascular fitness; along with resistance training to build muscle mass, how this happens will vary with each patient.

Keeping patients engaged is key. “Motivation and thus adherence might be improved by early achievement of certain exercise training goals,” the authors state.

The paper specifically recommends aerobic training 3 to 5 times per week, and it discusses the benefits of high intensity interval training (HIIT), which allows patients to maximize heart rate in short bursts from 1 to 4 minutes. But the paper cautions that HIIT “requires high levels of motivation and capability of the patient,” demands more supervision, and calls for a structured training plan.

A simpler strategy is telling the patient to break up long periods of sitting by walking around and stretching.

Comorbidities

The paper discusses how to decide who can exercise, and which forms are safe for which patients. It calls for doctors to create “relevant and achievable targets,” including those that involve improving the quality of life. Some patients with T2D have serious health problems that would prevent certain types of exercise, or require them to slowly build up cardiorespiratory fitness over an extended period.

The paper spells out precautions and protocols for patients with arrhythmia, myocardial ischemia, cardiovascular autonomic neuropathy, and left ventricle dysfunction. Authors say those with peripheral artery disease should not perform high-intensity exercise. They recommend that patients be regularly checked for hypertension, glycemic status, and spell out when stress tests are required.

The main problem, however, is adherence, which the authors say “is severely affecting the outcome of many trials.”

Re: winter diabetes thread

cherry — Thu, 17 Jan 2019 11:03:31 GMT

Diabetes and Stress Hyperglycemia Linked with Worse Outcomes After Stroke

Written by Elizabeth Michaelson Monaghan

With William (Lik-Hui) Lau, MBBS, and Walter N. Kernan, MD

People with diabetes face greater complications after having a stroke. And, if you have diabetes, the chance that you might experience a cardiovascular event is 1.5 times greater than someone who doesn’t have diabetes.

In fact, patients with diabetes have poorer health outcomes and longer hospital stays when experiencing an ischemic stroke, the most common type of cerebrovascular event,1 according to a review published in Journal of Diabetes Investigation.

In a review of 39 studies that encompassed nearly 360,000 patients,1 the investigators also found that an estimated 28% of people who had been hospitalized for a stroke had diabetes, indicating that diabetes was more common in stroke patients than in the general population.

Stress Hyperglycemia: A Warning to Patients with Diabetes

Stress hyperglycemia—a form of high blood sugar—is a condition brought on by an acute illness, or a cardiovascular event, and is usually discovered during a hospital stay. Stress hyperglycemia (incident high blood sugar) generally resolves after the patient recovers from the illness, but the effects can be long-lasting.2,3

"The most appropriate cutoff point for stress hyperglycemia in patients with pre-existing diabetes needs to be established, but certainly a patient with a well controlled (< 7%) hemoglobin A1Cc (HbA1c) whose glucose concentration is consistently higher than the threshold defined for hospital-related hyperglycemia would qualify," according to Dr. Dungan.

So you could say, "stress hyperglycemia can be defined as a fasting blood sugar higher than 124 mg/dL (milligrams per deciliter of blood), 3,4 or a random blood sugar higher than 200 mg/dL for both patients with established, well-controlled diabetes and those without diabetes."4

In patients, with or without diagnosed diabetes, stress hyperglycemia is associated with worse cardiac functioning after an ischemic stroke. But for patients without diabetes, stress hyperglycemia appears linked with more severe strokes—and a greater risk of dying.

“Stress hyperglycemia appears to be more consistently associated with poorer outcomes after stroke compared with established diabetes,” says the study first author, William (Lik-Hui) Lau, MBBS (equivalent to an MD from a US medical school) and confirmed by the senior author, Elif I. Ekinci, MBBS, PhD, associate professor at the University of Melbourne in Australia. This “supports the hypothesis that stress hyperglycemia reflects stroke severity.”

“However, even after adjusting for this, stress hyperglycemia and established diabetes are both still independently associated with poorer outcomes after stroke,” Dr. Lau tells EndocrineWeb. In addition, anyone who has a stroke should also be aware of their increased risk of experiencing another stroke event.1

Stress hyperglycemia is linked with other health issues as well. And in hospitalized patients, it’s associated with a greater likelihood of complications like sepsis, urinary tract infections, and pneumonia.5 Finally, in patients without no known diabetes, experiencing stress hyperglycemia raises the risk of diabetes.6

How Common Is Stress Hyperglycemia?

It’s difficult to estimate how many people experience stress hyperglycemia, since a patient with abnormally high blood sugar may actually have undiagnosed diabetes. Of the estimated 30 million people in the US with diabetes, 7.2 million, or nearly one in four people, have diabetes,7 according to the Centers for Disease Control and Prevention. "Not all patients are necessarily evaluated for diabetes during an inpatient stay,” says Dr. Lau.

The prevalence of nondiabetes-related stress hyperglycemia “has been quoted to be between 8-35 percent of patients who presented with an ischemic stroke,”8 says Dr. Lau. “This variability is in part due to the heterogeneity [or differences] in the definition of stress hyperglycemia between the studies”9 he says. For instance, the American Association of Clinical Endocrinologists and the American Diabetes Association have defined hyperglycemia as any blood sugar above 140 mg/dL.10

While Study Design is Lacking, Findings Raise Valid Concerns

The findings of the meta-analysis and literature review are intriguing, but the methods used to leave room for some questions, says Walter N. Kernan, MD, professor of medicine at Yale School of Medicine in New Haven, Connecticut.

“I’m not sure that they looked at evidence from clinical trials. I was able to identify at least one paper in this field that they did not include in their analysis,” he tells EndocrineWeb. Nonetheless “I don’t have criticisms of the findings—that diabetes is common among patients with stroke, and is associated with adverse outcomes.”

“I think this field is rapidly moving towards greater insights about the role of diabetes in affecting outcome after stroke,” says Dr. Kernan who was not involved in this study. “This paper is addressing a really important area in vascular neurology that’s full of promise.” The recommended treatment for stress hyperglycemia is to begin patients on insulin and with very close monitoring of blood sugar levels.11,12

To prevent a second episode, or recurrence of vascular events such as heart attack or stroke, often heralded by a surge in blood sugar, “two new agents, SGLT2i (sodium-glucose cotransporter 2 inhibitors) and the GLP-1 (glucagon-like peptide-1) receptor agonists are effective at lowering the risk for major adverse cardiac events in patients with type 2 diabetes, as these patients are at higher risk for, or who have, vascular disease,”13,14 says Dr. Kernan.

Furthermore, the recent Insulin Resistance Intervention After Stroke (IRIS) trial found that in patients with prediabetes who experienced an ischemic stroke, the diabetes medication pioglitazone can “substantially reduce the risk for stroke and myocardial infarction [heart attack],” 15 says Dr. Kernan. He points out that prediabetes is “at least as common as diabetes” in patients with ischemic stroke.

Need for Further Research on the Relationship of Hyperglycemia and Stroke

“Larger, more robust studies using defined diabetes diagnostic and stroke outcome measures are needed,” Dr. Lau tells EndocrineWeb. “Specifically, the use of combined glucose testing to include fasting blood glucose, glucose tolerance testing, and hemoglobin A1c to determine if—and how—these measures estimate the true prevalence of existing and newly diagnosed diabetes, and can predict outcomes in both ischemic and hemorrhagic stroke.

The HbA1c test, which estimates average blood sugar control over the past three months, may be a particularly valuable measure since HbA1c results not only remain unaffected by stress hyperglycemia, but higher HbA1c levels are also linked with worse outcomes—including stroke recurrence and greater risk of death—after stroke.

Finally, Dr. Lau concludes, “Whether the treatment of stress hyperglycemia improves stroke outcomes is an important question to answer.”

Re: winter diabetes thread

AnjalenaQVC — Thu, 17 Jan 2019 11:08:54 GMT

This post has been removed by QVC because it is political.

Re: winter diabetes thread

cherry — Thu, 17 Jan 2019 12:10:46 GMT

Certain Diabetes Medicine May Raise Risk for Amputation

French researchers recently discovered that certain diabetes medicines known as diuretics may raise the risk for amputation. This conclusion was obtained after an analysis of approximately 1,500 patients with type 2 diabetes. After seven years, 13% of participants who used diuretics had gone through an amputation or other procedure of the lower leg. This was compared to 7% of those who didn’t take diuretics. Likewise, taking diuretics was found to have a 75% increased risk of having an amputation or a bypass or angioplasty.

Based on these findings, researchers from Bichat Hospital in Paris warn that diuretics be used cautiously in patients with type 2 diabetes. However, further studies are needed to confirm these results.

These findings were presented at the European Association for the Study of Diabetes meeting on October 1, 2018.

Re: winter diabetes thread

Anonymous — Thu, 17 Jan 2019 12:29:03 GMT

This post has been removed by QVC because of copyright seal

Re: winter diabetes thread

cherry — Fri, 18 Jan 2019 11:01:39 GMT

Jan. 17, 2019

An advisory panel for the Food and Drug Administration split evenly on Thursday over whether the agency should approve the first oral medication to treat Type 1 diabetes.

The committee voted 8-8, leaving it up to the agency to decide by the end of March whether the drug, sotagliflozin, should reach the market.

The drug, which is used along with insulin, is being developed by the drug makers Sanofi and Lexicon Pharmaceuticals, who plan to sell it under the brand name Zynquista. It carries a higher risk for developing diabetic ketoacidosis, a life-threatening complication that happens when the body doesn’t get enough insulin, which led some of the reviewers to vote against it.

The companies said they would continue work with the F.D.A. throughout the review process.

The drug is a once-daily pill designed to help people manage their blood sugar levels. In Type 1 diabetes — also known as juvenile diabetes because it is often diagnosed in childhood — the body does not produce insulin, so people with the disease must monitor their blood sugar and take insulin. But relying on external insulin can lead the body’s blood sugar levels to rise and fall, which is uncomfortable and can lead to health problems.

Re: winter diabetes thread

cherry — Fri, 18 Jan 2019 11:05:14 GMT

Scientists working to develop more effective treatments for diabetes are turning to stem cells. Such cells can be transformed into cells that produce insulin, the hormone that controls blood sugar.

But there's a major challenge: the amount of insulin produced by theses cells is difficult to control.

Now, by tweaking the recipe for coaxing human stem cells into insulin-secreting beta cells, a team of researchers at Washington University School of Medicine in St. Louis has shown that the resulting cells are more responsive to fluctuating glucose levels in the blood.

When they transplanted the beta cells into mice that could not make insulin, the new cells began secreting insulin within a few days, and they continued to control blood sugar in the animals for months.

The new study is published Jan. 17 in the journal Stem Cell Reports.

"We've been able to overcome a major weakness in the way these cells previously had been developed. The new insulin-producing cells react more quickly and appropriately when they encounter glucose," said principal investigator Jeffrey R. Millman, Ph.D., an assistant professor of medicine and of biomedical engineering. "The cells behave much more like beta cells in people who don't have diabetes."

The researchers now believe it may be time to evaluate whether the same stem-cell approach could produce insulin and effectively control blood sugar in people.

Millman was a part of a research team at Harvard that, in 2014, converted skin cells into stem cells and, in 2016, did the same thing with skin cells from a patient with diabetes. Each time, the stem cells were then treated with various growth factors to coax them into insulin-secreting beta cells. The beta cells, however, didn't work as well as the researchers had hoped.

"Previously, the beta cells we manufactured could secrete insulin in response to glucose, but they were more like fire hydrants, either making a lot of insulin or none at all," he said. "The new cells are more sensitive and secrete insulin that better corresponds to the glucose levels."

For this study, Millman's laboratory still grew beta cells from human stem cells, but they made numerous changes to the "recipe" for producing insulin-producing beta cells, treating the cells with different factors at different times as they grew and developed to help the cells mature and function more effectively.

After that process was complete, the researchers transplanted the beta cells into diabetic mice with suppressed immune systems so that they wouldn't reject the human cells. Those transplanted cells produced insulin at levels that effectively controlled blood sugar in the mice, functionally curing their diabetes for several months, which, for most of the mice in the study, was about the length of their lives.

As laboratory researcher rather than a clinician, Millman said he can't predict exactly when such cells may be ready for human trials but believes there are at least two ways that stem cell-derived beta cells could be tested in human patients.

"The first would be to encapsulate the cells in something like a gel—with pores small enough to prevent immune cells from getting in but large enough to allow insulin to get out," he said. "Another idea would be to use gene-editing tools to alter the genes of beta cells in ways that would allow them to 'hide' from the immune system after implantation."

Millman said that if stem cell-derived beta cells are proven safe and effective for people with diabetes, his method of manufacturing the cells quickly could be ramped up to an industrial scale. In his laboratory alone, his team is able to grow and develop more than a billion beta cells in just a few weeks.

Re: winter diabetes thread

cherry — Fri, 18 Jan 2019 11:13:10 GMT

THURSDAY, Jan. 17, 2019 (HealthDay News) -- An experimental drug may help people with type 2 diabetes curb their blood sugar without causing it to drop to dangerously low levels.

Researchers found that the compound -- dubbed TTP399 for now -- improved patients' blood sugar control when it was added to the standard medication metformin for six months.

And it did so without causing hypoglycemia -- blood sugar drops that, if severe, can lead to convulsions or loss of consciousness.

The findings, published Jan. 16 in the journal Science Translational Medicine, come from an earlier "phase 2" trial. And more research is needed before TTP399 can be added to existing armaments against type 2 diabetes, said senior researcher Carmen Valcarce.

But, she added, the effects seen so far on blood sugar control are comparable to, or even better than, what's seen with current medications for the disease.

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Valcarce is chief scientific officer for vTv Therapeutics, the North Carolina-based company developing TTP399.

Type 2 diabetes affected over 30 million Americans in 2015, according to the American Diabetes Association. It arises when the body can no longer properly use insulin, a hormone that regulates levels of glucose (sugar) in the blood. When blood sugar levels habitually soar, that can take a toll on the body over time -- damaging the blood vessels and heart, nerves, kidneys and eyes.

And while there are medications for type 2 diabetes, there's still a need for additional options, Valcarce said.

"Some people don't respond well to the current medications," she noted. "Some people can't tolerate the side effects."

Dr. Debra Simmons is an endocrinologist and professor at the University of Utah, in Salt Lake City.

She agreed there's a need for additional diabetes medications that work through actions that are different from available drugs. The specific underlying causes of diabetes vary from person to person, said Simmons.

TTP399 works by activating an enzyme called glucokinase, which acts as a blood sugar "sensor."

Other compounds that target glucokinase have been developed. But they've been stymied by side effects -- not only hypoglycemia, but elevations in triglycerides (a blood fat).

art of the problem, according to Valcarce, is that some earlier compounds affected glucokinase in both the liver and the pancreas. And when it's activated in the pancreas, that may cause blood sugar to plummet.

Another issue, Simmons said, is that some compounds disturbed the way glucokinase normally interacts with a protein that regulates it. That seemed to be spurring the rise in triglycerides.

So TTP399 was designed to avoid those problems.

Valcarce's team put it to the test in 190 patients with type 2 diabetes. All were already taking metformin, and some were randomly assigned to add a daily dose of TTP399. The rest of the patients added either inactive placebo pills or a diabetes drug called sitagliptin (Januvia).

After six months, patients on the new compound showed a greater reduction in their A1c level, versus placebo patients. A1c is a measure of a person's average blood sugar level over the past two to three months.

There were no cases of serious blood sugar drops, the researchers said, and no negative effects on triglycerides.

Larger, longer-term studies are still needed, Simmons said, to see how the drug's effectiveness and safety hold up.

Simmons pointed to the bigger picture: That researchers are studying the underpinnings of diabetes and trying to develop new treatment options.

But, she stressed, "diet and exercise are always going to be important in managing diabetes."

WebMD News from HealthDay

Re: winter diabetes thread

cherry — Fri, 18 Jan 2019 11:24:59 GMT

This is not a thread about politics, it is about the latest health concerns for diabetics, and the latest news

It is important, to many of us to ,be able to know this stuff. So ,please do not post material ,that endangers this thread...

Re: winter diabetes thread

cherry — Sun, 20 Jan 2019 12:34:18 GMT

A new experimental dru,g shows promise, for working without upsetting the digestion. It is copy righted ,so, I will provide the link

https://www.upi.com/Experimental-diabetes-drug-better-than-current-meds-trial-results-suggest/4001547816591/

Re: winter diabetes thread

cherry — Sun, 20 Jan 2019 12:51:46 GMT

Lisa Crook was lucky. She saved $800 last year after her insurance company started covering a new, less expensive insulin called Basaglar that was virtually identical to the brand she had used for years.

The list price for Lantus, a long-acting insulin made by Sanofi that she injected once a day, had nearly quadrupled over a decade.

With Basaglar, “I’ve never had my insulin cost drop so significantly,” said Crook, a legal assistant in Dallas who has Type 1 diabetes.

But many people with diabetes can’t get the deal Crook got. In a practice that policy experts say smothers competition and keeps prices high, drug companies routinely make hidden pacts with middlemen that effectively block patients from getting cheaper generic medicines.

Such agreements “make it difficult for generics to compete or know what they’re competing against,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University School of Medicine.

(MORE: Health providers try to inform immigrant patients of risks without scaring them off)

Here’s how it works: Makers of established brands give volume-based rebates to insurers or intermediaries called pharmacy benefit managers. In return, those middlemen often leave competing generics off the menu of drugs they cover, called a formulary, or they jack up the price for patients. The result is that many can’t get the cheaper drugs unless they shoulder a bigger copay or buy them with no help from insurance.

Brand-drug sellers “pay for position” on the formulary, said Michael Rea, CEO of Rx Savings Solutions, which helps health plans and employers manage pharma costs. “In this country, the most cost-effective drugs don’t necessarily mean anyone will have access to them … [Companies with] the deepest pockets win.”

This so-called rebate trap joins a long history of efforts by makers of brand-name drugs to stifle generics, including protecting drugs with multiple layers of dubious patents, “pay for delay” deals to keep generics off the market and withholding key ingredients needed for generic production, critics say.

Because rebate contracts are secret, nobody knows the full extent of the practice nor how much it costs the health system in unrealized savings.

“The deals between the drug companies and the PBM middle players are guarded as fiercely as Fort Knox,” said Robin Feldman, a law professor at the University of California, Hastings College of the Law, who studies pharma policy. “No one gets to see them.”

But new research is turning up plenty of evidence of rebates distorting the market, such as numerous instances of effective, less expensive generics missing from formularies or patients burdened with higher out-of-pocket costs for generic drugs.

In unpublished research, Dusetzina found that only 17 percent of Medicare plans for seniors covered Basaglar, the biosimilar launched by Eli Lilly two years ago. Nearly all of them covered brand-name Lantus, sold by Sanofi, as of early last year.

Her research suggests rebates from Sanofi might have induced insurers to leave lower-priced Basaglar off their formularies, Dusetzina said.

Sanofi works with insurers and pharmacy benefit managers “to negotiate access for patients to our portfolio of products including Lantus,” said company spokesman Jon Florio, declining to disclose specifics.

Medicare plans covering Lantus but not Basaglar include numerous offerings from Anthem, the biggest for-profit, Blue Cross and Blue Shield insurer.

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“After evaluating the total cost impact on consumers, taxpayers and the government, we chose to cover the brand drug, Lantus, over the biosimilar, Basaglar,” said Anthem spokeswoman Lori McLaughlin.

Replacement versions of complex drugs often made from living cells are called biosimilars, not generics. Basaglar is considered clinically equivalent to Lantus but, because of a legal wrinkle, won’t technically be considered a biosimilar by regulators until 2020.

Merck scrapped its own biosimilar version of Lantus last fall, despite receiving tentative approval by the Food and Drug Administration, after “assessing … the market environment,” the company said.

Coverage of Lilly’s Basaglar has grown, and the drug is now included in formularies used by slightly more than half the patients who have health insurance, said Eli Lilly spokesman Greg Kueterman.

In another forthcoming study, this one examining 2018 Medicare coverage, researchers at Johns Hopkins Bloomberg School of Public Health found that “almost every plan has at least one branded drug on the formulary that’s in a better place than the generic,” said Gerard Anderson, the professor leading the research.

(A grant from the Laura and John Arnold Foundation, which helps support Kaiser Health News, financed the Hopkins research).

In 2015, only 19 percent of generic drugs covered by Medicare were in the preferred formulary tiers with the lowest out-of-pocket costs, found a study last year by consultants Avalere. In 2011, on the other hand, 71 percent of generics had been in the best tier, which helps determine what patients are prescribed.

The Association for Accessible Medicines, the generic drug lobby, paid for that study. Rebate-influenced barriers to generics are “increasingly problematic,” said AAM CEO Chip Davis.

Disputes over formulary choices have hit the courts. Pfizer sued Johnson & Johnson in 2017, alleging that rebates induced insurers to prefer Remicade, an anti-inflammatory biologic, at the expense of Pfizer’s lower-priced product.

Critics of rebate traps include top Trump administration officials, under pressure from a president who has promised to lower drug prices.

Because quick rebates from brands are often more attractive to PBMs and insurers than long-term savings from generics, “this is a real challenge in terms of biosimilars coming to market and gaining market share” Scott Gottlieb, head of the FDA, said in an interview.

Such objections add to a crescendo of grievances against hidden rebates. Consumers and advocates have complained for years that rebates cut costs for PBMs and insurers but do little for patients, who are often left paying their out-of-pocket share based on soaring list prices.

Crook’s out-of-pocket costs for Lantus rose steadily over the years to about $900 annually, she said. After switching to Basaglar last year, her cost was less than $100.

Mark Gooley, who has Type 1 diabetes and lives in Florida, said he started ordering Lantus by mail from Canada after the U.S. list price rose fourfold in a little more than a decade.

“I have a very low opinion of companies like Sanofi,” he said. “They could afford to sell it to me when it came out” at a much lower price, he said. “Inflation has not been 400 percent.”

Because of rebates paid to PBMs, Sanofi’s net price for Lantus has actually decreased over the past five years despite the list-price increases, said company spokesman Florio. “Unfortunately, these savings are not consistently passed through to patients,” he said.

PBMs say they respond to the terms drug companies offer and negotiate to save billions for government, insurers and employers. “Simply put, the easiest way to lower costs would be for drug companies to lower their prices,” the Pharmaceutical Care Management Association, the PBM lobby, said in an emailed statement.

For its part, PhRMA, the branded-drug association, has said it wants to scrap the rebate system and have PBMs paid for services provided.

Congress has done little to fix the rebate problem despite widespread criticism, but senior legislators in both chambers have pledged to address high drug prices this year.

Last summer, the Department of Health and Human Services proposed changing “safe harbor” protections that shield pharma rebates from being viewed as illegal kickbacks. But the proposal, under review at the Office of Management and Budget since July, has never been publicly aired, leaving the industry to wonder how substantial it is and if it will ever take effect.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Re: winter diabetes thread

cherry — Sun, 20 Jan 2019 21:32:57 GMT

15 easy low carb meals made in a crock pot. Click on slide show

https://www.popsugar.com/fitness/Low-Carb-Slow-Cooker-Recipes-45634898

Re: winter diabetes thread

cherry — Mon, 21 Jan 2019 11:14:44 GMT

an. 8, 2019 -- Drinking diet soda may raise the risk for a severe type of diabetic eye disease that can lead to blindness, a new study says.

The study, published in Clinical and Experimental Ophthalmology, is the first to evaluate the link between soft drinks and what’s called proliferative diabetic retinopathy.

"In our clinical sample of people with diabetes, consuming more than four cans, or 1.5 liters, of diet soft drinks per week was associated with a twofold increased risk of having proliferative diabetic retinopathy," first author Eva Fenwick, PhD, told Medscape Medical News. Fenwick is a clinical research fellow at the Singapore Eye Research Institute and an assistant professor at the Duke-NUS Medical School, Singapore.

The study did not find the same results among those who drank regular, sugar-sweetened soft drinks.

More studies are needed to tell whether soft drinks are unhealthy alternatives to sugar-sweetened beverages, Fenwick says.

.

Diet soft drinks have been marketed as healthier than regular soft drinks, yet a growing body of evidence has suggested that artificial sweeteners may also harm your health. Past research has linked diet soda to a higher risk of diabetes, heart disease, and stroke.

Some researchers believe that diet beverages may "fake out" the body to assume that it has taken in more energy than it really has. That may lead to more hunger and higher calorie intake in the long run.

The study included 609 adults -- 73 with type 1 diabetes , 510 with type 2 diabetes, and 26 with an unknown type of diabetes -- at an eye hospital between 2009 and 2010. The average age of the participants was 64.6 years. They came from the Diabetes Management Project, a study of English-speaking adults with diabetes in Melbourne, Australia.

Participants reported how many soft drinks they drank as part of a 145-question food questionnaire. Of the total sample, 46.8% drank regular soft drinks, and 31.2% drank diet soft drinks.

Almost a quarter had proliferative diabetic retinopathy.

Those who drank more than four 12-ounce servings of diet soda a week were 2.5 times more likely to have the disease, researchers found. The researchers adjusted results for things that usually make diabetic retinopathy more likely, such as diabetes duration, smoking, and body mass index.

Those who regularly drank sugar-sweetened soft drinks were not as likely to have the disorder.

"Our finding that regular soft drink was not associated with increased risk of proliferative diabetic retinopathy could be due to the small numbers of high consumers. We had to merge the high-consumer category with the moderate-consumer category, and this may have masked the true relationship," Fenwick told Medscape Medical News.

"Although the results of our study must be interpreted within the context of several limitations, they add to the growing body of literature on the harmful effects of diet drinks on a range of health outcomes, including CVD [cardiovascular disease], diabetes, and metabolic syndrome," Fenwick said.

"Given that diet soft drinks are perceived as a healthy alternative to regular soft drinks, clinicians and patients should be aware that diet soft drinks may not be without risks of their own," she concluded.

Medscape Medical News