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Re: Diabetes news for spring 2019

Newswise — NEW ORLEANS—Caucasians and Hispanics with diabetes have a greater risk of fracture compared to those without diabetes, while African Americans with diabetes have little to no additional fracture risk, according to a study to be presented Saturday, March 23 at ENDO 2019, the Endocrine Society’s annual meeting in New Orleans, La.

“Diabetes has been associated with additional risk of fracture, but it had not been well studied in African Americans or Hispanics, the two racial-ethnic groups with the highest rates of diabetes in the United States,” said lead researcher Rajesh Jain, M.D., of the Lewis Katz School of Medicine at Temple University in Philadelphia, Pa.

He noted that because of the additional fracture risk associated with diabetes, some medical groups have suggested additional osteoporosis screening or treatment to help prevent fractures in patients with diabetes.  “This research could mean that African Americans with diabetes may not require the additional screening or treatment for osteoporosis that Caucasians or Hispanics with diabetes may require,” Jain said.

The researchers evaluated data from 19,153 people with diabetes (7,618 Caucasian, 7,456 African American and 4,079 Hispanic) and 26,217 people with hypertension (15,138 Caucasian, 8,301 African American, and 2,778 Hispanic), all at least 40 years of age. When controlling for other important factors, the risk of fracture in white and Hispanic people with diabetes was 23 percent higher than those without diabetes.  However, the risk of fracture in African Americans with diabetes was not significantly different than those without diabetes.

“This is a novel finding and has not been previously reported,” Jain said.

African Americans, regardless of whether they had diabetes, had more than 10-fold risk of a fracture if they had a fracture in the past, compared with about a two-fold increased risk in white and Hispanic people.

“This suggests risk factors for fracture may differ in African Americans,” Jain said.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

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Re: Diabetes news for spring 2019

I just had a bone density test done, and I have a 3% risk of a hip fracture ,and an 11 % chance of a fracture in my left arm.

 

Most women suffer some  bone loss during menopause. I decided to do weight training ,at the gym. to help my bones stay strong. I am going 3 days a week ,and train on the weight machines . I walk a mile a day ,so I decided not to do the treadmill.

 

 

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Re: Diabetes news for spring 2019

 
Nick Jonas holding a sign© Bang Showbiz Nick Jonas

Nick Jonas says managing his diabetes has been "quite the journey".

The 26-year-old singer was diagnosed with type one diabetes when he was 13, and has said now partnered with global health service Cigna on their Health Improvement Tour, which features a cross-country, traveling mobile clinic that delivers free health screenings to local communities.

Nick says it took him a long time to understand how his physical and emotional health were connected, and thinks Cigna's new tour will help encourage his fans to "prioritise a healthy life".

He said: "I'm a type 1 diabetic, diagnosed at 13 and have gone on quite the journey in my life in regards to just understanding what that connection is [between your physical and emotional health].

"Partnering with Cigna on this made the idea even simpler to me. Having lived with this disease for so long and taking those steps to prioritise a healthy life, I'm trying to encourage my fans to do the same."

And the Jonas Brothers star insists those struggling with their health "must" go to their doctor, because knowing how to tackle the problem can make "every aspect of your life better".

 

He added: "You must go see your doctor and get your check-ups and make sure you're in the healthiest space you can be in because it's going to make every aspect of your life better. That's a message I can get behind."

Nick also notes that mental health is just as important as physical health, and urged people not to allow themselves to get "lonely".

Speaking to People magazine, he said: "Isolation and loneliness is a big factor for a lot of people and something you may not believe is connected, but it certainly is. I would encourage all of my fans to think about companionship. I'm really fortunate [that] I get to connect to people whether it's at a show or through social media, and I hope to do the same with this."

 
 
 
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Re: Diabetes news for spring 2019

Coping With Diabetes Is a Family Affair

March 1, 2019, at 9:00 a.m.
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Coping With Diabetes Is a Family Affair

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By Serena Gordon
HealthDay Reporter


(HealthDay)

FRIDAY, March 1, 2019 (HealthDay News) -- When Giuseppina Miller's 8-year-old son, Peter, was first diagnosed with type 1 diabetes, he necessarily got a lot of his parents' attention.

"We tried to adjust pretty well, but I was getting no sleep because I had to check his blood sugar in the middle of the night, and I was worried all the time. My two younger daughters felt the stress and ended up getting ignored a little bit," Miller said.

The young girls -- just 7 and 5 at the time -- struggled to understand why their brother suddenly garnered so much parental attention, and one day Miller overheard the girls teasing their brother about his diabetes.

"They didn't really understand, so I thought it might help if they lived a day like he did. I had them eat like he did. And, at the time, he had a very strict diet because of the type of insulin he was taking," Miller said.

"I also made them ****** their fingers when he had to test his blood sugar. Obviously, they couldn't do insulin injections, but living like him for the day taught them what he had to deal with," she said. "It helped them understand."

Like Miller's daughters, many people struggle to understand what life is really like for someone living with diabetes -- whether it's a diagnosis of type 1 or type 2 diabetes.

William Polonsky, president of the Behavioral Diabetes Institute, said, "So many adults have said to me, 'The day I was diagnosed with diabetes, people started acting like I lost IQ points. They started speaking slower and louder, and were telling me what to do.'"

Polonsky said that people may assume that you have diabetes because of something you did. "There's a subtle form of blame and shame associated with diabetes. As if the fact that you have diabetes, or if you're not managing it perfectly, it may be due to your own personal failing," he explained.

When family or friends offer unsolicited advice, it's typically because they're concerned and are trying to be helpful. Yet, instead of asking how they could best help a person with diabetes, people often just "take their best guess," Polonsky noted.

These folks often wildly miss the mark. A common complaint is that loved ones act like the "diabetes police." They may ask: Do you need to check your blood sugar? Why is your blood sugar so high? Should you really be eating that food? Have you tried the latest diabetes "cure" I saw on the internet?

A better approach is to simply ask the person with diabetes how you can help them, Polonsky advised.

"Say 'Hey, it looks like living with diabetes is hard. How can I help you?'" he suggested.

Or, if you see that someone you love with diabetes needs to make healthier lifestyle choices, offer to join them as opposed to telling them what to do. For example, ask them if they want to exercise with you.

Paula Trief, a professor of psychiatry and behavioral sciences at SUNY Upstate Medical University in Syracuse, N.Y., said a "we're in this together" attitude may help the person with diabetes and their partner.

Whatever type of diabetes a person has, "there's a fair amount of anxiety about what the future holds, and a fear of complications," Trief said.

 
 
But, when partners collaborate, it can help reduce the anxiety.

Trief and her colleagues recently published a study in the journal Diabetic Medicine that found when partners of people with diabetes were involved in diabetes education, they had less distress about diabetes and felt better about their relationship overall. And, the people with diabetes had a slight improvement in their blood sugar control when their partner took part in their diabetes education.

Plus, it's a cost-effective intervention, she noted. "It doesn't cost any more financially if a partner comes to a doctor visit with you," Trief said.

What if you're the person with diabetes being bugged by the diabetes police? "Don't talk to anyone in that moment when you're angry," Polonsky said. "Find a dispassionate moment, and say, 'I know you want to be helpful. Can I give you a couple of ways that could help me, such as pick up a lunch for me if I forget mine or go for a walk with me?'"

Miller said that diabetes definitely affects all of your relationships -- siblings, spouses, grandparents, friends -- in some way.

"It's one of those things you can't really understand unless you've lived it," she explained. "It's like when you have a baby, until you have a baby, you just don't get it. Like everything else in life though, everyone handles it differently. Try to respect everyone's different strengths and weaknesses."

More information

Read more about getting helpful support from family and friends from the Joslin Diabetes Center.

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Re: Diabetes news for spring 2019

 
Removal of ‘zombie cells’ alleviates causes of diabetes in obese mice  
 

Article ID: 710147

Released: 25-Mar-2019 12:05 AM EDT

Source Newsroom: Mayo Clinic

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https://newsnetwork.mayoclinic.org/discussion/removal-of-zombie-cells-alleviates-causes-of-diabetes-...

Newswise — ROCHESTER, Minn. — Mayo Clinic researchers and their collaborators have shown that when senescent cells — also known as “zombie cells” — are removed from fat tissue in obese mice, severity of diabetes and a range of its causes or consequences decline or disappear. The findings appear in Aging Cell.

Inflammation and dysfunction of fat tissue cause some of the insulin resistance in obese people. In many cases, that dysfunction is caused by zombie cells that already have been shown to be responsible for conditions related to aging and illness, including osteoporosis, muscle weakness, nerve degeneration and heart disease. These cells also accumulate in the fat tissues of obese and diabetic people and mice.

In this study, the researchers, using genetically modified mice and wild-type (normal) mice, removed zombie cells two ways: by causing genetically-mediated cell death and by administering a combination of senolytic drugs. Senolytic drugs selectively kill senescent cells but not normal cells. The result: Glucose levels and insulin sensitivity improved. The mice also showed a decline in inflammatory factors and a return to normal fat cell function.

The senolytic drugs also prompted improved kidney and heart function, both of which are common complications of diabetes.

“Our findings show that senescent cells are a cause of obesity-related inflammation and metabolic dysfunction, and that senolytic drugs hold promise as a treatment of these conditions and their complications, which include diabetes,” says James Kirkland, M.D., Ph.D., senior author of the article. Dr. Kirkland is the director of the Robert and Arlene Kogod Center on Aging at Mayo Clinic.

The research was funded by the National Institutes of Health, the Minnesota Partnership for Biotechnology and Medical Genomics; Robert and Arlene Kogod; the Connor Group; Robert J. and Theresa W. Ryan; American Federation for Aging Research, the Glenn, Ted Nash Long Life, and Noaber Foundations; and the Biotechnology and Biological Sciences Research Council of the U.K. Dr. Kirkland is the Noaber Foundation Professor of Aging Research.

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Re: Diabetes news for spring 2019

Diabetes: Nuts could reduce cardiovascular risk

Published Monday 25 February 2019
By Chiara Townley
Fact checked by Isabel Godfrey
New evidence supports the current recommendation for people with type 2 diabetes to eat nuts to prevent cardiovascular issues and premature death.
People with diabetes may benefit from eating nuts.
Nuts are packed full of essential nutrients that could benefit overall health.

They contain high levels of unsaturated fatty acids, fiber, vitamin E, folate, and minerals, including potassiumcalcium, and magnesium.

The latest research has shown that nut consumption may help reduce the risk of chronic disease.

A recent study, which featured in the Journal of the American College of Cardiology, identified an association between eating nuts and a lower risk of cardiovascular disease.

Type 2 diabetes and nut consumption

Type 2 diabetes is a chronic condition that affects the way in which the body metabolizes glucose, which is its primary source of fuel. Possible complications include kidney damage and cardiovascular disease.

According to the American Diabetes Association, in 2015, more than 30 million people in the United States had diabetes.

 
Boosting nut intake

In this latest study, researchers used self-reported diet questionnaires about nut consumption. Close to 16,000 adults participated, and they filled out the questionnaires before and after they received a diagnosis of type 2 diabetes.

The researchers found that all types of nut offered health benefits, especially tree nuts.

As the name suggests, tree nuts, which include almonds and walnuts, grow on trees, while groundnuts, such as peanuts, grow underground. Tree nuts may offer more benefits because they contain higher amounts of nutrients in comparison with groundnuts.

Their analysis showed that people with type 2 diabetes who ate five servings of nuts per week had a 17-percent reduced risk of cardiovascular disease and a 34-percent lower risk of death relating to this condition.

Those who consumed more nuts after their diabetes diagnosis had an 11-percent lower risk of cardiovascular disease and a 25-percent reduced risk of death related to heart disease compared with people who did not increase their intake of nuts.

"Our findings provide new evidence that supports the recommendation of including nuts in [healthful] dietary patterns for the prevention of cardiovascular disease complications and premature deaths among individuals with diabetes," said Dr. Gang Liu, Ph.D., lead study author and nutritional sciences researcher at the Harvard T.H. Chan School of Public Health in Boston, MA.
 
Even small increases might help

The team of researchers found that eating even a small number of nuts made a significant difference. Each additional serving per week of nuts led to a 3-percent reduction in the risk of cardiovascular disease and a 6-percent lower risk of death due to heart disease.

Although the specific effects of nuts on heart health are not clear, findings suggest that the nutrients in nuts may improve blood pressure, blood sugar control, and inflammation as well as enhancing the metabolism of fats and promoting blood vessel wall function.

"Cardiovascular disease is the leading cause of death and a major cause of heart attacks, strokes, and disability for people living with type 2 diabetes," says Dr. Prakash Deedwania, a professor of medicine at the University of California-San Francisco School of Medicine in Fresno and a member of the Know Diabetes by Heart science advisory committee. He continues:

"Efforts to understand the link between the two conditions are important to prevent cardiovascular complications of type 2 diabetes and help people make informed choices about their health."

Dr. Deedwania added that these findings add to the growing evidence that a healthful lifestyle, regular exercise, and a balanced diet can all have a significant favorable effect on the risk of cardiovascular disease in people with diabetes.
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Re: Diabetes news for spring 2019

 
 
What's Next for Lexicon Pharmaceuticals? American regulators rejected a type 1 diabetes treatment that analysts predicted would eventually eclipse $450 million in annual revenue.
 
Mar 25, 2019 at 9:30AM

The U.S. Food and Drug Administration (FDA) recently rejected the marketing application for sotagliflozin as a once-daily oral treatment for type 1 diabetes in combination with insulin. The decision follows a rare deadlock from an FDA advisory committee, comprising experts who weigh in on clinical trial data before regulators make an official decision. After eight members voted in favor of approval and eight voted against, the FDA erred on the side of caution by ruling against the application.

The rejection is a setback for the co-developers of sotagliflozin, Lexicon Pharmaceuticals (NASDAQ:LXRX) and Sanofi (NASDAQSmiley FrustratedNY), especially considering some analysts expected the drug to hit annual sales of $450 million for type 1 diabetes in 2024. Shares of the former have fallen by more than 50% since their June 2018 peak. 

But how significant is the setback in the grand scheme of things? Will it affect an upcoming regulatory decision in Europe? Let's review where things stand now, and what the likely next steps are in the near future.

A group of brightly colored pill capsules and a thermometer.

Image source: Getty Images.

How did Lexicon Pharmaceuticals get here?

Lexicon Pharmaceuticals is developing sotagliflozin, branded as Zynquista, to help treat symptoms of both type 1 and type 2 diabetes. The drug targets two proteins that affect how well the kidneys and intestines eliminate glucose from the body. If successful, then it could be another tool helping patients manage their blood glucose levels in addition to insulin therapy. If approved for both types of diabetes, some analysts think the drug could reach peak annual sales of $1.3 billion by the mid-2020s.

That blockbuster potential was challenged on Jan. 18 when an FDA advisory committee reached an impasse on the risk-benefit profile of the drug. The primary concern among dissenters: Zynquista caused a significant increase in the number of cases of diabetic ketoacidosis, which occurs when there's too little glucose in the body. In other words, the drug can be a little too efficient at glycemic control in patients with type 1 diabetes -- a potentially life-threatening overshoot of the intended goal.

Optimism was injected back into the drug's future on March 1 when the Committee for Medicinal Products for Human Use (CHMP), the European Union's equivalent to an FDA advisory committee, voted in favor of approval in type 1 diabetes. That recommendation will be taken into consideration by the European Medicines Agency (EMA) when it makes a final marketing approval decision in the coming months.

The roller coaster ride continued for investors on March 22, when the FDA officially rejected the marketing application for Zynquista in type 1 diabetes. The risk of diabetic ketoacidosis was too great, according to regulators, even with the controls and monitoring proposed by Lexicon Pharmaceuticals and Sanofi. What happens from here?

A businessman looking through binoculars.

Image source: Getty Images.

What are the next steps for Lexicon Pharmaceuticals?

There are three things for investors to watch going forward:

  1. The regulatory decision from EMA regarding the marketing application for Zynquista in type 1 diabetes, which is expected in 2019.
  2. The results from meetings between the FDA, Lexicon Pharmaceuticals, and Sanofi on the next steps for Zynquista in type 1 diabetes.
  3. Updates from clinical trials for Zynquista in type 2 diabetes.

First, it's not uncommon for EMA and the FDA to go in different directions on a drug candidate. Investors shouldn't necessarily expect the FDA rejection to influence the decision made by European regulators in the coming months. Of course, that doesn't make the upcoming decision any less important or uncertain.

Second, Lexicon Pharmaceuticals and Sanofi both expressed confidence that they could work to address the concerns of American regulators. Whether that involves running additional clinical trials or developing a more robust monitoring program (which would add to the cost of treatment and degrade the ease of use) is unknown at this time, but earning U.S. marketing approval in type 1 diabetes is crucial for the future of Zynquista.

Third, the drug still has tremendous potential in type 2 diabetes -- there's just more competition. Zynquista works by targeting two proteins that affect glycemic control. Three similar drugs are already approved for use in type 2 diabetes, but each only targets one of the two proteins worked on by Zynquista.

Will the unique mechanism of action give Lexicon Pharmaceuticals and Sanofi an advantage over currently approved treatments while avoiding the increased risk of diabetic ketoacidosis observed in type 1 diabetes patients? It's possible -- and Sanofi is currently conducting 11 phase 3 trials across the globe to find out. It expects to have data in hand soon to support regulatory filings in the United States and Europe in early 2020. 

A question mark drawn on a notecard sitting on a table.

Image source: Getty Images.

 
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Re: Diabetes news for spring 2019

The Endocrine Society

NEW ORLEANS--Using the hemoglobin A1c blood test to diagnose diabetes tends to underestimate the prevalence of the disease, according to a new study to be presented Saturday, March 23 at ENDO 2019, the Endocrine Society's annual meeting in New Orleans, La.

"Based on our findings, A1c should not be solely used to determine the prevalence of diabetes," said lead researcher Maria Mercedes Chang Villacreses, M.D., of City of Hope's Diabetes and Metabolism Research Institute in Duarte, Calif. "It should be used in conjunction with the oral glucose test for increased accuracy."

The hemoglobin A1c is a test that shows the average level of blood sugar over the past two to three months. People who have diabetes usually have this test to see whether their blood sugar levels have been staying within a target range. This test is also used to diagnose type 1 and type 2 diabetes. It is often used to diagnose diabetes because no fasting or any preparation is required.

A glucose tolerance test, also known as the oral glucose tolerance test, measures the body's response to sugar (glucose). In this test, a person's blood is taken after an overnight fast, and then again two hours after they drink a sugary drink. The glucose tolerance test can be used to screen for type 2 diabetes.

The new study included 9,000 adults without a diabetes diagnosis. The participants got both an A1c test and an oral tolerance glucose test, and the researchers compared the results. The researchers found the A1c test didn't catch 73 percent of diabetes cases that were detected by the oral glucose test. "The A1c test said these people had normal glucose levels when they didn't," Chang Villacreses said.

The researchers also found race and ethnicity had a significant impact on the accuracy of A1c. It was more likely to detect abnormal glucose levels in non-Hispanic whites than in non-Hispanic blacks or Hispanics.

"Our results indicated that the prevalence of diabetes and normal glucose tolerance defined solely by A1c is highly unreliable, with a significant tendency for underestimation of the prevalence of diabetes and overestimation of normal glucose tolerance," Chang Villacreses said.

###

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world's oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org

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Re: Diabetes news for spring 2019

[ Edited ]

m Vail and Jamie Lanier look forward to a day when an artificial pancreas and a bandage-sized sensor placed under the skin will help them seamlessly manage the oft-changing insulin demands of their Type 1 diabetes.

Meanwhile, they are among those who look for help and inspiration from Dr. Paresh Dandona and his colleagues at the Western New York Center of Diabetes-Endocrinology in Amherst.

Dandona, a native of India who turned 75 last May, entered the diabetes field in the 1970s, after he landed a Rhodes Scholarship to attend the University of Oxford in England. He arrived in Buffalo in the early 1990s, after about a decade at Royal Free Hospital in London.

"With my loud, noisy personality, I knew that If I went to places in Boston or Johns Hopkins, I'd have enemies in no time,” he said with a laugh. “Here I was safe. Nobody bothered me, and we've done all kinds of things in different ways and different directions."

Dandona has become a pre-eminent international diabetes researcher involved in studies that have shown the impact of inflammation and exercise on blood sugar levels, the lower testosterone levels that often come with diabetes and, most recently, the effectiveness of using Type 2 diabetes drugs to help those like Vail and Lanier manage the more daunting Type 1 disease.

 

He has done so in his roles as regional diabetes center leader; distinguished professor and chief of endocrinology, diabetes and metabolism in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo; and with UBMD Internal Medicine.

"The value in doing these studies – and the idea that patients in Western New York are making such a big difference for the care of people with diabetes – is a big deal," said Vail, 52, who works in biotech and lives in Orchard Park. He was diagnosed with Type 1 diabetes at age 19.

Today, he said, "an insulin pump can deliver incredibly precise amounts of insulin all the time. You've also got a continuous glucose sensor that is incredibly accurate in telling you what your blood sugar is without using your blood. This is not exclusively cure-related, it’s 'How do we improve lives of those living with Type 1, and how do we get them to live an extra decade and die with diabetes instead of because of diabetes?' That's the goal."

Dr. Paresh Dandona continues his groundbreaking work by using Type 2 diabetes drugs to help treat those with Type 1 diabetes. The Juvenile Diabetes Research Foundation provided more than $1.6 million toward his current research. (Derek Gee/Buffalo News)

A world center

Diabetes has haunted Dandona since the early 1970s, when he started treating people with the condition in Europe. His fellowship years in England came during a time when health care providers measured blood glucose (sugar) levels once every few weeks and treatment options were limited to insulin provided at much less precise levels than now. He was among doctors during those years who took part in clinical trials of the drug metformin, which by 1996 – the year after he set up his Buffalo diabetes center in the basement of now-closed and demolished Millard Fillmore Gates Circle Hospital – had become standard treatment for Type 2 diabetes.

“Diabetes pills” called sulfonylureas, which stimulate beta cells to produce insulin, were the only other medications available at the time to address the more common form of diabetes. A similar class of drugs, called thiazolidinediones (TZDs), became available a year after that, after clinical trials Dandona and other Buffalo researchers also helped conduct.

"Now you have so many drugs available that I call this the golden age of Type 2 diabetes,” Dandona said. "On the basis of the use of those drugs, not one patient should be out of (blood sugar) control.

"Unfortunately,” he added, “that golden age of availability of drugs, or weapons, has not been translated into clinical practice. We are far behind on that in terms of commitment and in terms of knowledge."

Diabetes challenges

High cholesterol can be lowered by prescribing a statin, Dandona said, while high blood pressure also will drop with help from medication. Diabetes often must be attacked by a combination of drugs and behavioral changes, Dandona said, which make it "a much more complex affair."

Major inroads in Type 2 diabetes treatment came out of necessity, as well as the relative simplicity of the disease, in which the body can no longer properly use the insulin it makes. Insulin is a hormone needed to get glucose from the bloodstream into the cells.

Almost 30 million Americans have Type 2 diabetes, and almost three times that number have blood sugar levels in a prediabetes range that put them at risk for it. Lifestyle, obesity and lack of exercise generally drive those numbers, which have grown substantially since Dandona arrived in Buffalo.

Type 1 diabetes is another matter. It is diagnosed when the body cannot produce insulin, or produces trace amounts quickly overwhelmed by an overly zealous autoimmune response. About 1.25 million Americans have the condition, accounting for fewer than 5 percent of all diabetes cases.

Those with Type 1 diabetes can face a daunting time using insulin in the proper level because different foods and activities boost demand for the hormone. The human body generally can sense, understand and respond to those changing demands by producing more or less insulin. Those demands can change from minute to minute, hour to hour, and person to person.

Someone with Type 1 diabetes must make informed decisions about when to inject insulin; otherwise, levels can go too high or too low, endangering their health.

"It's a constant struggle," said Dandona, who treats all forms of diabetes.

"I love barbecue sauce, but I have to give myself too much insulin just to have barbecue chicken. It's not worth it," said Lanier, 39, an educational project manager for the federal government who lives in the Masten District. "It's also not worth giving myself insulin for OJ or apple cider when I can have an entire meal."

Jamie Lanier, a patient of Dr. Paresh Dandona, shows him the app she uses to monitor her blood sugar levels. Dandona helped her on her doctoral thesis, which focused on the dynamics of the doctor-patient relationship. (Derek Gee/Buffalo News)

A question of control

Blood sugar levels that regularly stay in the normal range are critical for everyone – but particularly those with any type of diabetes, said Karen Swierski, executive director with the regional chapter of the Juvenile Diabetes Research Foundation (JDRF), which supports children, adults and families touched by the disease.

"I don't think everybody understands that it's the blood sugar control that causes the complications: the heart attack, the stroke, the kidney disease, the blindness,” Swierski said.

That’s why compliance counts – especially now, after a January study showed that only about half of those with Type 1 diabetes reach target levels of hemoglobin A1c despite new medications and growing use of insulin pumps.

Dandona and Lanier can relate – but say that education is important not only for patients, but also health care providers, especially those in primary care expected to understand a wide range of health conditions.

It wasn't that Lanier couldn’t accept the disease when she was diagnosed seven years ago. “I didn’t understand it,” she said. “I didn't understand what it meant to have a high or a low carb count. I was told, 'You have Type 1 diabetes and if you don't take insulin, you'll die.' They gave me the title of the book, and the back cover, but they didn't tell me the chapters in between. It wasn't fair."

The word “noncompliance” is banned in the UB-Kaleida Health clinics Dandona oversees. The doctor credits longer appointment times, learning more about patient professional and family lives, and diabetes nurse educators – particularly those embedded in primary care and specialty practices – as important parts of the treatment process.

"My philosophy is that … noncompliance is the product of lack of knowledge on behalf of the doctor and lack of confidence and ability to communicate what needs to be done,” Dandona said. “Then, when things don't happen, the doctor finds it very convenient to blame the patient – and that's wrong."

Using what Dandona called an “aggressive approach” to treatment in the center that involves helping patients meet medication and behavioral goals, patients have not progressed to diabetic foot ulcers, gangrene or foot amputation since 1997. During the last half-dozen years, the staff also has been able to heal every treatable diabetic foot ulcer that has come their way.

"This is not because we had any magic,” he said. “It was sheer blood sugar control. That's probably the most important thing."

Greater understanding

During this decade, Dandona and his fellow regional-based researchers have focused a greater percentage of their work on other mechanisms involved in Type 1 diabetes – and how Type 2 diabetes drugs can help.

Last June, Dandona told those gathered at the annual American Diabetes Association meeting that some of his patients taking liraglutide, one of those drugs, experienced a nearly 0.6 percent reduction in their hemoglobin A1c levels. They required less insulin as a result and lost an average of 8 pounds.

Late last year, Dandona and Dr. John Petrie, professor of medicine at the University of Glasgow, Scotland, began a three-year, $1.6 million study to combine insulin therapy with two similar Type 2 diabetes drugs – dapaglifozin and semaglutide – or with semaglutide alone. The JDRF funded the study.

The three drugs suppress a hormone called glucagon, which opposes the action of insulin. This suppresses appetite, reduces body weight and slows emptying of the stomach after a meal, creating more balanced blood sugars. Semaglutide also works to release a higher percentage of blood glucose out of the body through the kidneys.

The goal is FDA approval to move all three drugs – now “off-license” to treat Type 1 diabetes – into the licensed category, which should lower costs of treatment.

Vail and Vail's wife, who also has the condition, already have managed to keep their blood sugar levels in a healthy range on lower dosages of insulin, Dandona said.

The diabetes foundation and its supporters are thrilled to participate in the research, Swierski said. She said the foundation was founded in 1970 to cure diabetes and has evolved to serve three missions: to cure, treat and prevent the disease.

"We're working on a vaccine, too," she said. "The last five years have been incredible. I have a firm, solid belief we're going to be the ones to find a cure for Type 1 diabetes."

Dr. Paresh Dandona chats with Jim Vail, who has benefited from adding drugs designed to treat Type 2 diabetes to his Type 1 diabetes insulin therapy. (Derek Gee/Buffalo News)

Diabetes fast facts

Type 1 diabetes

This autoimmune disease is diagnosed when the body cannot produce insulin, a hormone needed to get glucose (sugar) from the bloodstream into the cells. It once was believed to strike in childhood but can do so at any age. It can run in families and the cause has nothing to do with behavioral and nutritional choices. Type 1 makes up fewer than 5 percent of diabetes cases.

Type 2 diabetes

By far the most common form of diabetes, this metabolic disorder prevents the pancreas over time from making enough insulin to keep blood sugar levels in the normal range. This process, called insulin resistance, leads to higher blood sugar levels, or hyperglycemia. This can run in families, though a poor diet, lack of exercise and obesity are considered major risks regardless of heredity.

Numbers

  • About 31 million American adults have diabetes; more than one-quarter of them have not been diagnosed.
  • Roughly 84 million more have prediabetes, higher-than-normal blood sugar levels that put them at higher risk for Type 2 diabetes.
  • One-quarter of those over age 65 have diabetes.

Find support

Juvenile Diabetes Research Foundation: Call or visit jdrf.org/westernny to reach the WNY chapter, which serves children, adults and families.

American Diabetes Foundation: Call  or click here  to reach the WNY chapter, which serves children, adults and families.

Diabetes self-management programs: Call  or visit 211.org and search for diabetes resources in your ZIP code.

Source: American Diabetes Association

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Posts: 971
Registered: ‎12-31-2012

Re: Diabetes news for spring 2019

@cherry 

 

What does it all mean for a person with type 1?