Survey Reveals the Heavy Burden of the Pandemic on People with Diabetes

The COVID-19 pandemic has now been ongoing for over a year, and even with the light finally visible at the end of the tunnel, it is undoubtable that it will have lasting effects, for years to come.

Late in 2020, we partnered with the American Diabetes Association (ADA) to conduct a survey-based analysis to assess the effects of the COVID-19 pandemic on Americans living with diabetes.

Approximately 2,600 responses were collected from the Thrivable online patient panel. People from all 50 states shared their experiences during the pandemic, describing the impacts on access to healthcare, food, outlook on receiving a COVID-19 vaccine, and more.

Key Findings: Reduced Health Care and Food Access

  • About 4 of 10 Americans with diabetes delayed seeking routine medical care, with more than 50% stating the fear of COVID-19 exposure was the primary reason.
  • About 1 in 5 Americans with diabetes have foregone or delayed getting an insulin pump or continuous glucose monitor (CGM).
  • More than 1 in 4 stated their access to healthy food was reduced, with about 1 in 5 relying on food assistance programs.
  • Almost half who receive assistance report that the food they receive negatively affects their diabetes management.
  • About 1 in 5 people who receive nutritional assistance report not having enough food to eat.

Moreover, about 1 in 5 Americans with diabetes have reported having to choose between buying food vs. affording their diabetes supplies.

The effects of the COVID-19 pandemic are widespread and span across multiple facets of people’s lives. For people with diabetes, many of whom are already struggling to afford their healthcare expenses, the financial effects of the pandemic may be particularly grim.

Perspectives on the COVID-19 Vaccine

When asked about their comfort level of receiving a COVID-19 vaccine as soon as it is made available to them, people with diabetes reported being more likely to want to receive it right away as compared to data collected from the general population.

Less than half as many people with diabetes stated that they would never want to get the vaccine as compared to data on the general population (10% vs. 21%, respectively).

It is perhaps not surprising that people with diabetes feel more strongly about receiving a COVID-19 vaccine than the general population. Currently, the Centers for Disease Control and Prevention (CDC) state that people with type 2 diabetes  “are at increased risk  of severe illness” from COVID-19, while people with type 1 diabetesmight be at an increased risk for severe illness.”

Other Insights: Barriers to Clinical Trials Participation

In addition to exploring the financial burden of the pandemic and assessing readiness to receive a COVID-19 vaccine, we also gathered information regarding previous participation or willingness to participate in a clinical trial. As per the recent press release,

“People with diabetes have participated infrequently in clinical drug trials in the past (only 11% report having done so), but the majority – 60% – say they are likely or very likely to participate in such a study in the future. Yet nearly a quarter of those who responded to the survey said they didn’t know how to participate in a drug trial if they wanted to do so.”

Check out the full press release from the ADA as well as the more data below:

New Data Alert: COVID-19 Brings Crisis of Access for Millions Living with Diabetes

Effects of the COVID-19 Pandemic on People with Diabetes

Methodology and Panel Demographics

These figures are based on Thrivable’s survey of more than 2,500 people with diabetes nationally, between December 7th and December 14th, 2020

  • A multiple-choice survey was distributed online to people with diabetes (U.S. residents) who signed up for the Thrivable Insights panel.
  • Participants were not compensated for their responses.
  • Data was analyzed using Qualtrics and Excel.
  • Details on panel breakdown include:
    • N = 2,595
    • o 47% with type 1 diabetes, 53% type 2
    • o 69% female, 31% male
    • o All 50 U.S. states are represented

Source: diabetesdaily.com

How Race and Ethnicity Affect Diabetes Prevalence, Management, and Complications

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney, Matthew Garza, and Eliza Skoler

Black, Indigenous, Hispanic, and Asian individuals, and people of all non-white racial and ethnic groups are more likely to have diabetes and diabetes-related health complications than their white peers. Here’s how social determinants of health lead to differences in diabetes care and outcomes, creating racial, ethnic, and economic health disparities in the United States.

According to the 2020 National Diabetes Statistics Report published by the Centers for Disease Control (CDC), diabetes affects over 34 million people in the United States – that’s more than one in ten people. However, diabetes does not affect all communities equally. As with many conditions – such as heart disease, chronic lung disease, and chronic kidney disease – a person’s race, ethnicity, and socioeconomic status influences both their risk for developing diabetes and their access to diabetes management resources. The health disparities that exist among the many races in the US are not attributable to genetics or biology alone, but also to socioeconomic factors and social determinants of health that disadvantage people of color.

Though genetics and biology do play important roles in diabetes prevalence and complication rates, this article will focus on the societal factors that affect the lives of people living with diabetes – such as access to healthy food, healthcare, employment, and other socioeconomic factors. We aim to specifically explore the racial health disparities that disadvantage communities of color. We will also highlight some of the factors underlying the concerning patterns in diabetes prevalence, management, and complications, and share ways to promote health and access to care for people with diabetes, regardless of race and ethnicity.

Defining Key Terms

  • Race & Ethnicity – Race is a socially constructed way to group individuals based on skin color and physical features. There is no specific set of genes that defines a race. Ethnicity is also socially constructed, and it categorizes people based on a shared sense of group membership (like language, culture, history, or geography).
  • Socioeconomic status – Socioeconomic status is a measure of a person’s economic and social standing. This term is often used interchangeably with social or economic class.
  • Health disparities – Health disparities are differences in health outcomes among various populations or communities. They are closely linked to social, economic, and environmental disadvantages that affect groups that have systematically experienced greater obstacles to health (due to factors including race, gender, age, sexual orientation, and economic status.)
  • Health equity – Health equity is the goal that every person, regardless of their background or circumstance, is able to live a healthy life with full access to quality healthcare and other health resources. Achievement of health equity requires valuing every person equally and addressing avoidable inequalities with focused, societal efforts to eliminate injustices and health disparities.
  • Social determinants of health – These are factors that influence a person’s health but fall outside the scope of a healthcare professional’s influence. They are the conditions in which people are born, grow, live, work, and age. For example, social determinants of health can include a person’s race, gender, socioeconomic status, education, and where they live and work; these factors are often longstanding and have multi-generational effects. Social determinants of health are one of the major causes of health inequities – the unfair and avoidable differences in health status.
  • Systemic racism – Also called institutional or structural racism, it is defined by systems and structures (such as medicine or the healthcare system) that have procedures or processes that disadvantage people of color.

Systemic racism lies at the center of this article. As we discuss racial health disparities and their underlying causes, keep in mind that these factors are a result of the long-standing structures that affect the lived experiences of people of color – they are not attributed to the personal decisions of individuals.

A Look at Racial Health Disparities in Diabetes

What do health disparities actually look like in the US? The data show concerning patterns: Black, Indigenous, Hispanic, and Asian populations are more heavily affected by diabetes than their non-Hispanic, white counterparts, in diagnoses, management challenges, and diabetes-related complications.

The CDC’s diabetes statistics report showed alarming differences among races in the estimated percentage of adults with diabetes (both diagnosed and undiagnosed) in the US from 2013 to 2016:

  • Black, non-Hispanic: 16.4%
  • Asian, non-Hispanic: 14.9%
  • Hispanic: 14.7%
  • White, non-Hispanic: 11.9%

While these differences in rates are stark, the evidence shows that diabetes prevalence is not dependent on race from a genetic or physiological standpoint alone. For example, in this study from 2007, when researchers accounted for socioeconomic factors, the differences in rates of type 2 diabetes between racial groups were reduced. This supports the idea that socioeconomic factors that disadvantage people of color are a significant cause for these health disparities.

In a 2017 study published in the Journal of Racial and Ethnic Health Disparities, a team of researchers from Meharry Medical College and Vanderbilt University found that there were differences in the quality of diabetes care between racial and ethnic groups. Using the 2013 Medical Expenditure Panel Survey (MEPS) data, they looked at adherence to five ADA-recommended services over one year that indicate quality of diabetes care. Compared to white individuals, Hispanic, Black, and Asian individuals received fewer diabetes management checks, including A1C tests, eye exams, foot exams, blood cholesterol tests, and flu vaccines. Even in adjusted models which controlled for factors like insurance coverage, poverty, and education, some of the disparities remained. Most notably, Hispanic, Black, and Asian individuals were still less likely to receive the two recommended annual A1C checks. The researchers showed that this difference in quality of care occurred partly because populations of color had less access to health insurance and diabetes management education, compared to white populations.

Trends in care translate to trends in diabetes outcomes – including complications and death rates. A study from 2014 looked into racial and ethnic differences in diabetes complications and mortality. Black, Indigenous, and Hispanic individuals had higher rates of retinopathyend-stage kidney disease, and amputations than non-Hispanic white individuals. Furthermore, these groups were more likely to die from diabetes than non-Hispanic white Americans:

  • Indigenous populations were 3 times more likely to die from diabetes
  • Non-Hispanic Black Americans were 2.3 times more likely to die from diabetes
  • Hispanic Americans were 1.5 times more likely to die from diabetes

Just as with the risk of diabetes, people of color are not genetically predisposed to diabetes-related complications due to race alone. A combination of social and environmental factors plays into a person’s ability to successfully manage their diabetes.

How Genetics and Biology Are Involved

Racial and ethnic categories are not as closely associated with genetics and biology as some people think. In fact, categories such as white, Black, Asian, and Hispanic are defined more by society than by any set of specific genes. However, to fully address the factors that affect diabetes prevalence and outcomes, we must understand the role of genetics and biology. Studies have shown that there are biological differences among races that correspond to how a person metabolizes (or utilizes) glucose, their insulin sensitivity, and how fat is distributed in the body – however, a person’s family history of diabetes is more telling of their genetic risk for that condition than the color of their skin. The research on how genetics, biology, and race all intersect and interact to influence diabetes is complex; there is still much to determine.

As discussed, genetics alone do not explain diabetes-related health disparities among the races. Furthermore, we cannot reduce the large health disparities by focusing solely on biological factors, which are largely predetermined; we must instead focus on the socioeconomic factors and social determinants of health that exacerbate racial disparities, which are in large part founded in longstanding systemic racism. Below we describe some of the many elements of systemic racism that affect a person’s ability to manage their diabetes and receive quality diabetes healthcare.

Main Causes of Racial Health Disparities in Diabetes Prevalence

The factors we discuss here are influenced by systemic racism that is built into the social, economic, and political fabric of the United States. The systemic racism that people of color experience results in things like lower wages, fewer academic and professional opportunities, and reduced community resources. With this in mind, factors like income, unemployment, health insurance, and food and exercise environments are not entirely personal choices, but can be explained by a number of external causes.

Income 

In the US, there are major racial differences in wealth. A 2018 Kaiser study offered this breakdown of people living below the federal poverty level:

  • 1 in 4 Indigenous people
  • 1 in 5 Black people
  • 1 in 5 Hispanic people
  • 1 in 10 white people

Further statistics on income and poverty levels can be found in the US Census Bureau’s 2019 report, which confirms the racial disparities in poverty rates. People living with incomes below the federal poverty level in 2018 were earning only $12,000 a year (or $25,000 for a family of four). These families – and many above the federal poverty level – often can’t afford the nutritious food, safe exercise opportunities, and healthcare needed to prevent and manage diabetes.

Unemployment and Health Insurance

People of color in America are also more likely to be unemployed. According to the US Bureau of Labor Statistics, the rates of unemployment in 2019, broken down by race, were:

  • 6.6% of Indigenous people
  • 6.1% of Black people
  • 3.9% of Latino and/or Hispanic people
  • 3.1% of white people

These unemployment rates and racial disparities have been further exacerbated by the COVID-19 pandemic, which dramatically increased unemployment rates in the US. Though unemployment is closely tied to income, it can also influence a person’s access to health insurance, since many people receive health insurance from an employer.

Stat

Image source: diaTribe

The high cost of healthcare means those who are uninsured or underinsured often do not get the care they need, including preventive healthcare (such as annual check-ups and prediabetes screenings) and instead must rely on inconsistent care. Unfortunately, Black, Indigenous, and Hispanic people are less likely to be insured in America. According to a Kaiser study of non-elderly individuals in the US, these were the rates of uninsured people in 2018:

  • 21.8% of Indigenous people (identified as American Indian or Alaskan Native
  • 19% of Hispanic people
  • 11.5% of Black people
  • 7.5% of white people

Food and Exercise

A healthy diet and regular exercise are known to reduce the risk and improve the outcomes of type 2 diabetes. However, Black, Hispanic, and Indigenous communities in the US have less access to healthy foods and experience higher rates of food insecurity than white communities. According to the USDA, more than 35 million people lived in food insecure households in the US in 2019, including:

  • 25% of Indigenous people
  • 19.1% of non-Hispanic, Black households
  • 15.6% of Hispanic households
  • 7.9% of non-Hispanic, white households

Food insecurity is most common among low-income communities, which are disproportionately occupied by people of color. Moreover, food deserts (where there is little to no access to healthy foods) and food swamps (full of unhealthy fast-food options) are located primarily in minority neighborhoods. These communities are often faced with local food options that put them at an increased risk for diabetes: more small grocery stores with limited choices, fast food restaurants, and liquor stores, and fewer supermarkets with fresh fruit and vegetable options, bakeries, and natural and whole foods.

In addition to less access to healthy and affordable food, people of color often also have less time, money, and overall access to venues for exercise. This article from the New York Times about the racially exclusive culture around jogging is an eye-opening example of the barriers to exercise that many Black people face. Even at a time when some of the world’s most elite runners are African or Black, Black runners and joggers (in America, especially) often engage in protective measures such as running only during the daytime, steering clear of certain neighborhoods, or wearing Ivy League sweatshirts to deflect any suspicions that could lead to racist attacks.

Main Causes of Racial Health Disparities in Diabetes-Related Health Complications

Barriers to healthcare (such as a lack of health insurance or insufficient income) continue after a person is diagnosed with diabetes. Without ongoing, regular diabetes care, people face higher rates of health complications. Here are some of the barriers:

  • The high cost of insulin has made the life-saving drug inaccessible to many people, including people of color who have higher rates of unemployment and little or no health insurance. An American Action Forum report showed that insulin costs a person an average of $6,000 per year and found that one in four people with diabetes report rationing their insulin because they cannot afford the cost of their full prescribed dose.
  • Despite major advances in diabetes technology that make diabetes management easier, including wider use of CGM and insulin pumps, disparities exist in who has access to these tools. Black individuals are less likely to use an insulin pump or CGM than their white counterparts – which may be due to failure of the healthcare professional to write a prescription for technology, insufficient information about diabetes technology, an inability to afford these devices, or subtle racism on the part of the established medical system.
  • Even for people who have insurance, the costs of diabetes care and a diabetes-friendly nutrition plan can be challenging for people with low incomes.

Social and racial barriers widen diabetes health disparities. There is a history of prejudice against people of color in our healthcare system: Black, Indigenous, and Hispanic individuals can have the same income, insurance, and medical condition as white people yet still receive lower quality care due to systemic racism. In 2018, fewer than 12% of practicing physicians in the United States were Black, Hispanic, or Indigenous individuals. This means that there are fewer healthcare professionals who can earn trust and identify with communities of color. For more information on racism in healthcare, check out Unequal Treatment.

The Importance of Addressing Health Inequity in Communities of Color

It is clear that the disparities in diabetes prevalence, care, and management can be explained in part by of a number of social determinants of health, many of which are influenced by systemic racism. Every person with diabetes faces health barriers. But for many, the color of their skin can make successful diabetes management even more difficult and sometimes impossible. Every person with diabetes should have access to diabetes care, medication, and technology, and to living a healthy life with diabetes.

What Can We, as a Society, Do to Reduce These Disparities?

It will take extensive, collaborative, and creative work to address these disparities. We can begin by educating ourselves and others. Some good first steps include learning about the challenges faced by people of color with diabetes, about the people working to address these issues already, and about the ways to get involved. Check out some of our other articles on these subjects:

At diaTribe, we want to acknowledge the people and the organizations at the local, state, and national levels who are already doing the work needed to effectively tackle the health inequalities that lead to higher rates of diabetes and less favorable outcomes among people of color. In addition to those whose jobs focus on addressing health disparities, there are other ways for people to be involved in promoting health equity. Here are some ideas to consider:

No matter what skills or resources you may have, determine how your expertise might be of benefit – particularly if you are in the health field where you can address systemic racism and health disparities. The more we learn about how the social determinants of health and racism in healthcare contribute to a person’s risk for diabetes and influence their diabetes management, the better prepared we’ll be to knock down barriers to quality care.

We acknowledge that every person should have the resources to manage their diabetes and, in the case of type 2 diabetes, to prevent it. All people, and especially people in positions of privilege, have a responsibility to help break down barriers to equal care for underserved communities. As people with diabetes and their allies, we have to do the work – and build upon the work already being done – to address racial health disparities and create more equitable and inclusive healthcare for people of color – in fact, for all of us.

Source: diabetesdaily.com

New Therapy to Treat Type 1 Diabetes Rolls Out Clinical Trial

Type 1 diabetes is an autoimmune condition whereby the person’s own immune system attacks the pancreatic cells that produce insulin. Insulin signals for glucose uptake into cells, a carefully regulated and important process, that when disrupted, can lead to an array of health complications, and without treatment, results in death. Many advances in the care of type 1 diabetes have been made in the last century; however, there is no cure for the condition, and patients rely on frequent blood glucose monitoring and insulin injection or infusion therapy to survive.

We have been closely following the work of Dr. Bart Roep and his colleagues at the City of Hope over the last several years. We first spoke to him at the 79th American Diabetes Association (ADA) Scientific Sessions in 2019.

“Dr. Roep has dedicated his professional life to trying to cure type 1 diabetes. Over an almost 30-year career, he has earned numerous prestigious awards and is perhaps most well-known for his work discovering how T-cells recognize specific antigens on beta cells in the context of type 1 diabetes pathogenesis. Currently, he is Chan Soon-Shiong Shapiro Distinguished Chair in Diabetes and the founding chair of the Department of Diabetes Immunology within City of Hope’s Diabetes & Metabolism Research Institute. Dr. Roep is also the director of the Wanek Family Project for Type 1 Diabetes.”

The immune system coordinates defenses against pathogens (like viruses and bacteria) via intricate cross-talk between different immune cells in the body. It is also able to recognize the host (self-tolerance) and under normal circumstances, should not attempt to destroy the person’s own cells (with the exception of special circumstances, like cancerous cells, for instance).

Photo by iStock

For the treatment of autoimmune conditions, like type 1 diabetes, much research is ongoing in an effort to “re-write” some of the “programming” and cellular cross-talk thought to be responsible for autoimmune attack. The “inverse vaccine” for the treatment of type 1 diabetes attempts to do just that in the following process:

  1. Immune cells are taken from patients and “re-educated” in the test tube to improve self- tolerance
  2. These cells are injected back into the patient, in hopes that they will not longer drive autoimmune attack, but rather “educate” the immune system to tolerate the person’s own beta cells

Last year, we reported that the initial safety and tolerability studies appeared promising.

Now, additional clinical trials are poised to begin:

“The vaccine is made using one’s own immune cells (dendritic cells) and a beta cell protein. The vaccine may teach the immune system to stop attacking the beta cells, which may help the beta cells recover and make enough insulin to control blood sugar levels. The vaccine may also help reduce future type 1 diabetes related complications.”

It is a very exciting time for type 1 diabetes as we move from just treating the symptoms to actually trying to stop the disease,” Roep remarked in a recent press release.

What are your thoughts on this research? Would you participate in the trial?

Source: diabetesdaily.com

New Target A1C Recommended for Youth with Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza and Lydia Davis

The American Diabetes Association has lowered the A1C target for children to less than 7.0%, aiming to improve long-term health outcomes without increasing hypoglycemic events.

The American Diabetes Association (ADA) recently issued a new recommendation on A1C targets for children: youth with type 1 diabetes should aim for an A1C below 7.0%, rather than the previously recommended target of 7.5%. The ADA also emphasized that although this is a target for the general population of children with type 1 diabetes, it is important that each child’s A1C goal be personalized, taking into account hypoglycemia awareness, baseline A1C, and other health issues.

In 2018, the American Diabetes Association (ADA) reiterated its long-held recommendation that children with type 1 diabetes should aim to have an A1C of less than 7.5%. This target was designed to help prevent severe hypoglycemia (low blood sugar) in children. The ADA has revised that position in light of a recent review paper, which showed that elevated blood glucose levels can lead to significant complications during child development, including abnormal brain development, an increase in heart problems, retinopathy, and neuropathy. The review also showed that newer diabetes therapies and technology have resulted in a lower risk for severe hypoglycemia.

However, for certain groups of at-risk children, this new recommendation may not apply, and it may be safer to target an A1C of 7.5% or higher. Children with low hypoglycemia awareness, those who cannot alert others to symptoms of hypoglycemia, those without access to helpful diabetes technology (such as continuous glucose monitoring), and those who cannot test their blood glucose levels regularly should continue to aim for an A1C of less than 7.5%. Children with a history of severe hypoglycemia should aim for an A1C of less than 8.0%.

In contrast, children who are not at risk for hypoglycemia (for example during the often-experienced “honeymoon” period) should aim for an A1C as low as 6.5%.

The lower A1C goal of 7.0% will hopefully lead to a reduction in diabetes complications during childhood and throughout the lives of people with type 1 diabetes, without increasing their risk of severe hypoglycemia while they are young.

Source: diabetesdaily.com

COVID-19 Vaccine for People with Diabetes: What’s Going On?

The COVID-19 vaccine is here, and like most things dealing with the pandemic, the rollout of both the Pfizer-BioNtech and the Moderna vaccines has been a nightmare. The Trump administration’s Centers for Disease Control and Prevention (CDC) Advisory Committee for Immunization Practices (ACIP) released loose guidelines for states to follow in determining how to disseminate the vaccine but has largely left most of the decisions up to the states. Most people don’t yet know when they’ll receive the vaccine, and on the whole, most states are still in phase 1a, disseminating shots to frontline healthcare workers and those living in long-term care facilities.

In their initial recommendations, people with type 1 diabetes would receive the vaccine further down on the priority list, along with healthy individuals under 65 years old. People with type 2 diabetes are classified as, “at increased risk for severe COVID-19–associated illness”, and are thus to be given priority access in phase 1c, along with people who suffer from other conditions, such as cancer, heart failure, sickle cell disease, chronic obstructive pulmonary disease (COPD), and smoking. Type 1 diabetes is classified as, “might be at increased risk for severe COVID-19-associated illness”, to be given access in phase 2, with other conditions such as being overweight (BMI >25), and suffering from neurologic conditions.

This would put people with type 1 diabetes in the general population rollout, months after not only people with type 2 diabetes have gotten their shots, but behind many other chronic conditions, too. This is a harsh slap in the face for a community that could face so many negative consequences should they contract the virus (not to mention people with diabetes make up 40% of all COVID-19 deaths).

But recent data has come out that people with type 1 diabetes suffer from mortality from COVID-19 at similar rates as people with type 2 diabetes, and a study conducted by Vanderbilt University said people with either type 1 or type 2 diabetes who have COVID-19 have three to four times higher risk of severe complications and hospitalization as compared to people without diabetes.

Several more studies show that having type 1 diabetes is potentially even more dangerous if you contract COVID-19  than having type 2: A Lancet Diabetes & Endocrinology study published last year looked at medical records from the National Health Service in England to conclude that the risk of dying from Covid-19 was almost three times higher for people with type 1 diabetes and almost twice as high for type 2 than for those without diabetes.

In Scotland, another Lancet study said being admitted to an ICU or dying was more than twice as likely for type 1 diabetes patients and nearly 1.5 times more likely for type 2 diabetes patients than for people without diabetes.

People with type 1 diabetes have been told that they live with a disability the entire time they’ve lived with this incurable illness. We’ve sat on the sidelines while going low, been discriminated against in the school and workplace, shut out from certain industries and employers, and know the unique and awful feeling of our skin tightening from a hyperglycemic event after our pump failed for the umpteenth time in our sleep. We require special accommodations, a militant watch on our medication, exercise, insulin, and food intake, and are never offered a break, a day off, or even a hint of affordable insulin.

We live in the unique situation of a dual-reality: having a chronic condition, yet feeling its invisibility every day. We’re never quite “sick enough”; we never “look” diabetic; sometimes, we feel like we don’t even “deserve” the meager accommodations that we get (always pre-board flights, because you’re allowed to!). We live every day with the knowledge that our life expectancy is likely shorter, our days are harder, and especially during this pandemic, many of us have lived in fear of a serious complication should we contract COVID-19 and the bleak consequences we could face. Many of us have stayed home, shut-in, and waited this out, while watching some of our able-bodied peers continue to ignore public health protocols and guidelines.

The end result of the CDC’s recommendations burns and is tangible: states, including Iowa, Illinois, and Virginia, are prioritizing dissemination of the vaccination to people living with type 2 diabetes before people living with type 1 diabetes. Simply put: we’ve been told to stay in, shut up, and wait it out for the vaccine, due to our fragile health condition, and now that the vaccine is here, our disability is yet again being ignored.

Yes, type 2 diabetes is being prioritized and that is right, good, and important, but type 1 diabetes needs to be prioritized, too. They’re not mutually exclusive. Currently, the United Kingdom is not differentiating between type 1 and type 2 diabetes; they are prioritizing people who have either type. Other countries are following suit.

On Tuesday, the Trump administration reversed course, adopting part of president-elect Joe Biden’s distribution plan, advising states to prioritize everyone over the age of 65 and any person with a chronic condition to get the vaccine as soon as possible; states have yet to officially adopt these plans on a wide scale.

Recently, several letters were sent from various diabetes advocacy organizations to the CDC urging them to reconsider their guidelines. Organizations such as T1International, Mutual Aid Diabetes, The American Diabetes Association, JDRF, Beyond Type 1, Children with Diabetes, The diaTribe Foundation, DiabetesSisters, and T1D Exchange have lent their voices to make the needs of the 1.6 million people living with type 1 diabetes in America known.

The bottom line is that we need to curb the tide of this pandemic. Almost 400,000 Americans are dead, with a holiday-related surge in cases, hospitalizations, and death on the way. We need to get shots into as many arms as quickly as possible and stop telling some of our most vulnerable populations that, yet again, they aren’t sick enough to qualify, and that they can wait. We can’t.

Source: diabetesdaily.com

How Sweet It Is: All About Artificial Sweeteners and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

What are artificial sweeteners, can people with diabetes consume them, and why are they controversial? Here we share advice and break down the types of sugar substitutes that are currently available

You may feel like you’re not sure how artificial sweeteners affect health or relate to diabetes – that’s fair, because there’s a lot of uncertainty on the subject. More than a dozen different kinds of artificial sweeteners are available. These products – also known as low calorie sweeteners, nutritive or non-nutritive sweeteners, or sugar substitutes – help make food and drinks sweet, without the calories found in sugar or the glucose spikes.

So, what are artificial sweeteners? How do they work? How do they affect people with diabetes? And ultimately, are artificial sweeteners good for you?

In short, artificial sweeteners can be much sweeter than sugar itself, so a little goes a long way. This can help reduce how many calories you consume from an artificial sweetener. Additionally, artificial sweeteners are typically not absorbed by the body the way sugar is, so they pass through you without as much concern for weight gain or blood sugar fluctuations.

In this article we’ll discuss what makes one artificial sweetener different from another, their side effects, whether they are safe or unsafe, and how to decide if an artificial sweetener is right for you.

“In our world of diabetes, [these products] make healthy eating more flexible, and they do not take away from one’s daily carbohydrate allotment,” said Toby Smithson, a registered dietician nutritionist and certified diabetes care and education specialist, and the founder of DiabetesEveryday.com. Smithson presented a seminar, “The Sweet Truth about Low Calorie Sweeteners,” at the virtual 2020 conference of the Association of Diabetes Care & Education Specialists (ADCES). Smithson has lived with diabetes for more than four decades and has watched artificial sweetener options grow. She is also a consultant for Splenda, a type of artificial sweetener.

A Bad Reputation

Despite how much they can help with blood glucose management, misperceptions about artificial sweeteners live on. For one thing, while artificial sweeteners themselves have few carbohydrates or calories, the foods they are in likely have some calories and carbs from other ingredients. “Claims like ‘sugar-free,’ ‘reduced sugar’ or ‘no sugar added’ are not necessarily carbohydrate-free or lower in carbohydrate content than the original version of the food. For this reason, we recommend that you read the nutrition facts label to understand how many carbs and calories you are eating,” states the American Diabetes Association’s website. “Using sugar substitutes doesn’t make an unhealthy choice healthy. It just means it’s less unhealthy.”

The Academy of Nutrition and Dietetics, the American Heart Association and the American Diabetes Association have all issued statements indicating that people can use artificial sweeteners cautiously when eaten as part of a healthy diet guided by current federal nutrition recommendations. In her presentation, Smithson said, “The expert consensus on low calorie sweeteners found low calorie sweeteners to be safe, they reduced sugar and energy intake, and had no adverse effects on sweet preference, appetite, or glucose control. Artificial sweeteners may improve diabetes management, but there hasn’t been enough data on gut health and artificial sweeteners to comment on that aspect.”

Still, negative perceptions linger. “Studies on certain sweeteners have revealed questions about their safety which have not been adequately answered,” said Dr. Robert Lustig, author of the upcoming book Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine“Two examples are aspartame and saccharin, which have been associated with cancer in animals. But these have not been proven in humans. Nonetheless, these doubts persist in the public’s mind.” Lustig argues that we don’t know enough about how sweeteners affect humans to determine whether they are fully healthy for our bodies.

One woman with diabetes came to see Smithson for nutritional guidance and explained that she drank sugary – not artificially sweetened – soda regularly. “She thought it was safer to do,” said Smithson. “To help her understand this, I explained how a regular soda would affect her blood sugar. We suggest drinking regular soda to help spike a blood glucose level within 13 minutes, as a treatment for hypoglycemia. It really got the point across to my patient.”

Today’s Sugar Substitute Options

Why would someone with diabetes think a Coca-Cola would be a better choice than a Diet Coke? With many different products on the market and varying news and studies about nutrition, it can be hard for the public to keep up with changing trends. Similarly, different artificial sweeteners have specific aftertastes, some more obvious than others.

“Some people will use eight teaspoons of sugar in a cup of coffee, and for them it would be hard to transition to an artificial sweetener immediately,” said Sandra J. Arevalo, a dietician, certified diabetes care and education specialist, and National Spokesperson for the Academy of Nutrition and Dietetics. She has counseled people with diabetes over the past 25 years. “I tell them to start reducing the amount of sugar, instead of switching immediately. To reduce the amount of sugar helps change the taste buds, which makes it easier to adapt” to using a smaller amount of an artificial sweetener.

What are the sweeteners available, and what do we know about them? This chart shows common artificial sweeteners that people use at home. All of them are low-calorie, low-carb sweeteners.

Sweetner

Image source: diaTribe

Some artificial sweeteners are mainly used in processed foods. If you’re checking for sweeteners on a food’s nutrition label look for the types listed above, as well as neotame and advantame – two more sweeteners that are thousands of times sweeter than sugar.

Overall, experts recommend using the smallest amount of any sweetener possible. “These sweeteners are safe on a single-dose basis; none of them will make you keel over and die,” said Lustig. “But the question is, what about multiple doses? It’s like tobacco smoke. One cigarette won’t kill you, and not even a pack of cigarettes in one day will kill you. But a cigarette a day for 20 years just might.”

Arevalo agrees.

“Just keep it to the minimum,” she said. “Enjoy it, but be careful of the amount.”

Are some sweeteners healthier?

Some people may be sensitive to certain artificial sweeteners, and Arevalo said plant-based sweeteners may cause fewer side effects such as stomach discomfort.

  • Stevia: Stevia sweeteners are plant-based and newer, and they cost more than sweeteners that have been on the market longer, notes Arevalo.
  • Monk fruit: “Monk fruit is gaining popularity due to consumer demand for ‘natural foods’ because it originates from the pulp of the fruit,” said Smithson.

Sugar alcohol sweeteners occur naturally in foods and are absorbed by the body more slowly than sucrose. They may be not calorie-free or carb-free, said Smithson. Typically used as a food additive for sugar free candies, cookies, mints and gum, sugar alcohols don’t cause cavities or a rapid jump in blood glucose levels, but they can cause diarrhea, stomach cramps, gas and bloating in some people, especially if you eat a lot of them. Swerve is a sugar alcohol sweetener that is popular among people eating very low carb diets – it has no calories and no effect on blood glucose, Smithson said.

So, which artificial sweetener is best?

Lustig noted that 2017 research published in the Canadian Medical Association Journal found that some studies suggest a possible link between using artificial sweeteners and weight gain and higher risk of obesity, high blood pressure, metabolic syndrome, type 2 diabetes (the studies included people with and without diabetes) and heart disease. However, more research is needed for definitive results.

Lustig’s bottom line is the less sweetness, the better. “Everyone needs to de-sweeten their lives, especially people with diabetes,” he said.

But many people love sweets. With any sweetener, both Smithson and Arevalo recommended that people conduct their own taste test to determine which product they like best, as some sweeteners have a bitter aftertaste. “Everyone’s taste buds are different and everyone’s feelings are different,” Smithson said. “Taste goes a long way and taste matters.”

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

Source: diabetesdaily.com

Get Your Flu Shot Now

This content originally appeared on diaTribe. Republished with permission.

By Tom Cirillo

Health experts are recommending more than ever that people with diabetes get their flu shot this year to reduce the chances of getting sick with both flu and COVID-19. Learn about your vaccine options, where to get them, and how the flu can affect people with diabetes

The American Diabetes Association, the American Heart Association, and the American Lung Association recently released a joint statement urging people to get flu shots this season. These organizations, along with countless others, are encouraging people to get a flu vaccination because of concerns that the COVID-19 pandemic may overburden the healthcare system this winter. In addition, without a flu vaccine, there is an increased chance of catching both viruses at once. Many of the symptoms of the flu are also symptoms of COVID-19. Check out our piece from earlier this year, “Flu Shots are Even More Important in a Pandemic” for clues on telling the difference between flu and COVID-19 – it’s harder than it looks!

Diabetes can complicate the recovery from both the flu and COVID-19 due to fluctuating glucose levels and a weakened immune system. Even if glucose levels tend to be stable, it’s important that people with diabetes do everything they can to avoid becoming infected and remain healthy. Getting a flu shot every year is one of the main preventive measures – and most insurance plans in the US (including Medicare Part B and Medicaid in many states) provide free flu vaccination! The CDC urges, and the ADA also strongly emphasizes, the importance of everyone in your household also getting a flu shot – you are significantly less likely to get the flu if the people you live with are also immunized, so please remind them if this hasn’t happened.

Between 5% and 20% of the US population will get the flu each year. And harm from the flu is often underestimated. Last year alone, the Centers for Disease Control and Prevention (CDC) estimated that there were 38 million cases of flu, leading to 400,000 hospitalizations and 22,000 deaths. 22,000! Each year a new flu vaccine is created to provide protection from the new strains of flu that scientists predict will be troublesome. Believe it or not, in years when the vaccine is well-matched to the virus, it reduces a person’s risk of illness between 40% to 60%. Last year about 52% of the population got a flu vaccine, which is estimated to have prevented 7.5 million illnesses, 105,000 hospitalizations, and 6,300 deaths. How can we make this percentage far higher for people with diabetes? Send us your best idea(s) and we’ll send you a free copy of Dr. David Kessler’s Fast Carbs, Slow Carbs!

It is by no means too late to get your flu shot – and in 2020, you want to be ahead of the curve, so do it now! Flu infections peak in February, and your flu shot will start protecting you from about two weeks after you receive it, for about six months. Use this amazing resource from Boston Children’s Hospital, the CDC, HealthMap, and Harvard Medical School to locate pharmacies and other facilities close to you where you can receive your vaccination. It showed 642 places within 50 miles of us right here in the San Francisco Bay Area.

There are several kinds of flu vaccines that people can receive.

  • Flu shots (injected using a needle) are recommended for people with diabetes. There are different flu shots available, with some being approved for people of specific ages.
  • The nasal spray vaccine is generally not recommended for people with diabetes.
  • Flu vaccine by jet injector (rather than needle) is approved for people between the ages of 18 and 64.

Talk with your healthcare team about your flu vaccine options to determine which is best for you.

Being sick with the flu can make it more difficult to manage your diabetes. If you do become sick, be sure to follow your sick-day plan. “People with diabetes experience more hyperglycemic events, and substantial increases in pneumonia, sepsis [inflammation resulting from your immune response to infection] and coronary heart disease after being diagnosed with the flu,” said Dr. Robert Gabbay, the ADA’s Chief Scientific & Medical Officer. “If an individual does get the flu, being vaccinated [usually reduces the symptoms of the flu and] helps them avoid more serious health consequences.”

It is easy to get vaccinated from your healthcare team or a pharmacy offering flu shots, including a grocery store pharmacy. If you are currently experiencing flu-like or other respiratory symptoms (such as fever, chills, body aches, sore throat, cough, runny nose), you should contact your healthcare team right away. There are anti-viral medications they can prescribe that can shorten the time you are sick and the severity of your illness.

In addition to the flu shot, there is another vaccine that you should receive: the pneumonia (pneumococcal) vaccine. This vaccine is about 60% effective at preventing lung infections (pneumonia) and other infections caused by the bacteria responsible for pneumonia. People with diabetes are also at greater risk of contracting pneumonia. The ADA recommends the pneumonia vaccine (which is also covered by most insurance plans) for all people with diabetes older than age 2. Right now, only about one-third of people with diabetes take advantage of this vaccine, so this is a great opportunity to reduce the number of cases of pneumonia. Depending on your age and underlying conditions you’ll need between one and three doses of the vaccine to keep you protected for the rest of your life. Be sure to talk to your healthcare team to determine the correct number of shots you’ll need, and when.

When thinking about keeping yourself healthy and reducing the risk of getting some combination of flu, pneumonia, and COVID-19 this winter, there is some good news. Strictly following the guidelines to avoid the coronavirus, such as mask wearing, frequent handwashing, and avoiding touching your face, also protects you from flu and pneumonia. Those precautions, plus getting the highly effective flu and pneumonia vaccines, are your best bet for staying healthy this winter and beyond.

Source: diabetesdaily.com

Great News: Trials Show Some Diabetes Drugs Can Actually Protect Your Kidneys

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza, Eliza Skoler, and Rhea Teng

More people with diabetes are taking drugs like Jardiance and Farxiga, originally developed to lower glucose in people with type 2 diabetes, because the latest data confirms that these drugs can protect your kidneys. A therapy still under investigation, finerenone, has been developed to protect the kidneys of people with and without diabetes

Recent research is showing that certain drugs can benefit your kidneys if you have type 2 diabetes. Diabetes is the leading cause of chronic kidney disease (CKD), and many people don’t receive adequate treatment for this condition, so advancements in therapy to treat and prevent kidney disease are important for the 800 million people worldwide who live with chronic kidney disease. We bring you some of the newest findings on finerenone, Jardiance, and Farxiga – three medications that have been shown to protect the kidneys in people with decreased kidney function, including those with diabetes and CKD.

Note: The latest results on Jardiance and Farxiga confirm earlier findings on two other SGLT-2 inhibitors – Invokana and Steglatro – which clearly show the kidney and heart benefits of this class of medication. As a result, SGLT-2 inhibitors are recommended for treating kidney disease in many people with diabetes. SGLT-2 inhibitors were a focus of the recent American Society of Nephrology’s virtual kidney conference. As research has shown an increased number of benefits of these medications – in terms of glucose levels, weight loss, hypoglycemia reduction, and heart and kidney health – new guidelines have rapidly developed (since 2013) for the use of these drugs in people with type 2 diabetes. And, in the case of Farxiga, SGLT-2s can also protect the kidneys in people without diabetes.

Finerenone

Finerenone is currently being tested to treat CKD in people with type 2 diabetes – it’s a new type of drug (called a non-steroidal MR antagonist) that interferes with the receptors that cause kidney cells to retain, or hold onto, excess salt and water. In the FIDELIO-DKD trial, almost 6,000 people with type 2 diabetes and kidney disease received either finerenone or placebo (a “nothing” pill) and were enrolled in the study for over two and a half years. The results from the trial demonstrated the benefits of finerenone:

  • Finerenone significantly reduced the risk of severe kidney outcomes by 18% over two and a half years.
  • Finerenone reduced the risk of severe heart outcomes by 14%, compared to the placebo.

The FIDELIO-DKD trial showed this medication to be helpful for people with type 2 diabetes. Given these positive results, finerenone has been submitted to the FDA and the European Medicines Agency for approval as a CKD treatment option for people with type 2 diabetes.

Jardiance

New findings from the EMPEROR-Reduced trial showed that Jardiance, an SGLT-2 inhibitor, improved heart and kidney outcomes in adults with heart failure with reduced ejection fraction (HFrEF, or a reduced ability to pump blood out of the heart), regardless of whether they had chronic kidney disease at the start of the trial. Of the 3,730 people enrolled in the trial – with or without type 2 diabetes – participants taking Jardiance showed:

  • A 22% reduced risk for severe heart outcomes among people with CKD, and a 28% reduced risk in those without CKD.
  • A 47% reduced risk for severe kidney outcomes in those with CKD, and a 54% reduced risk in those without CKD.

The variation in risk reduction was determined to be due to chance, rather than a difference in health outcomes between people with and without CKD. These results show that even though CKD increases a person’s risk for heart issues, Jardiance lowered that risk to the level of people without CKD.

Farxiga

New analysis of the DAPA-CKD trial found that Farxiga, another SGLT-2 inhibitor, protects the kidneys regardless of the cause of kidney disease, in people with or without type 2 diabetes. This builds on the positive results presented earlier this year on Farxiga’s ability to treat people with heart disease and CKD.

Why is this important?

More than 800 million people around the world live with chronic kidney disease, including 45 million people in the US (almost 14% of the US population). The need for effective medications that work for everyone, including those with or without diabetes, is high. Treatment with SGLT-2 inhibitors – or non-steroidal MR antagonists – could be key to helping these people.

Organizations like the American Diabetes Association and the European Association for the Study of Diabetes now recommend that people with type 2 diabetes and kidney issues be treated with SGLT-2 inhibitors or GLP-1 agonist medications. If you have diabetes or kidney disease, talk with your healthcare team about which of these treatment options may be helpful for you.

It’s important to catch kidney disease early so that it can be treated. If you have diabetes, ask your healthcare team to test your kidney function every year. To learn more about preventing kidney disease, view diaTribe’s helpful infographic. You can also read about UACR and eGFR, the two lab tests that are commonly used to evaluate kidney health.

Source: diabetesdaily.com

How to Get Through to Your Teen With Diabetes

If you’re raising a pre-teen or adolescent living with diabetes, you know that sometimes conveying the seriousness of the disease can be a difficult challenge. What oftentimes is easier and convenient now, such as grabbing fast food on the go, or neglecting to adequately count carbohydrates, take insulin or even test for days on end can contribute to serious complications later on in life. It can be extremely difficult to get through to your teen but making sure they know the seriousness of a life with diabetes is paramount. So, how do you communicate with a teenager when diabetes is the last thing they want to deal with? Does “tough love” work on teens?

Feeling Invincible

One’s adolescent years are an incredible time of drastic and fast change. Not only are teenagers growing rapidly physically and emotionally, but they’re also dealing with the drama of school and friends, and the challenges that managing a chronic condition brings. Teenagers and young adults often tend to feel quite invincible, even earning the nickname “young invincibles” for their seeming unwillingness to buy affordable health care plans or take reasonable preventive actions to take care of themselves and their bodies. More often than not, when teenagers neglect their diabetes management, it’s a sign of feeling quite burnt out.

Do Scare Tactics Work?

Can scare tactics help your teenager take their diabetes more seriously? When communication is difficult, it can seem almost impossible to prioritize diabetes management. Sometimes a teenager just doesn’t want to hear it, and in the worst of cases, giving your teenager scare tactics in the form of storytelling worst-case scenarios, playing the game of “what if” with complications, and threatening them can backfire, resulting in dangerous management patterns, disordered eating, or can even cause them to completely shut down all communication.

Lynn, from Pennsylvania, says,

“Scare tactics don’t work with me, and no one I know has used them. The best support I’ve gotten is when my loved ones decided to eat keto. We plan low-carb meals and look for new recipes together. If [my family] was eating tons of carbs, it would make it harder for me to stay low-carb. Otherwise, we don’t really talk much about my diabetes…my family does sometimes ask about my blood sugar after trying a new dish to see if it ‘worked’ for me.”

Cora adds,

“As young people, people with type 1 diabetes take criticism and scare tactics to heart. It’s basically verbal abuse because we don’t hear the practicalities behind what the parent is saying. Young people hear strongly worded comments about efforts to control our diabetes, and we take it personally. Except it comes through as ‘you’re bad’, ‘you’re lazy’, or ‘you’re incompetent’.”

Alienating your teenager with scare tactics is harmful, and you most likely will not get your desired result (more attention paid to their diabetes). There are healthier ways to help a person with diabetes in your life.

Photo credit: Adobe Stock

Honesty Doesn’t Have to Be Scary

It’s important to not scare your teenager with threats of complications, or a dark and scary future that may not come to fruition. Instead, model good behavior and have the whole family adopt practices that encourage a healthy lifestyle.

Meryl says,

“The best thing I have found to do is offer foods that he likes and can eat and not to nag.”

The good news that is well-adjusted teenagers eventually will take over the management of their diabetes, and thanks to technology, will begin to thrive. The power struggle and shirking of responsibility that comes with adolescence will end. In the meantime, here are some strategies to help you and your teenager thrive through this period of transition.

  1. Be there to listen. The power struggle between a teenager with diabetes and their parents comes down to them wanting to feel more independent, and the parents ultimately having to give up some (or all!) control of diabetes management and rigorous expectations. Make sure you’re there to talk with your teen, but more importantly, to listen to their wants and needs. If they want autonomy and space, be there to give it, but also hold them accountable (by showing you their glucometer memory, pump data, or meals and carbohydrate counts), to eventually earn more freedom. This way, you can problem-solve and strategize around emerging issues together. Additionally, here are some things not to say to someone with diabetes. 
  2. Find a great endocrinologist. Find a doctor that your teenager will work well with, and remember that communication is key. Finding the right dietitian, social worker, nurse, and primary care physician is also critical during this vulnerable time in a teenager’s life. Make sure your teenager feels comfortable talking with their doctors, sharing their concerns, and standing up for themselves during visits. This will be crucial for good diabetes management as they take on more of the responsibility of their care moving forward.
  3. Expose them to other teens with diabetes. Sign your teenager up for a diabetes camp, or a local support group for teenagers dealing with diabetes. Make sure they know that they are not alone, and find ample opportunities for them to meet other kids their age who are struggling with the same issues that they are. Usually, once a kid or teenager makes a “dia-bestie” their diabetes management improves, because now the thing that used to single them out suddenly makes them part of the cool crowd, like having the newest Patch Peelz or insulin pump.
  4. Try a tech break. If your teenager is struggling with constant insulin pump and continuous glucose monitor (CGM) changes all the time and is feeling like a cyborg, let them take a technology break. Sometimes a change in routine helps everyone suffering from diabetes burnout, and it can help bring a fresh perspective of and appreciation for the technology when you bring it back.
  5. Seek individual or family counseling. Sometimes a child loses interest in their diabetes management due to depression, which is more common among people with diabetes. Teenagers who have depression may not always exhibit the classic symptoms of depression such as crying, sudden anger, and changes in sleep and eating patterns. Regardless, a teen who stops taking an interest in their diabetes management is sending a clear message and call for help. This is an excellent time to find a great therapist who can help your teenager work through their issues.

Peter from New Jersey adds,

“From my experience, the key is to bring them to these realizations gradually, at a pace they can handle. That pace is very individual, and parents, and sometimes even doctors need to work on understanding that pace. In the meantime, just support them and make sure they don’t make any huge mistakes.”

These strategies can help you and your teenager thrive during this turbulent time in their lives, by prioritizing compassion, openness, and love. Also, be sure to check out recent research from the American Diabetes Association (ADA) about what works when it comes to transitioning to self-management.

What have you found to be the most helpful strategies in helping your teens thrive with diabetes? Please share your thoughts and experiences in the comments below.

Source: diabetesdaily.com

The Latest Heart Health and Diabetes Guidelines from the American College of Cardiology

This content originally appeared on diaTribe. Republished with permission.

By Joseph Bell

New SGLT-2 inhibitor and GLP-1 agonist diabetes medication recommendations for people with type 2 diabetes

The American College of Cardiology (ACC) updated its guidance in mid-August for heart health in people with type 2 diabetes. These recommendations are supported by the American Diabetes Association (ADA), and ACC similarly supported ADA’s 2020 Standards of Care for heart disease.

What’s New?

Compared to the 2018 ACC guidelines, the 2020 update gives more attention to preventing diabetes complications, rather than treating them once they have already developed. If a person with type 2 diabetes has heart disease, kidney disease, or heart failure – or is at high risk of heart disease – the ACC recommends discussing SGLT-2 inhibitor or GLP-1 agonist medications with their healthcare professional. Unlike the 2019 European Society of Cardiology guidelines, however, the ACC does not make a specific recommendation about SGLT-2 inhibitors or GLP-1 agonists as first-line drug therapies.

Additionally, in 2018, the ACC recommended Victoza as the preferred GLP-1 agonist and Jardiance as the preferred SGLT-2 inhibitor. However, with abundant clinical research since then, the ACC now recommends additional therapies, all equally:

  • For GLP-1 receptor agonists: TrulicityOzempic (injectable once-weekly GLP-1), and Victoza (once-daily GLP-1). Of these, only Trulicity is recommended for people with multiple risk factors for heart disease. The ACC also suggested that Rybelsus (oral GLP-1) may be included in these recommendations after more research is completed.
  • For SGLT-2 inhibitors: FarxigaInvokana, and Jardiance. The ACC also mentioned the potential heart and kidney benefits of Steglatro, given results from the VERTIS CV study.

Importantly, the ACC noted that starting either an SGLT-2 inhibitor or GLP-1 agonist medication should not be dependent on a person’s A1C levels; rather, it should be based on whether they would benefit from the drugs’ heart and kidney benefits. Many people with diabetes on an SGLT-2 or GLP-1 medication also see weight loss, reduced hypoglycemia, and lower A1C – even though heart health and kidney health are the reason that the therapies are prescribed. The ACC also recommended either drug class on top of existing metformin therapy. We look forward to a future stance on SGLT-2/GLP-1 combination therapy, although no guidance has been provided so far.

The American Heart Association (AHA) just made its own statement on SGTL-2 and GLP-1 inhibitors here – it’s technical language but check out the “Conclusion and Next Steps” section at the end.

Source: diabetesdaily.com

1 2 3 5

Search

+