Keys to Long Term Success and Preventing Complications

Contrary to popular belief, you can live a long, healthy life with type 2 diabetes, without developing complications. In its 2010 report, Diabetes UK found that someone with type 2 diabetes is likely to have a reduced life expectancy by up to 10 years, and someone living with type 1 diabetes is likely to have a reduced life expectancy by up to 20 years.

However, with advanced technologies and therapies, people are living longer and healthier than ever. Results from the University of Pittsburgh after a 30-year longitudinal study found that people with type 1 diabetes born after 1965 had a life expectancy of 69 years — longer than any study had ever previously found.

In part four of our four-part series on living well with type 2 diabetes, we will dive into the keys to long term success managing your condition, and how to prevent complications over the long term.

What Causes Complications?

It’s important to know what causes complications in people with type 2 diabetes. Not everyone living with diabetes will develop complications, but the occurrence of chronic hyperglycemia, or high blood sugar, can lead to heart disease, kidney failure, nerve damage, and retinopathy (the most common complications of diabetes). It’s important to keep your blood sugars in range as much as possible to help prevent the onset of these complications.

Keys to Long Term Success

A number of factors have been shown to help slow the progression of (or completely prevent) complications in people with diabetes:

  • Keep HbA1c in range – Studies have shown that keeping your HbA1c lower than 7% can prevent the onset of complications, and closely monitoring your blood sugar (testing regularly) can help tighten your control. Talk with your doctor about the ideal number of times she would like you to test per day, and make sure you always test before and after meals.
  • Take your medications as prescribed – Some people think that insulin is “bad” or they just don’t like the thought of taking a pill every day. You’re prescribed your medicine for a reason, and you should follow all doctors’ orders to take them as prescribed. Rationing or skipping doses can quickly lead to complications or even premature death.
  • Follow a sensible diet – You don’t need to go completely paleo or keto to have better blood sugars, but speaking with your doctor or seeing a nutritionist can help you develop an eating plan that will work for you that you can sustain. Be sure to include plenty of fresh vegetables, protein, and water. Eating similar foods, eating a low carbohydrate lunch (of 20 grams or fewer) and limiting meals at restaurants has also been shown to help improve blood sugar management in people with diabetes.
  • ExerciseExercise is one of the most important things you can do to prevent complications. Not only does it lower blood sugars, but it gets the heart working and the blood pumping, increasing circulation and strengthening your whole cardiovascular system. Exercise boosts your immune system, and increases serotonin in the brain, making you feel good and helping to prevent the onset of depression. According to our Thrivable Insights study, people with type 2 diabetes who have an HbA1c <6.5% are more likely (20% vs 8%) to exercise 4-6 times per week than people living with type 2 diabetes who have an HbA1c of 8% or higher.
  • Surround yourself with support – Diabetes is a marathon, not a sprint, and the journey can be lonely at times. A study from the University Hospital in Denmark found that loneliness may actually cause premature death by damaging the blood vessels of the heart, which can be compounded with a diagnosis of diabetes. Long term success with your diabetes care is much more likely if you surround yourself with supportive family and friends, or if you can find a community who will understand. Sharing your thoughts, worries, and feelings will help lighten your load, and you may just learn a thing or two that you didn’t previously know about diabetes and how to better care for yourself!

Have you had diabetes for a long time, and are thriving without complications? What are some of the best strategies you’ve employed to achieve success? Share this post and comment below!

Source: diabetesdaily.com

Advancements in Treatment: The Use of Adjunctive Therapies in Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Paresh Dandona and Megan Johnson

Read on to learn about the research around GLP-1, SGLT-2, and combination therapy use in type 1 diabetes. Dr. Paresh Dandona is a Distinguished Professor and Chief of Endocrinology at the University of Buffalo, and Megan Johnson is a fellow on his team

For people living with type 1 diabetes, new treatments are finally on the horizon. The University at Buffalo (UB) Endocrinology Research Center is helping to revolutionize the treatment of this condition. Among the most promising new therapies are two non-insulin medications currently used in type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists.

SGLT-2 inhibitors, such as Farxiga, act the kidney to help the body excrete more glucose in the urine. Meanwhile, GLP-1 receptor agonists like Victoza work in several different ways: increasing the body’s natural insulin production, decreasing the release of the glucose-raising hormone glucagon, slowing the emptying of the stomach, and curbing excess appetite. Some people with type 1 diabetes take these medications as an addition to insulin treatment as an “off-label” drug. To learn more about off-label, check out the article: Can “Off Label” Drugs and Technology Help You? Ask Your Doctor.

Why consider these medications?

In people without diabetes, the body is constantly releasing more or less insulin to match the body’s energy needs.  People with type 1 diabetes do not make enough insulin on their own and have to try to mimic this process by taking insulin replacement – but it isn’t easy.

People with type 1 diabetes often have fluctuations in their blood sugars, putting them at risk for both low blood sugars (hypoglycemia) and high blood sugars (hyperglycemia). Many individuals are unable to manage their blood sugars in a healthy glucose range with insulin alone. In fact, less than 30% of people with type 1 diabetes currently have an A1C at the target of less than 7%.

Can GLP-1 agonists be safely used in type 1 diabetes?

Over the past decade, the endocrinologists at the University at Buffalo and other research groups have been conducting studies to see whether GLP-1-receptor agonists can safely be used in type 1 diabetes.

  • The first of these was published in 2011 and showed a decrease in A1C within just four weeks of GLP-1 agonist treatment. Importantly, people given GLP-1 agonists plus insulin also had much less variation in their blood sugars, as measured by continuous glucose monitors (CGM).
  • Another study involved 72 people with type 1 diabetes who took GLP-1 agonist or placebo (a “nothing” pil) in addition to insulin for 12 weeks. The GLP-1 group had decreases in A1C, insulin requirements, blood sugar fluctuations, and body weight. People in this group did report more nausea – a common side effect of GLP-1 agonists.
  • Since then, multiple studies, some involving over 1000 people and lasting up to 52 weeks, have shown that GLP-1 treatment in people with type 1 diabetes can reduce A1C and body weight, along with insulin dosages.

Many of these studies, but not all, have suggested that GLP-1 agonists can do this without increasing the risk for hypoglycemia or diabetic ketoacidosis (DKA). There is also some evidence that GLP-1 agonists can improve quality of life in type 1 diabetes.

Who should consider GLP-1’s?

The effects of GLP-1 agonists seem to be especially strong in individuals who are still able to make some insulin on their own, although it also works in people who do not.

In one notable study, researchers gave a GLP-1 agonist to 11 people with type 1 diabetes who were still able to produce some insulin. To get an estimate of insulin production, they measured levels of a molecule called C-peptide, which is produced at the same time as insulin. In these 11 individuals, C-peptide concentrations increased after GLP-1 treatment. By the 12-week mark, they had decreased their insulin dosage by over 60%. Incredibly, five people were not requiring any insulin at all. Even though the study was very small, the results were exciting, because it was the first study to suggest that some people with type 1 diabetes had sufficient insulin reserve and thus, could – at least temporarily – be treated without insulin.

Can SGLT-2 inhibitors be used in type 1 diabetes?

SGLT-2 inhibitors like Farxiga have also shown tremendous potential. In two large studies called DEPICT-1 and DEPICT-2, adults with type 1 diabetes were randomly assigned to take either placebo or SGLT-2 inhibitor in combination with insulin. Over 700 people from 17 different countries participated in DEPICT-1, and over 800 people with type 1 diabetes participated in DEPICT-2. At the end of 24 weeks, people taking dapaglifozin had a percent A1C that was lower, on average, by 0.4 compared to people who had received placebo, and it was still lower, by over 0.3, at 52 weeks. The number of hypoglycemic events was similar in both groups.

As with GLP-1 agonists, people taking SGLT-2 inhibitors had weight loss and decreased insulin requirements. People taking SGLT-2 inhibitor, however, did have an increased risk of diabetic ketoacidosis (DKA). If individuals consider this therapy, they should be cautious about not missing meals or insulin, and not drinking large amounts of alcohol, as these behaviors can lead to increased ketone production.

Several other research groups, in trials recruiting up to 1000 individuals, have seen similar results when using this class of medications.  Researchers have been conducting additional studies to try to determine how best to minimize the risks associated with them. Farxiga (called Forxiga in Europe) has now been approved as the first oral agent as an adjunct treatment for type 1 diabetes in Europe and Japan.

Promising Combination Therapy

Now, endocrinologists are also looking at whether GLP-1 agonist and SGLT-2 inhibitor combination therapy could increase the benefits of each of these treatments. A study conducted on a small number of people showed that GLP-1 agonists can help prevent ketone production, so it is theoretically possible that this medication could reduce the risk of DKA that was seen with SGLT-2 inhibitors.

In an early study involving 30 people with type 1 diabetes who were already on GLP-agonist and insulin were randomly assigned to take SGLT-2 inhibitor or placebo, as well. People who received both drugs saw an 0.7% reduction in A1C values after 12 weeks, without any additional hypoglycemia. People on the SGLT-2 inhibitor did make more ketones, though, and two individuals in the combination group experienced DKA. Larger studies are now being conducted to expand on these results and learn more about how to give these drugs safely. The hope is that non-insulin therapies will soon be approved for type 1 diabetes. By unlocking the potential of these therapies, we can do more than manage blood glucose levels – we can improve people’s lives.

Source: diabetesdaily.com

Research Trends with Dr. Maria: Cholesterol Benefits & More

Dr. Maria Muccioli holds degrees in Biochemistry and Molecular and Cell Biology and has over 10 years of research experience in the immunology field. She is currently a professor of biology at Stratford University and a science writer at Diabetes Daily. Dr. Maria has been living well with type 1 diabetes since 2008 and is passionate about diabetes research and outreach.

In this recurring article series, Dr. Maria will present some snapshots of recent diabetes research, and especially interesting studies than may fly under the mainstream media radar. Check out our first-ever installment of “Research Trends with Dr. Maria”!

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Allergen in Diabetes Tech Adhesives

Diabetes technologies, like insulin pumps and continuous glucose monitors, are steadily gaining popularity, especially among patients with type 1 diabetes. While the technological advances have shown considerable benefit in improving patient outcomes and quality of life, one common issue is the unfavorable reactions to adhesives. A recent study published in Diabetes Technology & Therapeutics identified that a common culprit of these allergic reactions to adhesives may be a chemical called colophonium, a commonly-used adhesive, which was shown to be an allergen in over 40% of patients in the small study. Read more about the study and the use of this adhesive in medical products here.

Bariatric Surgery May Worsen Retinopathy

Retinopathy (eye disease) is a common complication of diabetes, and can be serious, leading to severe visual impairment and even blindness, especially when left untreated. A recent study published in Acta Ophthalmologica has uncovered a potential link between patients who undergo weight loss surgery and worsening retinopathy. Researchers adjusted for confounding variables, including glycemic control (A1c) and found that those who underwent bariatric surgery experienced worse retinopathy outcomes. Although the sample size was small, the data showed a significant worsening of eye disease in those who underwent surgery as compared to controls. Learn more about the study and outcomes here.

Super Healthy Probiotic Fermented Food Sources

Photo credit: Adobe Stock

Benefits of Probiotics for Type 2 Diabetes

The relevance of the gut microbiome in various health conditions, including diabetes, is gaining more and more attention. A recently published meta-analysis in The Journal of Translational Medicine discusses what we currently know about the effects of probiotic supplementation in patients with type 2 diabetes. Excitingly, probiotics can improve insulin resistance and even lower A1c! Learn more about exactly what the clinical trials have shown here.

Herbal Therapies Gaining Attention

With most modern medicines derived from plant compounds, it is not surprising that more research is being geared toward examining the effects of various herbal remedies on blood glucose levels and insulin sensitivity. A recent review published in The World Journal of Current Medical and Pharmaceutical Research summarizes the effects of some medicinal plants with potential anti-diabetic properties. Learn more about what is known about commons herbs and how they may be beneficial for glycemic control here.

Low HDL Cholesterol Linked to Beta Cell Decline

Research has previously suggested that higher HDL cholesterol levels may be protective of beta-cell function. A longitudinal study recently published in Diabetes Metabolism Research and Reviews indicated that patients with lower levels of HDL cholesterol were more likely to experience beta cell deterioration and develop type 2 diabetes than those with higher HDL cholesterol levels. Learn more about this study here.

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Please share your thoughts with us and stay tuned for more recent research updates!

Source: diabetesdaily.com

Diabetes Eye Screenings: Why They Are Important and Challenging

This content originally appeared on diaTribe. Republished with permission.

By Renza Scibilia and Chris ‘Grumpy Pumper’ Aldred

Regular eye screenings are important for people with diabetes. Learn more about diabetes-related retinopathy screenings from diabetes advocates Renza and Grumpy

What Causes Diabetes-Related Retinopathy?

Diabetes-related retinopathy occurs when many years of high blood sugar levels cause damage to blood vessels in the eye. This damage triggers your body to make more blood vessels – but these new vessels are fragile and easily damaged, which can result in bleeding or scarring in the eye that worsens vision. Fortunately, there are medications available that can improve symptoms. For more background on diabetes-related retinopathy, see here.

There is more to developing a diabetes-related eye condition than just A1C. Time in range also plays a role, as seen by recent research – diaTribe will be updating readers on this in the coming months!  Blood pressure also plays an important role in our risk, as can rapid fluctuations in glucose levels. Family history of eye conditions, such as glaucoma and age-related macular degeneration (AMD), may increase the risk of diabetes-related eye issues, so knowing and sharing your family history is important when discussing your eyes at screening appointments.

The importance of eye screenings

In diaTribe’s past interview with ophthalmologist (eye doctor) Dr. Ivan Suñer of Memorial Hospital of Tampa, we learned that people with retinopathy often have no noticeable symptoms until they are at high risk for losing their vision. Early detection of diabetes-related retinopathy is crucial to prevent vision loss. Thus, his number one piece of advice was to see a doctor regularly for eye screenings. The American Diabetes Association (ADA) recommends that people with diabetes get a comprehensive eye exam every two years if there is no evidence of retinopathy. For those with retinopathy, the ADA recommends an eye exam every year.

Given the importance of eye screenings, Renza and Grumpy – within a few days of each other – both recently tweeted about our upcoming eye screening checks. (Renza has annual visits to her private ophthalmologist as suggested by Australian guidelines; Grumps receives a screening every three to four months to monitor some damage in his left eye.)

Both of us (Renza and Grumpy) are fortunate that we live in countries with national eye screening programs for people with diabetes. (Australia’s program was launched just this year; the UK program has been around for a number of years now.)

In Australia, KeepSight operates as a “recall and reminder” system. People with diabetes register with the program and are sent prompts to make appointments. The frequency of these reminders is individually tailored, determined by how frequently screening checks are required.

In the UK, the Diabetic Eye Screening Program (time for a rename and some #LanguageMatters attention!) is overseen by the National Health Service (NHS). Screening appointments are made for people with diabetes, and follow up letters are sent with the results.

National screening programs work because they offer a coordinated and consistent approach that has the potential to reach a wide number of people. In an ideal world, they capture all people living with diabetes, ensuring screening occurs at the right time, changes to the eyes are identified early, and appropriate treatment is started immediately.

When implemented properly, the results of screening programs can be staggering. Before the UK program was established, diabetes-related eye conditions were the leading cause of preventable blindness in the UK. That is no longer the case.

The challenges of eye screenings

Not many people with diabetes look forward to their eye screenings. And many of us will look for any excuse to put off making or going to our screening appointment. There are a number of reasons for that.

While it may be one of the least invasive checks on our screening list, it can be one of the most disruptive. If pupil dilating drops are required, the rest of the day is often a write-off. Even when the blurred vision goes, we are often left feeling tired or with a headache from the bright light and eye strain caused by the drops.

On top of organizing time off work or school for ourselves, we may need to involve a friend or family member to take us to the appointment. All of these things can make coordination of our appointment difficult and become a reason that we postpone or cancel.

But logistics are only one reason we may decide to put off our appointment. Many of us are anxious about results from screening checks. Diabetes-related complications are often presented to us in such a scary and threatening way that we are frightened to organize and attend appointments. (Renza recently wrote this piece, “Why Scare Tactics Don’t Work in Diabetes” for diaTribe about how her introduction to diabetes-related complications when she was diagnosed with diabetes scared her so much that she was simply unable to face the thought of diabetes screenings.)

And those of us who have missed an appointment or two, or have never been screened before, become worried that we will be “told off” when we do eventually gather the courage to attend.

What works and how can we do better?

  • Making the process of actually having a diabetes eye check as easy and smooth as possible will always mean more uptake. Bringing screening to the people, rather than expecting people to travel long distances, will reduce a significant barrier to keeping up-to-date with screening checks. There are a number of different initiatives that are working toward making screening checks more convenient.
  • Pharmacies are being used in some areas to provide initial screening checks (using a retinal scanning camera), with any necessary follow-up being conducted by specialist eye health care professionals. This works well because it means the initial screening check – which will pick up any changes – is done somewhere convenient and familiar, and without the need for dilating drops. Hopefully this will reduce some of the nervousness people may feel about going to a clinic or hospital setting.
  • Coordinated reminder systems are great! Anything that helps ease the weight of “diabetes administration” is welcome to help with the daily tasks demanded by diabetes.
  • Counselling around the visit would also be helpful for some!

Having any sort of diabetes-related complications screening is never just about the process of attending and completing the screening. Just the thought of, and planning for, the appointment can be distressing for people, especially for those who have had complications presented to them in a scary or threatening manner. Offering counselling before and/or after screening is a great idea to help address some of those anxieties, and provide people with practical tips for coping.

Screening checks are part of the process of managing diabetes-related complications

We’d urge healthcare professionals to acknowledge just how difficult it can be for someone to simply show up for a screening appointment, and commend those that do. A little word of understanding can go a very long way!

As ever, peer support can be hugely beneficial. Whether it be sharing stories about how people manage to navigate anxieties and nervousness about eye screening checks, or how people have dealt with a diagnosis, speaking with others who have walked a similar path can be useful and can help reduce the isolation many people feel.

And finally, most people with diabetes do know the importance of regular complications screening, and that early detection and treatment will likely result in better outcomes. (In Grumps’ case, this early detection has meant that the issues have not progressed for several years and that, to date, no treatments have been required.) But that is not enough. We need to follow messages and campaigns that highlight the importance of screening with advice on how to make the process easier and more comfortable for people with diabetes, while recognizing how difficult it can be. Humanizing the experience of screening, and giving results and follow- up, is all an important part of the story.

Source: diabetesdaily.com

100 Things You Can Do This Year for a Better Life with Diabetes

The New Year is here and many of us are hoping to make those resolutions stick. Keep in mind that there are many ways you can influence change, and some steps you can take may seem small but are very effective nonetheless. Please note that anytime you make changes to your diet or exercise routine, it’s also a good idea to check in with your doctor and plan ahead for any necessary medication adjustments.

Without further ado, check out this list of 100 simple things you can try to do this year for a better life with diabetes:

  1. Change your lancet.
  2. Eat lower carb.
  3. Take the stairs.
  4. Join a gym.
  5. See your eye doctor.
  6. Try a new vegetable recipe.
  7. Pack your lunch.
  8. Cut back on alcohol.
  9. Quit smoking.
  10. Invest in comfortable shoes.
  11. Buy a scale to keep accountable.
  12. Check your blood pressure.
  13. Stand while working.
  14. Go for a walk after lunch.
  15. Give gardening a try.
  16. Grocery shop the perimeter.
  17. Stretch.
  18. Keep a blood sugar log.
  19. Try a new diabetes app.
  20. Consider a continuous glucose monitor (CGM).
  21. Check your blood sugar more often.
  22. Don’t reuse your needle/syringe.
  23. Use alcohol swabs for injections and site changes.
  24. Read a book about diabetes.
  25. Join a diabetes support group.
  26. Choose green veggies over starches.
  27. Visit your endocrinologist.
  28. Do basal testing.
  29. Track your cycle.
  30. Count carbohydrates accurately.
  31. Try a half-unit syringe or pen.
  32. Consider trying an insulin pump.
  33. Ride a bike.
  34. Consider getting a pet.
  35. Eat more real food.
  36. Cut back on dessert.
  37. Try a flour substitute.
  38. Try a sugar substitute.
  39. Track your macronutrients.
  40. Track your steps.
  41. Educate about diabetes.
  42. Start a fundraiser.
  43. Attend a diabetes event.
  44. Sign up for our newsletter.
  45. Participate in diabetes surveys.
  46. Treat lows only with glucose.
  47. Eat consistent meals.
  48. Consider intermittent fasting.
  49. Ditch the foods that don’t work well.
  50. Invest in quality proteins.
  51. Eat more plants.
  52. Eat less processed foods.
  53. Ice skate.
  54. Try canoeing.
  55. Go hiking.
  56. Spend more time in nature.
  57. Shovel snow.
  58. Go swimming.
  59. Try ziplining or tree-to-tree.
  60. Get your A1c checked.
  61. Lower the high alert on your CGM.
  62. Eat more probiotics.
  63. Get more fiber.
  64. Swap juice and soda for more water.
  65. Sign up for a “couch to 5k” program.
  66. Jog.
  67. Go rock-climbing.
  68. Rotate your injection sites.
  69. Change your pump-site regularly.
  70. Change your CGM sensor regularly.
  71. Wear your CGM more.
  72. Review your CGM report regularly.
  73. Get a primary care physician.
  74. Get your flu shot.
  75. Figure out if you’re a moderator or abstainer.
  76. Jump rope.
  77. Meditate.
  78. Start a journal.
  79. Keep a food log.
  80. Create a 504 plan for your child.
  81. Speak with your child’s school about non-food related celebrations.
  82. Advocate for yourself or your child better.
  83. Ditch the scale if you’re obsessing.
  84. Take before photos (you will want them!).
  85. Figure out what self-care means to you and practice it daily.
  86. Seek out a friend or therapist if you feel you need help.
  87. Give back to the community by volunteering your time.
  88. Try a sport or activity you never tried before.
  89. Have more grace with yourself.
  90. Surround yourself with positive influences.
  91. Try to see the big picture more often.
  92. Create a healthy work/life balance.
  93. Appreciate the little things.
  94. Don’t be so hard on yourself.
  95. Check in with friends who may need it.
  96. Spend more time with family.
  97. Take the time to thank others and let them know they are appreciated.
  98. Take more deep breaths.
  99. Target things you feel you can change and start with those.
  100. Remember to be grateful for another year around the sun.

Do you want to add anything that has worked well for you? Please share your tips in the comments below.

Source: diabetesdaily.com

Benefits of Time in Range: New Study Shows Cost Savings

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler and Albert Cai

A new paper suggests that as people with diabetes increase their time in range, healthcare costs decrease

IQVIA, a healthcare consulting firm, published a 22-page paper describing the limitations of A1C and the potential financial benefits of improving time in range, the time a person spends with blood glucose levels between 70-180 mg/dl. The paper was sponsored by Lilly Diabetes.

The paper predicts that if the average time in range for people with diabetes in the US increases to 70% or 80%, healthcare costs will be reduced. The savings could be up to $9.7 billion for the US healthcare system over ten years if the average time in range for people with diabetes is increased to 80%.

The graphic below shows how much money is saved over ten years just by reducing hypoglycemic (low blood sugar) events in people with type 1 diabetes. Other costs saving would likely come from a reduction in diabetes-related complications. Studies (Diabetes Care 2019, Diabetes Care 2018) have suggested that greater time in range is associated with a lower risk of health complications.

Stat

Image source: diaTribe

Unsurprisingly, the biggest reductions in healthcare costs were seen in people with high baseline A1C. While a 5% increase in time in range for a person with an A1C under 7% would save only $20 over ten years, the same 5% increase in time in range for a person with an A1C over 8% would lead to $1,470 in savings over ten years – mostly due to a greater reduction in the risk of diabetes-related complications. This means that to get the greatest health and cost benefits, it is essential to bring time in range practices to people who are most struggling to manage their blood glucose.

To calculate the effects of improving time in range, the study assumed an average time in range for people in the US of 58% (type 1 and type 2 diabetes). This 58% came from a 2019 review of four major CGM studies. However, these four studies were done at top diabetes centers and the participants had relatively low A1Cs (~7.5%). Additionally, the majority of people with type 1 diabetes and almost everyone with type 2 diabetes still don’t have access to CGMs. In other words, the actual population average is likely much lower than 58% time in range and the $9.7 billion calculated in cost savings would actually be much higher if the population’s time in range reached 80%.

IQVIA provides several reasons why CGM should be used to support blood glucose management in people with diabetes:

  • A person with diabetes can understand how variables like food, exercise, and sleep habits affect blood glucose and can use that information to improve decisions and outcomes.
  • Healthcare professionals can provide more individualized care to support people with diabetes.
  • The healthcare system will save money on diabetes care.

The illustration below outlines how CGM can be used to monitor blood glucose and guide shared decision making for a healthcare professional (HCP) and person with diabetes (PwD).

Stat

Image source: diaTribe

The last eight pages of the paper discuss how time in range can become more commonly used, asking policymakers, healthcare professionals, and people with diabetes to drive the time in range movement forward. IQVIA’s ideas include:

  • promoting CGM to help people measure and understand time in range;
  • educating healthcare professionals and people with diabetes about the health benefits of time in range; and,
  • tackling affordability and access issues to make sure all people with diabetes (or even prediabetes) can use CGM.

This paper not only emphasizes the importance of time in range for well-being but also highlights time in range as a public policy matter. While there is clearly much work to be done, this study is an important step in underscoring the need to bring CGM and time in range to more people.

Source: diabetesdaily.com

Banned from Policing Due to Diabetes

Meet Craig Roth. He’s a fit, formidable man. By day, he helps to keep people safe from violence, crime, and illegal activities that often plague city streets. By night, he’s an active, well-respected, and engaged citizen. He loves his community, and they, him. He’s also been living with type 1 diabetes (T1D) since 1999.

This is Craig’s story, and it’s sadly not that unique. People with diabetes are often told that they can do anything, and having the grit and fortitude that we do, we believe them. We run track, we excel in school, we apply to colleges, we have first kisses, we make varsity, we travel abroad, we run marathons–we do a lot. But there’s still a lot that we can’t do, some barriers that we haven’t been able to crush. For Craig, becoming a Nassau County Police Officer was one of those barriers.

People with diabetes can be police officers. It varies by state, but minimum qualifications typically include being at least 21 years of age with United States citizenship and state residency (of where you’re applying), possessing a high school diploma or GED and a valid driver’s license, and demonstrating strong moral character. For people with diabetes, a medical doctor must also approve of the applicant prior to attending the police academy. The process is grueling, and the checklist is long:

  1. Meet the aforementioned minimum qualifications for prospective officers
  2. Complete an online application and self-assessment
  3. Take a written and video test and submit a background history packet
  4. Complete language skills and written suitability tests
  5. Pass the polygraph examination
  6. Attend an interview with a psychologist for psychological screening
  7. Pass the physical agility test
  8. Pass the background investigation
  9. Attend at least one formal interview with representatives from the police department
  10. Pass the background investigation
  11. Complete fingerprinting, a drug screen, and a medical exam
  12. Complete a second psychological exam
  13. Attend police academy training
  14. Complete field training as a probationary officer
  15. Begin working as a police officer

Craig Roth excelled at every step of the way, except the county medical exam.

After applying through the Nassau County Civil Service Commission (who’s in charge of hiring police in that municipality) in January 2015,  he was told that his application was on hold and that he needed to supply additional information regarding his type 1 diabetes, and also to undergo a cardiovascular stress test. This wasn’t all that abnormal, and he willingly complied.

By all accounts, Mr. Roth is healthy and fit. He wears an insulin pump, and maintains his HbA1c below 8%. He likes to run and stay active. But he, and other people with diabetes, are held to a higher standard when it comes to their health. The world expects excellence, perfection. A misstep, a low blood sugar, a seemingly innocuous pump failure, and we’re judged harshly.

In April 2015, his application was denied by the civil service commission. The reason given was, “endocrine condition which precludes ability to fulfill the physical requirements of a police officer,” according to official documentation. He appealed and submitted documentation from his endocrinologist proving that he was fit to serve. Due to his appeal, he was then referred to a county doctor, hired by the commission, for an additional health screening.

Despite having well-controlled glucose levels, normal heart rate, blood pressure, lung capacity, eyesight, hearing, mental agility, weight, and all normal blood draws, when Mr. Roth had his medical exam, the county doctor assigned to his case became concerned that “extreme physical exertion” required of police officers would cause “glycemic instability” in the patient, according to his deposition. In layman’s terms: exercise causes low blood sugars. The doctor was also concerned that the job could damage his insulin pump. He wasn’t “fit” for the job. Roth was ultimately rejected from the position.

We trust doctors. They save lives every day. But the problem here is that Craig Roth was 23 at the time of his medical examination, and had been living with diabetes for over 16 years at this point. Additionally, he had also previously been both a Long Beach Police Officer, a New York City Police Officer, and a security detail with the Nassau Community College, and never had any issues on the job. His endocrinologist gave him the green light to be a police officer. He was young, motivated, and in the prime of his life. He just wanted the opportunity to do what he loved.

Despite all of that, Mr. Roth was denied employment by Nassau County Civil Service.

Craig Roth

Photo credit: Craig Roth

In chatting with him for this story, Mr. Roth has said that he’s met many other women and men who have been denied the opportunity to become police officers simply due to their diabetes diagnosis. Dr. Marlaine Tapply, a doctor who works frequently with the civil service commission, found that Roth was only ever the third person with type 1 diabetes to apply as a police officer with the Nassau County Police Department. All three applicants were rejected.

Dr. Tapply said in her deposition that Roth was denied a job because of, “how brittle and fragile his diabetes was.”

These county doctors people are referred to oftentimes don’t know the patients, their histories, or their stories. They don’t specialize in diabetes (usually, they’re family doctors or internists). They’re often times unfamiliar with the nuances of type 1 diabetes. They simply see them for a 15-minute exam and make a determination that changes the course of their lives. Despite having adequately controlled HbA1c levels, and no complications, doctors can sometimes let their fear of the unknown and common stigmas around diabetes dominate their decisions to approve medical examinations for police officers, intelligence officers, the military, Peace Corps volunteers, pilots, and other professions that people with diabetes can have trouble accessing.

Wanting his story to prevent future issues for other people with diabetes, Mr. Roth says, “With additional light, I hope that people can understand that discrimination is alive and well against diabetics – however people turn a blind eye and choose not to care.”

In filing a lawsuit against Nassau County, Mr. Roth unfortunately lost. Nassau County offered a small cash settlement, albeit requiring he never be employed by the civil service commission in the future. He did not accept the terms. Appealing to the United States Supreme Court, they have decided not to hear the case.

This seems to only have fueled his passion, “I want people to know how the current system stands. Fighting this as a T1D is an uphill and costly battle, and needs to change.”

Mr. Roth has since found employment with another police precinct and hopes his story helps to spread awareness of the struggles people with diabetes face when seeking employment, even in 2020.

In Mr. Roth’s case, many turned a blind eye, and few were willing to help him seek the justice he so desperately deserves. Issues like these can arise when there are no standard hiring procedures around people living with a chronic disease, and determinations are made on a case-by-case basis, or “feeling.”

According to court documents, hiring officials homed in on five 911 calls made by the Roth family due to episodes of hypoglycemia, that Craig experienced while sleeping, over 3 years ago (at the time of his employment application). Only one resulted in Roth needing transport to a medical facility. At the time, Craig was not on a Continuous Glucose Monitor (CGM). He is now.

Little did his family know that those calls would change the course of their son’s future.

These are people’s real stories, and they need to be told. Our voices need to be amplified. We need to spread awareness of what’s going on, even in 2020, so that we’re finally listened to.

We thank Craig Roth for sharing his story and hope that someday he can find justice and peace.

If you feel that you have been discriminated against in the workplace, you can file a complaint with the U.S. Equal Employment Opportunity Commission.

You can file an Americans with Disabilities Act complaint alleging disability discrimination with the U.S. Department of Justice.

Have you ever been barred from a job because of your diabetes? Share this story and comment below!

Source: diabetesdaily.com

How People Invalidated My Feelings Towards My Diabetes

By Madelyn Corwin

I haven’t felt this way about my diabetes before this year. When I was diagnosed, it was a “do or die” attitude. No time to cry. No time to make my classmates pity me.

My teachers rarely believed me when I said I needed to get a snack for a low of 40. I believed them when they’d tell me, “I’ve had diabetic students in the past, but it’s never been like this. None of them have needed to leave the classroom this much.” I believed them.

I thought I was being dramatic. I thought I was doing something wrong. And that I was annoying. So from those points on, I hid it. Injections in the bathroom and skipping the nurse’s office before lunch. Sometimes I wouldn’t even inject for lunch because I’d be walking with my friend to the lunchroom, and I didn’t want to cut off our conversation because I had to inject myself. I’d skip completely. Because I was always told, “It’s not a big deal,” “You’re fine,” “It’s not deadly.” I didn’t want to be different. And I feared the comments of “Oh, you have to go do that?” because I thought people would think I was weak for injecting myself.

Photo credit: Madelyn Corwin

That’s how bad it got. I’d sit in the class after lunch period, and my vision would be so f***ing blurry, I couldn’t see the board or even focus. And then the teacher would, of course, get mad at me because I couldn’t answer a question they’d randomly called on me for. I’d play soccer with blood glucose levels up in the 350s and think it was fine. I’d get yelled at for “not running to the ball quickly enough.” I didn’t wanna say “because I’m f***ing dying coach!” I didn’t want to be viewed as weak.

I wish I had this community (Diabetes Online Community) when I was in high school and my early college years but I didn’t. I take myself so much more seriously now. I got my first A1c below 7.4% since I’ve joined this community. I’ve gotten rid of my microalbumin. My vision doesn’t blur as bad as it used to during highs. I eat healthier. I always give insulin. I always correct highs. I always change my site. I always check my sugar. I don’t think I would be able to do all that without meeting everyone I met online. Because I was conditioned to believe I was fine. That nothing was wrong. That I was normal. But that was the furthest thing from the truth.

 

I was made to feel for 8 years of having type 1 diabetes that my disease wasn’t serious and that if I complained about it, the typical reply was “at least you don’t have cancer.” I am so glad I found thousands of other type 1s online, especially those who’ve lived with this since they were kids as well that I can relate to. I used to have thoughts in my head like, “This s**t is so f***ing hard. Why am I always being told it’s not a big deal by perfectly healthy people?” or “I can’t believe I’ve had to do this since I was a kid and I have to do this for the rest of my life and everyone’s first response is, ‘At least, it’s not cancer.’”

I stayed quiet for seven years. I didn’t share with my online friends what was wrong with me because I was conditioned to believe it “wasn’t a big deal.” I thought if I told people what was wrong with me, they wouldn’t care, or they’d just say the typical “well, it’s manageable!” comments. I even hid the struggles from people I dated, which caused me to not take good care of myself because I wouldn’t correct if I was high because I didn’t want them to think I’m being dramatic or “too serious” about diabetes.

Photo credit: Madelyn Corwin

Photo credit: Madelyn Corwin

I’m so glad I found all of you. It helps me feel more validated for all the hard work I put in every hour of the day just to see the next. I feel my hard work to keep my body alive is finally recognized through the people I met online. I don’t think I was ever validated like this before. I was told I was “normal” and “can do anything” but I’m so glad I met some of you all to tell me that we aren’t normal, and we do need to have boundaries, and that’s OK. Thank you.

Source: diabetesdaily.com

Omada’s Type 2 Diabetes Coaching Program Will Now Include Abbott FreeStyle Libre

This content originally appeared on diaTribe. Republished with permission.

By Emily Fitts

Omada Health and Abbott partner to bring FreeStyle Libre to Omada Health’s digital coaching program for people with type 2 diabetes

Under a new partnership between Omada Health and Abbott, participants in Omada Health’s type 2 diabetes program will receive the FreeStyle Libre continuous glucose monitor (CGM). Any person with type 2 diabetes who is enrolled in Omada’s program will be eligible to receive FreeStyle Libre following a personal online consultation with a doctor. The FreeStyle Libre will be delivered directly to the participant’s home.

When the FreeStyle Libre is scanned, glucose data will be sent to the Omada Health app and will be available for users to see patterns, track progress, and get personalized recommendations from their assigned coach. This technology enables coaches to give specific advice based on unique patterns and allows users better understand the way their daily decisions affect their blood sugar, as well as mood, weight, sleep, and more.

Omada’s type 2 diabetes program provides participants with an app, access to coaches, connected devices (including a wireless weight scale, blood pressure meter, glucometer, and now a FreeStyle Libre CGM), educational materials, and a peer support group, all of which aim to help people change their behavior using tailored coaching and care.

Beyond type 2 diabetes, Omada offers programs for prediabetes, hypertension, and anxiety and depression. In particular, Omada’s original program – a digital version of the Diabetes Prevention Program (DPP) – is the largest digitally-delivered DPP in the US and has shown positive results for participants in terms of weight loss and A1C reduction.

Omada’s programs are primarily offered through employers and health plans that cover the costs of the program, although individuals can sign up independently and pay for the program themselves. Take this short survey to see if you are eligible.

To find out about other similar programs, read our article on how to get unlimited test strips and personal diabetes coaching.

Source: diabetesdaily.com

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