UK Study Under Review Finds People With Type 1 Diabetes More at Risk to Die of COVID-19 Than People With Type 2 Diabetes

There’s a large UK study (2 million people) under peer review that’s gaining traction on social media. Why? Because it defies our – already overtaxed mental states – of what’s possible.

Covid-19: people with type 1 diabetes more likely to die than those with type 2.” This is how The Guardian, among other publications, headlined it.

NHS (United Kingdom National Health Service) research reports that people with type 1 diabetes are at 3.5x higher risk for death if they get COVID-19 than people without diabetes. In contrast, people with type 2 diabetes are twice as likely to die as people without diabetes.

Surprised? I was. And even though the research is currently being reviewed, and nothing’s yet been proven, the data has a strong statistical basis.

If you’re curious what all this means, I can share with you information I’m privileged to have access to. I am part of a team of global diabetes experts – MDs, researchers, scientists, heads of the university, and hospital departments. The group was formed a few months ago under the leadership of Professor Itamar Raz, diabetologist and former head of Israel’s national diabetes health policies and Guang Ning, Head of Shanghai Clinical Center for Endocrine and Metabolic Disease.

The team is digesting a barrage of information, sharing their expertise and experiences and brainstorming prevention and treatment guidelines that they can safely, and quickly, recommend to health professionals and the public.

Unnerved by The Guardian article, I reached out to the group immediately. Philip Home, Emeritus Professor at Newcastle University, UK responded within an hour. It was 10:30 PM in the UK.

Here’s what I can tell you with the proviso, as Home emphasizes, that currently this research presents an interpretation of the data, which is dependent on a rapidly changing situation in the UK. This means its application to other people, in other circumstances, is not easy – medicine is as much art as it is science. And, it’s hard to know whether there have been any population and/or calculation errors. For instance, some people with type 2 diabetes on insulin may have been incorrectly counted as type 1s.

Below (in italics) is a summary from my email exchange with Professor Home.

Those Not Necessarily at Higher Risk:

This comment is currently a hypothesis, but we do think people who have no evidence of vascular damage, no retinopathy, no albuminuria (including microalbuminuria) and no cardiovascular disease, are likely not at greater risk to be hospitalized or die if they get COVID-19 than people without diabetes.

Further, if one’s blood sugar is also well managed, A1c under 7.5%, they are probably at no greater risk of getting COVID-19 in the first place than someone without diabetes.

Those at Higher Risk for Poorer Outcomes:

People who have type 1 diabetes who show evidence of vascular damage, should they get COVID-19, would be at higher risk of severe outcomes including hospitalization and death. The risk for vascular damage is higher the longer you’ve had diabetes, particularly if glucose levels have been high.

Further, if you have poor glucose management you may be at greater risk to contract the virus.

People can check with their health professionals whether their markers that indicate vascular damage are in range, that includes CRP, HDL cholesterol, triglycerides, and liver enzymes (ALT). They can also check if they have any albumin leakage through the kidney. Also, they can check with their eye professional whether they have any retinal damage.

Understanding that this is a vascular issue and that vascular damage increases risk for comorbidities such as cardiovascular disease, I better understand why it’s possible someone with longer duration type 1 diabetes, who gets COVID-19, may be at higher risk for worse outcomes than someone with type 2 diabetes.

What else can you do now to protect yourself should you get COVID-19? First, don’t panic. As Home says, the data is not yet in. Second, use this time to build your nutritional and metabolic health. In other words, follow the common recommendations:

  1. Do your best to keep your blood sugar in target range
  2. Eat as healthily as you can – vegetables, whole, not processed foods, some fruit, dairy if you can tolerate it, beans, seeds, nuts, healthy fats
  3. Be active, even if you’re in lockdown

Like everyone, diabetes or no diabetes, wear a mask when out in public, stay six feet away from others and wash, wash, wash your hands. My personal prescription includes using those clean hands to then pour a glass of antioxidant-rich red wine.

Note: I wish to gratefully acknowledge Professor Home who responded to my query immediately, answered my questions, lowered my stress level and helped me interpret the medical data.

Source: diabetesdaily.com

The Impact of COVID-19 on African Americans

This content originally appeared on Beyond Type 1. Republished with permission.

By T’ara Smith

Think the coronavirus is the “great equalizer”? Think again. New data on the deaths from coronavirus shows the pandemic is impacting communities of color, specifically African-Americans, at disproportionate rates. African-Americans and other minorities are more likely to have underlying conditions such as diabetes, hypertension, heart disease, and asthma, which contribute to the mortality rate of COVID-19. These underlying conditions stem from health inequalities that range from food accessibility to barriers to healthcare.

African American

Image source: Beyond Type 1

Compared to non-Hispanic whites, Black/African-Americans are 60 percent more likely to have diabetes according to the Office of Minority Health. However, this doesn’t mean minorities are more susceptible to being infected by COVID-19, but that when they are infected they are more likely to die from it.

“It’s not that they’re getting infected more often. It’s that when they do get infected, their underlying medical conditions wind them up in the ICU and ultimately give them a higher death rate. We really do need to address the health disparities that exist in the U.S,” said Dr. Anthony Fauci, National Institute of Allergy and Infectious Disease (NIAID) director and leading expert on the coronavirus pandemic, at a White House briefing on Tuesday.

Recent data reported from cities and states magnifies how dire the pandemic situation has become for African-Americans. In Michigan, African-Americans made up 35 percent of COVID-19 cases and 41 percent of deaths — African-Americans consist of 14 percent of Michigan’s population. Specifically, Detroit, a city with predominantly Black residents, is a hot spot for coronavirus cases. In Chicago, 72 percent of COVID-19-related deaths were Black, who only make up 29 percent of the city’s population. Louisiana has shown a trend nearly identical to Chicago’s.

Evidence shows African-Americans are also having more difficulty getting tested for coronavirus. In early April, Syracuse University reported that while COVID-19 testing is far too low in the United States in general, the testing rates are lower in states with higher percent black populations and poverty rates.

Coronavirus Further Exposes Long-Existing Health and Economic Disparities

The prevalence of chronic health conditions in minorities such as diabetes can be attributed to long-existing barriers to quality of life essentials such as food, health care, and sustainable income. Food deserts, or areas where there is no access to food or quality healthy food, are more abundant in minority neighborhoods. African-Americans are more likely to be uninsured, rely on government insurance, and are less likely to have private insurance compared to their white counterparts, according to the Office of Minority Health. They’re also more likely to have a lower median income. Recent data also shows the wave of millions of job losses is disproportionately affecting minorities.

“It’s jarring to me to hear that African-Americans are disproportionately affected by COVID-19,” said Mila Clarke Buckley, Beyond Type 2 Leadership Council member and owner of the Houston-based Hangry Woman website, who has been living with type 2 diabetes since 2016. “We do have to recognize the systemic factors that play a role in this. Even though I have privilege and resources, I don’t feel safe. It has highlighted the importance to me of practicing social distancing, and staying in as much as possible. I don’t want to be in a position where I can’t get the care I need if I were to get the virus.”

Current CDC recommendations to decrease the risks of contracting coronavirus are to stay home and practice social distancing. However, not everyone has the privilege to abide by those guidelines. A report by the Economic Policy Institute based on federal labor data shows Black and Hispanic workers are less likely to be able to work from home.

“Taking public transportation to get to jobs as essential workers because they can’t afford to not work, living in food deserts and having to travel to get groceries, and other issues that have been reported on,” said Dr. Fauci at a press conference.

Constance Brown-Riggs, MsEd, RD, DCES, CDN, discussed another layer to the public health crisis’ impact on minorities: the lack of trust in the healthcare system itself.

African American

Image source: Beyond Type 1

“There are many factors that contribute to health disparities in people of color. One factor is the mistrust of the medical community. Additionally, numerous studies show that health care provider bias also contributes to health care disparities,” said Brown-Riggs. A New York Times article published in January summarized the generations of institutional racism and discrimination towards African-Americans.

“One of the most troubling explanations for mistrust is the Tuskegee experiment, in which poor black men were unknowingly infected with syphilis and allowed to live with the deadly infection so doctors could track the life history of the disease. Black Americans who know of the study report a greater mistrust of medicine and research,” said Brown-Riggs.

Global patient diabetes advocate of Black Diabetic Info and Beyond Type 2 Leadership Council member, Phyllisa Deroze, also echoes a similar sentiment about bias within the healthcare system.

“I’m not surprised that African-Americans are impacted more,” said Deroze, who lives with LADA diabetes. “I have long since said that the coronavirus might not discriminate, but the American Healthcare system has a long history of being biased. Just look at the maternal mortality rate – black women are 3-4 times more likely to die than white women [in childbirth].”

African-Americans and other minorities have also reported experiencing racial discrimination at medical appointments. Among professionals who work with minorities with diabetes, Brown-Riggs says the lack of diversity plays is a factor as well.

Studies show that most health care providers have an implicit bias in terms of positive attitudes toward whites and negative attitudes toward people of color,” says Brown-Riggs. “This bias is particularly worrisome when the majority of people with type 2 diabetes are African American or Hispanic American and the majority of diabetes care and education specialists and nutrition professionals are white.”

Pressing Forward Despite Systemic Barriers

African American

Image source: Beyond Type 1

Still, African-Americans and other minorities with diabetes are taking the steps to lower their risks of getting the novel coronavirus. Paul Ellis, a person with type 2 diabetes living in Cerritos, California, says despite the issues within the healthcare system, he’s going to do what’s necessary to decrease his chances of contracting it. “I try not to let [the health disparities] get to me,” said Ellis. “I’m determined to manage the disease the best I can and have made a lot of progress since I was diagnosed. I lost a lot of weight, and between that, exercise, diet, and meds, I am doing pretty well. I even did a virtual 5k for the first time a couple of weekends ago and even though I was as slow as molasses, I did it to show myself I won’t be beaten.”

Likewise, Deroze is not taking any chances with COVID-19 and says she’s taking the guidelines seriously. However, the stress and anxiety from the COVID-19 have impacted her glucose levels.

“I’m staying indoors and am only leaving the house for an hour walk in the morning,” said Deroze. “After going to the grocery store a week ago, I decided I didn’t want to be around many people. I started to see an increase [in my blood sugar] the second week of quarantine. The lack of my usual exercise routine and the abundance of food in the house contributes to that. I know this is partly due to environmental stress, but this is a lot to deal with at once.” 

Fortunately, the push for telehealth may yield its benefits for those who need to seek care without leaving their homes. Brown-Riggs suggests inquiring about telehealth with healthcare professionals.

“During this COVID-19 pandemic, it’s extremely important for African Americans and other minorities with diabetes to stay in contact with their diabetes treatment team. Under the recently enacted Coronavirus Preparedness and Response Supplemental Appropriations Act, physicians, nurse practitioner (NPs), physician assistants (PAs), nurse-midwives, clinical nurse specialists (CNSs), and registered dietitians (RDs) or nutrition professionals (RDNs) are permitted to provide telehealth services,” said Brown-Riggs.

She also emphasizes that it’s important to continue with regular self-care behaviors such as eating healthy, being active, and getting regular sleep. For people who are food insecure, check out local food assistance programs and banks. Brown-Riggs warns against scams and misinformation from people looking to capitalize on those most vulnerable to COVID-19.

There are other steps being taken to address this issue from an institutional level. Chicago Mayor Lori Lightfoot said in a news conference that an urgent public-health education and outreach campaign will be launched in minority neighborhoods worst-impacted by the coronavirus.

In early April, California released partial race-based data that did not show a disproportionate impact of COVID-19 on racial minorities — but the bottom line is that we need more data. “Based upon the 37% of the data that’s in, we are not seeing [race and ethnic disparities],” said California Governor Gavin Newsom. “But I caution you, the data is limited. Nothing is more frustrating than the disparities that manifest in relationship to public health. Those issues preceded this crisis and they persist in this crisis.”

The coronavirus crisis is a global pandemic, but its impact will follow the same patterns of health inequality built into systems, institutions, and culture. It’s important to remember that minority communities are already facing disproportionate impacts of COVID-19, with additional barriers to the resources and care needed to mitigate damage caused by the virus.

Source: diabetesdaily.com

Big Changes! Centers for Medicare & Medicaid Services (CMS) Loosen Requirements for Obtaining a Continuous Glucose Monitor (CGM) During COVID-19

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan and Kelly Close

In-person visits, lab tests, and finger stick documentation are no longer required at present to get a CGM

Editor’s note: This article was updated on May 21, 2020 to reflect that lab testing is still required for an insulin pump and pump supplies.

High blood sugar levels leave the body vulnerable to infections, meaning those individuals with poorly controlled diabetes are at greater risk of contracting COVID-19. To properly monitor and respond to glucose levels and to strengthen the immune system to fight off infections, a continuous glucose monitor (CGM) can be very helpful.

If you are on Medicare, obtaining a CGM through your healthcare professional is a relatively involved process, requiring an in-person clinic visit, lab tests, documentation of frequent finger sticks (four or more times a day), and a lot of paperwork. At present, only those on insulin have an opportunity for approval. However, due to COVID-19 and the increased risks it poses for people with diabetes, the Centers for Medicare & Medicaid Services (CMS) announced that it will not enforce the following criteria for receiving a CGM:

  • In-person clinic visits
  • “Clinical criteria,” including lab tests for C-peptide or auto-antibodies, or demonstration of frequent finger sticks

This means that people with diabetes do not have to go to the doctor’s office or undergo lab tests to receive a CGM. Importantly, these loosened restrictions also reduce the amount of paperwork and bureaucracy for healthcare providers and give them greater flexibility in providing CGMs. Lab testing is still required for insulin pumps and pump supplies.

This increased access to CGMs is a huge win for the many people with diabetes on insulin who would not otherwise be able to get a CGM. Because CGMs provide real-time data for blood sugar levels, users are able to monitor their glucose and proactively adjust their insulin doses. Not only do CGMs help increase time in range, and thus have the opportunity to increase productivity and quality of life, but they can also improve overall diabetes management and can help keep patients out of the hospital.

We hope that in the future, at least those on SFUs will be able to get CGM, as SFUs can prompt hypoglycemia, which is especially dangerous right now, given the importance of staying out of the hospital.

Every person with diabetes can benefit from either a professional CGM used regularly (at least yearly) or a 24/7 CGM. While these new CMS guidelines are temporary in response to COVID-19, we are hoping and advocating for making the changes permanent. With the rise of the Beyond A1C movement and increased awareness of time in range, CGM (24/7 or professional) is an essential tool for people with diabetes to live happy and healthy lives, both during and after COVID-19.

This article is part of a series on time in range maybe possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

Source: diabetesdaily.com

David’s Journey to Becoming a Certified Diabetes Educator

We spoke to someone with type 1 diabetes who is working on earning their Certified Diabetes Care and Education Specialist (CDCES) credential, formerly known as Certified Diabetes Educator (CDE). David shares some of his journey and explains more about this educational process. 

Hi David, thank you so much for taking the time to speak with me. So many people living with diabetes are passionate about our cause and choose a profession related to our condition. I am always seeing questions within the community about how to become a Certified Diabetes Care and Education Specialist (CDCES) and I thought it would be helpful for our readers to have someone walk us through their journey on becoming a CDCES.

When were you diagnosed with type 1?

I was diagnosed with type 1 diabetes on October 13, 2008 when I was 11 years old.

How did you handle it growing up?

I didn’t know how to handle it as a kid, honestly. I hadn’t fully accepted my disease until I turned about 14 years old when I began to take this disease into my own hands in a more responsible fashion. Once I fully accepted this disease, I handled it very well, in a positive light!

Have you always wanted to become a CDE or did you start down a different path?

No! I actually didn’t want to be a certified diabetes educator until my junior year of college. I was choosing to go on several different routes. I started out majoring in biomedical sciences/pre-med to become an endocrinologist, then changed to pre-dentistry, and then I lastly switched to graphic design. I was convinced I wanted to be a graphic designer, up until I was in my third year of college, I realized my calling to become a diabetes educator, as I realized my passion for educating others on diabetes and tackling some of the common misconceptions behind it.

I then dedicated all my design work to becoming centered around diabetes education and stereotypes and then graduated with my BFA in graphic design, emphasis in photography and digital illustrations, creating a final Senior Gallery Exhibition where I was able to hold a display in a gallery of design work 100% related to type 1 diabetes. Now, a year later, I am getting my master’s in public health, majoring in health education and wellness coaching to eventually become a Certified Diabetes Educator, all with a designer’s twist to it!

Did you have any mentors (like a diabetes educator) who helped you with diabetes management? 

I would say first and foremost, my very first (pediatric) endocrinologist who diagnosed me as a type 1 diabetic and was very encouraging to me that I could lead a normal life with type 1 diabetes. I also have been inspired by several active members and leaders in the diabetes community who have truly shaped my passion and experience in this diabetes space.

Photo credit: David Mina

Did you have any positive or negative experiences with educators that shaped your perspective of how to best approach helping others with the condition?  

Yes! Absolutely. When I was about 13 years old and began caring for my diabetes on my own terms, I wasn’t caring for my diabetes in a responsible way, which led my hemoglobin A1c to skyrocket and be at the highest it had ever been. Once I went in for my 3-month check-up with my endocrinologist and diabetes educator, my diabetes educator sat me down and gave me a very mean and stern lecture as to how I was not caring for my diabetes and if I kept that up, I would be facing some very serious consequences, such as amputations, heart problems, and vision loss.

After that appointment, as scared and depressed as I was, I took that anger and frustration and proved not only my diabetes educator wrong, but I also proved to myself that I could reach a certain level of peace and stability over my own diabetes management. Though my diabetes educator hurt me with the words she used and her strict demeanor, I thank her for instilling that drive in me to fight against my diabetes and create a world where diabetes does not have to be the “worst case” for anyone! That is when I chose to start up my social media brand, @type1livabetic, where I try to encourage others to view their diabetes with positivity, rather than negativity!

What was the first step you took in order to get closer to your goal of becoming a CDE?

The very first step I took in order to get closer to my goal of becoming a CDE was to finish my undergraduate degree in graphic design, create a full body of work related to type 1 diabetes, then apply into a masters program that would grant me a Masters in Public Health (MPH). Once I finish my master’s program in December of 2020, I will be one step closer to earning my title as a Certified Diabetes Educator (CDE).

I understand you are more than halfway through the Health Education & Wellness Coaching Program through the School of Public Health. Congratulations! How has that been? I know you mentioned you liked to incorporate type 1 into class discussions and assignments, can you give us an example of something you did?

So far, my program has been pretty enjoyable for the most part. My biggest challenge thus far has been transitioning from design school and being a graphic design major, where I was so used to projects, rather than studying for tests and doing assignments. So now, being in a more health-related field, I am having to adjust my whole mentality in terms of how to go about studying and applying real-life health situations into my program.

When I get the chance, I always make sure to incorporate type 1 diabetes into any class discussion and/or assignment. At certain points in my program, we would have an assignment for class discussion and the topic would be diabetes that week. I chose to share my experiences with diabetes and try to educate my classmates at the same time, as I am aware that many still have some ideas about diabetes that may not be true, so I find as we all make it our mission to become health care professionals, I am able to help them gain a better understanding on what diabetes actually is, both type 1 and type 2, through simple lectures, class discussions, and assignments.

Photo credit: David Mina

What type of schooling do you need to have before you can go on to become a CDE? And are there different options?

The traditional route, from what I have heard, is that most CDEs have a background in nursing, nutrition, and/or dietetics, however, the type of schooling I need, based on the unique path I am going towards, is that I will need to gain my MPH degree, then obtain a certain amount of internship hours in the field of diabetes afterwards. After that, I will take the CDE exam and hope to become an official CDE finally!

Have you found other people living with diabetes going through your program?

I honestly have not, as my path is very unique, however, in sharing my own journey and experiences with this program, I have found a handful of my type 1 friends and followers showing interest in going through my program, which is amazing!

What have you found to be, or think will be, the most challenging part of becoming a CDE?

I believe that given I am a type 1 diabetic myself, I will be able to have a stronger impact on my patients as a CDE, making it easier for myself and for others, however, I believe the hardest or most challenging part will be having to learn how to work with others from a variety of different backgrounds and be able to still help them and connect with them on a very personal level.

I understand you need a certain amount of hours interning, how many exactly and where do you hope you can spend that time learning? In a hospital setting? Private office on-line coaching, etc?

Yes, I am not entirely sure of the exact amount of intern hours needed, however, I do know it is somewhere between 1,000-1,600. I feel as though it can vary depending on which program I go towards. I plan to somehow connect with a diabetes-based company or organization, whether a medical device company or a certain organization, and help in interning as a designer, educator, or any outreach/marketing professional in their space, as a way to practice my educating degree, as well as my degree and strong passion of design.

Now, more than ever, providers are making use of telemedicine as much as possible? How do you feel this affects patient care? Are there pros and cons to an online educational setting? 

I personally have had a few medical (diabetes-related) appointments through a telehealth system and have found them to actually be very nice and convenient, from a variety of different perspectives. For the most part, it is nice to be able to see a doctor from the comfort of my own home and still be provided with the exact same patient care I know I need. I believe that this can affect some patients in a way that some may feel they receive better care in person with a doctor and are able to gain more from that face-to-face interaction. In this case, I would say that the pros and cons to an online educational setting truly depend on the patient as everyone is different and may require or desire a different degree of medical attention.

How has this education impacted you financially? Is it manageable, do they have any special programs or resources you can recommend to anyone who is interested but may not feel like they can afford it?

This form of health education has not impacted me financially, only in the sense that my insurance at the moment has been great and has helped me in receiving the care I desire. However, many organizations or medical offices have been great, especially these days, in providing a discounted program for patients who need to see their doctors regularly, but cannot afford it these days, given the current state we are all living in. I think it is always worth it to ask a doctor for any recommendations they may have for patients who may not be able to afford certain online care, such as a savings card, insurance coverage, or any local telehealth programs that allow a patient to receive the same type of care they normally would have, only online now.

What advice would you give someone just starting on their road to becoming a CDE?

Stick with it. I know it may seem a bit discouraging now, but think of the big picture. You are needed in this field to change the way we discuss and manage diabetes as a society. Think of yourself when you were newly-diagnosed with type 1 diabetes (if you have diabetes), and how you could have benefitted from having a certified diabetes educator, just like you! Do it for yourself and do it for others as well!

Source: diabetesdaily.com

The Truth About Diet Soda

Living with diabetes comes with many challenges; we need to constantly know what and how much we eat and drink, and continuously calibrate our medications, like metformin or insulin, accordingly. It can be exhausting. One shining beacon of light (and a delicious thirst-quencher) is diet soda. It’s sweet, it’s refreshing, and it has zero carbohydrates! But recently, more and more research has been released linking diet soda to a plethora of GI issues and health problems (including, surprisingly enough, obesity). So, what’s the deal? Is diet soda a harmless, carbohydrate freebie treat or a danger to one’s health and well-being? Read more to get the scoop.

Many people with diabetes yearn to have a refreshing beverage that won’t affect their blood sugars, and sometimes water just won’t cut it. On days when it feels as though the wind will cause hyperglycemia, nothing is crisper or more enjoyable than enjoying a diet soda–and they’re typically known as “free” food–meaning they don’t require an insulin dose, nor do they raise one’s blood sugar. Seems innocent enough, right? About 1 in 5 Americans drink at least one diet soda per day, according to the CDC, but few can figure out if they’re good or bad for us. What gives?

The Problem

Unfortunately, diet sodas are full of artificial flavors and chemicals, as well as artificial sweeteners, like aspartame and saccharin. A growing body of research links consumption with an increased incidence of type 2 diabetes, high blood pressure, obesity, dementia, stroke, and non-fatty liver disease.

On the other hand, many studies correlating diet soda consumption with chronic health issues have failed to control for other risk factors, like lifestyle (sedentary vs. active) and body mass index (BMI). This causes a selection bias, as the type of person that may be more likely to drink diet soda may already be trying to lose weight (higher BMI) or better control their type 2 diabetes (chronic inflammation from higher glucose numbers). On the whole, no studies have proven causation between diet soda consumption and cancer.

Does Diet Soda Make You Gain Weight?

In short, no, but they can lead to it. A  2012 study showed that the artificial sweeteners in diet soda may change the levels of dopamine in the brain, thus changing the way one’s brain responds to (and craves) sweet flavors. Artificial sweeteners are hundreds of times sweeter than actual sugar, and if you’re used to drinking the sweet flavor of diet soda, your brain will naturally adapt, and you may start craving sweeter foods as a result. Equal (aspartame) is 160-200 times sweeter than sugar, and Sweet’n’Low (saccharin) is 300-500 times sweeter than natural sugar. This can cause you to eat more foods made with sugar, and gain weight as a result, although these sweeteners have been deemed safe by the U.S. Food and Drug Administration.

Christoper Gardner, Ph.D., Director of Nutrition Studies at the Stanford Prevention Research Center says, “You may find fruit less appealing because it’s less sweet than your soda, and vegetables may become inedible” causing people to reach for more processed foods that contain added sugar and calories.

Additionally, if you’re drinking diet soda, you may feel as though you’re doing something “healthy”, and make up for it by not being as stringent about a healthy diet. A 2014 study showed that overweight and obese people who drank a diet soda ate between 90-200 more calories per day than those who drank sugar-sweetened soda. This explains the phenomenon of patrons ordering fries with their diet soda at fast-food restaurants.

“Diet sodas may help you with weight loss if you don’t overcompensate, but that’s a big if,” Gardner adds.

What Research Is Telling Us

A 2014 study out of Japan found that men who drank diet soda were more likely to develop type 2 diabetes than those who didn’t. The study findings even controlled for age, BMI, family history of the disease, and other lifestyle factors. Additionally, a 2017 study of over 2,000 people showed that drinking one diet soda per day tripled one’s risk of stroke and Alzheimer’s disease.

Additionally, in 2014, a meta-analysis published in the British Journal of Nutrition revealed that one’s risk of developing type 2 diabetes rose by 13% for every 12oz can of diet soda they consumed in a day.

Moderation Is Key

While all of these artificial sweeteners are chemicals, they can be part of a healthy diet, per the American Dietetic Association. If you’re replacing sugar-sweetened soda with diet soda, it can be a remarkably easy way to cut down on sugar and calories, but try and maintain a healthy diet with plenty of fruits and vegetables as well, and don’t “treat” yourself to fast-food or sugared goodies for “being good” by having a sugar-free soda.

If you’re looking for an afternoon caffeine hit that soda normally provides, try opting for black coffee or tea to avoid the artificial sweeteners. Better yet, try weaning yourself off of soda completely and opting for a healthier, and more natural seltzer water, like La Croix, that doesn’t contain any artificial additives or chemicals.

All told, diet soda isn’t the absolute healthiest thing you can be drinking (read: that’s water), but in moderation, with a healthy diet and plenty of exercise, it can be a delightful, carb-free treat. Cheers!

What are your thoughts on diet soda? Are you addicted to the stuff, or try to avoid it at all costs? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

A Diabetes Educator Walks Us Through a TeleHealth Endo Appointment

With our country slowly heading back to our “new normal,” we will likely have to go back to our regularly scheduled lives, which includes being diligent about keeping up with all our routine doctor visits. It is even more important when living with diabetes to have annual eye appointments, physicals, dental appointments, and of course, our endo and diabetes educator appointments.

Since many are apprehensive about this new set up and wondering how exactly it will work, I thought it would be great to talk to Dawn, a nurse practitioner and certified diabetes educator who works in an endocrinologist office and have her walk us through the process and what we can expect.

Thank you, Dawn, for taking the time to talk to me today! How long have you been living with type 1 diabetes? 

24 years at the end of this month. 

Did living with diabetes play into your decision to become a CDE?

I had a great CDE in 1995 in a rural town which was unheard of. Then in college, I had a great nurse practitioner (NP) that I still look up to as a mentor for my practice. She talked to me like a person. She talked to me without pressure, shame, guilt, accusations and disappointment. She helped me come to terms with my diabetes and I will forever be in debt to her. I want to pass on that experience to other people living with diabetes.

How has your endocrinologist office responded to COVID-19? Have you closed down? How did you prepare for seeing your patients virtually?

We stopped seeing patients in the office at the end of March. We do still need labs so our lab is open but that significantly reduces foot traffic. We are only ordering labs that are necessary and will dictate current decisions. If they are not needed right now, then they can wait. We have two practice locations and staff are staying at one location. This way, if one office is quarantined we still have the other office to ensure patients have medical support.

We transitioned to virtual visits using the telehealth visit option within our EMR (electronic medical record) and we are using doxy.me as well. We are calling patients ahead of time to let them know about the change in the appointment and encouraging them to try to log in and make sure it works prior to their appointment. This would give you the chance to troubleshoot technical issues prior to your appointment.  We have had a few patients who still needed to be seen in person but almost all of our visits can be completed via telehealth.

I know many patients are curious about how an appointment like this will work. Is there anything the patient needs to do prior to the appointment? I know my son has an upcoming telehealth appointment and we had to download a certain app.

I would recommend as listed above making sure your means of communication works. Do a trial run at the location you plan to be at. If you will be at work during the call, make sure it works at work. If you are at home, then make sure it works at home. Will you use a computer or a smartphone? Do you know how to troubleshoot the speakers, video and microphone? Do you have a pump, continuous glucose monitor, or meter to download ahead of time? If you do, then get these downloaded at home prior to your appointment. Do a practice run a week ahead of time so if you need to call for help you have time to do so.

Having blood sugar readings and pump downloads ahead of time has streamlined my practice. I can view them prior to the appointment and focus on key items to make the appointment more productive. We are encouraging all patients to download at home, but we have made the exception for a few (elderly) to come and download at the office.

Can you walk us through what to expect during the appointment?

My wonderful medical assistants (Ariel, Tonya, and Whitney) have been calling patients to go over medications, any new changes to medical history just before the appointment and checking to make sure the telehealth app or doxy.me is working. Hopefully, I have already reviewed blood glucose logs and pump downloads ahead of time. If not, I will encourage the patient to get that for me.

What are some of the drawbacks of a telehealth appointment? I know my endocrinologist usually examines my thyroid, heart, etc. How will the doctor be able to check vitals as well as other routine measures? 

Yes, not being able to physically assess a patient sometimes is tough. However, if I am concerned enough that we need an in-person assessment ASAP, then they likely should have an urgent appointment with their primary care provider. If someone is complaining of an enlarged thyroid, with a keen eye, we can visualize that in most people via video. However, nothing replaces a hands-on assessment. We will see a patient in the office urgently if needed.

Do you find that overall providers have more or less time to spend with their patients this way?

When we have data (CGM/BG/Pump/labs) there is more time for providers to spend having meaningful conversations with patients. This streamlines appointments.

As a medical professional, how are you finding the telehealth appointments? What do you find most challenging?

  • When I have the data prior to an appointment, I love telehealth. I also love that I can go over reports with the patient and educate them on what I am seeing.
  • The most challenging part is obtaining data prior to the appointment. My medical assistant makes 2-3 calls prior to an appointment trying to prepare each patient. If I don’t have data, then essentially we are making an educated guess about what medications need to change.
  • For example, a patient can complain of afternoon hypoglycemia. However, it could be a reduction in basal insulin needs, overcorrection of pre-lunch blood glucose, or a too aggressive carb ratio. If we do not have data (CGM/BG/Pump) information, there is no way to tell for sure. So we ask questions around and around to try to figure out the most likely scenario but if we are wrong, you may have less hypoglycemia but BG will run higher. I know I do not want my provider to essentially guess at what needs to change.
  • Another example is a high A1c and the provider increasing the long-lasting insulin (basal) or basal rates unnecessarily causing low blood sugar in the middle of the night. I see this often when providers are grasping at straws trying to improve blood sugar control. When the real reason may be significant after-meal blood sugar spikes.

For someone who is unfamiliar with Zoom and other related apps, it may present a novel challenge. Have you found patients are having trouble with the new set up? Do you provide explicit directions on how to get set up for the appointment?

Most patients who have reliable internet access and have a smartphone or computer with a camera the platforms we use work beautifully. Doxy.me just requires the patient to click on the link we provide in an email. Click and then wait for me to start the appointment.

What do you think the patients will find the most pleasant about the virtual appointment? And what about the worst aspect?

The best part is that you can sign on from anywhere with cellular service or Wi-Fi. So your time away from work or other commitments is minimal. The worst part is that you are still at work or home and there are often other distractions. For example, if children or a dog are disrupting the appointment, this can be distracting and cause the appointment to take longer. It is also not a good idea to have an appointment while driving.

What can you tell us about privacy compliance? How can patients be sure their information is safe?

When using the Healow app or Doxy.me, the voice and video access is encrypted, keeping the visit private. The actual video does not access the patient chart in any way.

Looking forward, what do you think our medical system will look like after COVID-19? What about in 10 years?

I have no idea. I have learned to never assume anything in medicine because just when we think something will happen, the opposite occurs. I am hoping this opens doors allowing more rural telemedicine. This will provide medical care, especially those with chronic diseases, living in rural areas that travel 1, 2, or sometimes 3 hours for appointments. Historically, telehealth is not covered by insurance and the cost falls onto the patient. This hopefully will allow for proper insurance billing of these appointments to be more cost-effective and convenient.

Thank you so much, Dawn, for taking the time to walk us through what a telehealth appointment will look like. I have had two so far and they both went successfully! Best of luck and thank you for what you do!

Source: diabetesdaily.com

$35 Insulin on Medicare Pilot: Is This the Beginning of Affordable Insulin for All?

On Tuesday, President Trump held a press conference announcing a new pilot program for seniors on Medicare that would cap the monthly co-payments of insulin to $35. The announcement was attended by senior executives of two main insulin manufacturers, Eli Lilly and Novo Nordisk, and staff from the American Diabetes Association, as well as the Surgeon General, Jerome Adams.

In typical Trump style, midway through his announcement, he proclaimed, “I don’t use insulin. Should I be? Huh? I never thought about it, but I know a lot of people are very badly affected.” While this comment has created a wave of groans and eye-rolls throughout the diabetes online community, the core of his message is more important: seniors in America will now be more able to comfortably afford their insulin.

For everyone on earth, insulin is a necessary hormone to live. People without diabetes produce insulin endogenously, whereas people with diabetes must take insulin exogenously. Without adequate access to affordable insulin, people with diabetes face serious complications, such as kidney failure, blindness, amputations, and premature death. Unfortunately, the rising costs of insulin over the past few decades have become a major barrier to appropriate management of diabetes. American seniors are some of the hardest hit by the rising costs, who are partially-retired or out of the workforce completely, often trying to survive on smaller, fixed-incomes.

Trump remarked, “Today I’m proud to announce that we have reached a breakthrough agreement to dramatically slash the out-of-pocket cost of insulin. You know what’s happened to insulin over the years, right? Through the roof.”

The pilot program will take effect starting in 2021, and would be part of the enhanced Medicare Part D Senior Savings Model, to which over 1,750 standalone Medicare Part D and Medicare Advantage plans have applied to participate in, according to the Centers for Medicare and Medicaid Services (CMS).

s$35 Insulin on Medicare Pilot

Photo credit: Adobe Stock

This is a welcome respite from the high cost of insulin for American seniors on Medicare, who, despite being covered by health insurance, sometimes have to pay hundreds if not thousands of dollars for their monthly insulin prescriptions.

Despite the multitude of executive orders and policy decisions the Administration has made to chip away the Affordable Care Act, this enhancement of American’s largest healthcare social safety net was met with applause from seniors all across America, many of whom have cooled their support of the President since the beginning of the COVID-19 pandemic and our nation’s response to it. This is an excellent first step to ensuring that our aging Americans can afford the insulin they need to take care of themselves.

It is estimated that Medicare beneficiaries (generally Americans over the age of 65) who use insulin and join a plan participating in this pilot could see average savings of $446, or 66% for their insulin every year. The pilot is funded in part by insulin manufacturers who will pay $250 million in discounts over the five years of the pilot. There has been a positive response from Medicare Part D plans nationwide, and CMS predicts coverage in the pilot will be available in all 50 states, D.C., and Puerto Rico. Medicare beneficiaries will be able to enroll in a pilot-participating plan during traditional Medicare open enrollment, which is October 15th-December 7th, 2020, for Part D coverage that begins on January 1, 2021.

1 in 3 Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more types of insulin, so this change isn’t insignificant. Out-of-pocket spending on insulin by seniors in Medicare Part D quadrupled between 2007 and 2016, from $236 million to $968 million, putting a harsh burden on millions.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services said, “We think that this creates a foundation and a platform to fix some of the problems that we have in the Part D plan (of Medicare). It’s time for that program to be updated.”

While this is a great first step, the pilot is only slated to last for five years, and it will only apply to the Medicare population- generally, people living with diabetes who are 65 and older. This begs the bigger question: how do we afford our insulin before we are eligible for Medicare? How can we ever hope to make it to that point, if insulin is unaffordable every step of the way? Men with type 1 diabetes have an average life expectancy of 66 years, compared with 77 years among men without it. Women with type 1 diabetes have an average life expectancy of 68 years, compared with 81 years for those without diabetes. Realistically, this may not even help people who have diabetes for very long.

We can only hope that this initiative creates enough momentum for the federal government to start capping the actual price of insulin, for the other 7 million Americans who rely on it every day to survive.

Source: diabetesdaily.com

Build Your COVID-19 Diabetes Go Bag

This content originally appeared on Beyond Type 1. Republished with permission.

By Jordan Dakin

When it comes to being hospitalized in the midst of the COVID-19 pandemic, it’s natural to worry about that possibility and while we hope we can stay home at all costs, being prepared for any scenario is the best course of action. As a result, packing a go bag in the case of a hospital visit during this time is crucial.

Most important? Pack your bag with 15 days of supplies to be on the safe side. The CDC recommends up to 14 days of quarantine in some cases for those who have been exposed or infected depending on the time it takes for symptoms to develop, so being prepared for a lengthy hospital stay just in case is advised.

The nature of COVID-19 is tricky because it requires isolation and even if you’re hospitalized for something diabetes-related, you run the risk of being exposed to COVID-19 in a hospital setting. Make sure you have all you need as it will be difficult for loved ones to get items to you if you are in isolation during a hospital stay.

Antiemetic or Anti-Nausea Medication

Zofran or any other antiemetic medicine is helpful to have on hand in case you do contract a mild form of COVID-19 to keep yourself from throwing up, as this can be dangerous and lead to DKA (diabetic ketoacidosis).

Carbs and/or Glucose Tabs

This may seem obvious, but it is so important. Be sure to pack some hard candy, fruit snacks, fruit juice, glucose tabs and gels, and any other preferred fast-acting carbohydrates.

Beverage(s) to Prevent Dehydration

This could include sports drinks, water, or a mix-in hydration powder with little to no carbs.

Ketone Strips and Glucagon

If you are sick, BGs are harder to manage and DKA can be a dangerous reality if you’re needing more insulin than normal while having trouble keeping carbs or fluids down. As a result, you should test for ketones more frequently when you are sick.

Insulin, Syringes, Pen Needles and Pump Supplies

Having backup methods to administer insulin is important in the event of a pump malfunction.

Testing Supplies Like a Blood Glucose Meter, Lancing Device, Lancet and Test Strips, Plus Sensors If Using Continuous Glucose Monitoring (CGM)

In some hospitals, it’s been difficult for patients to have their glucose levels checked hourly because healthcare workers don’t have enough personal protective equipment (masks, gloves, etc) to go in and out of patient rooms that often. Because of this, people with diabetes should be prepared to do their own testing and monitoring of blood glucose (BG). Bringing a backup method for testing aside from your CGM is also recommended in case sensors fail or other malfunctions occur.

Alcohol Swabs, Hand Sanitizer, Bandaids and Medical Tape

Disinfecting and keeping things clean and protected during this time is especially important.

Any Necessary Medications and Other Important Medical Details

This includes an itemized list of medications you’re currently taking, allergies to medications you might have, your physician’s information and emergency contact information.

Personal Protective Equipment

Pack your own gloves and masks or face coverings just in case. If possible, it might also be good to remember to wear PPE when entering the hospital to prevent excessive exposure to COVID-19.

Other Necessary Electronics and Chargers

Be prepared and bring any necessary cables to keep phones and tablets charged, especially if you’re using any kind of smart device to help monitor BGs.

A hospital stay during this time might sound scary, but it is important to take care of yourself and be prepared. If you are sick and have gone into DKA as a result and can’t keep down fluids, hospitalization becomes necessary and waiting only makes DKA more severe and life-threatening.

Source: diabetesdaily.com

Centralized Healthcare: Is It Best for the Patient?

There are many ways that a healthcare system can operate. The type of system that is best suited for a population may be dependent on many factors, including the population size, demographics, and various other economic, political and cultural considerations as well. 

Here we discuss some potential approaches to healthcare system organization and major considerations in health care reform. In large, because healthcare is a service that is paid for, the specific payment model represents a large consideration in the way the system works. Another big consideration is whether the services are paid for publicly or through private enterprises (like private insurance companies). Additional “middle-men”, such as pharmacy benefit managers (PBMs), health insurance companies, supply manufacturers and distributors, etc. can further complicate both price-setting, health care delivery, and patient outcomes. 

Many different countries have elected vastly different ways to govern health care. Some, like the UK, rely on a more centralized (public) model to deliver care and services, whereas others, like the US have historically relied more on privately funded providers and health services. In many cases, specialized entitlement programs (like Medicare and Medicaid) that are subsidized by the US Government can help specific patient populations gain access to the services they need at an affordable price. Also, although there are federal guidelines, in the US, states can also enact specific legislation to help people living in their state, by having specific state-run programs for the retired and low-income, as well as policy changes, like co-payment caps on state-regulated health plans for prescription medications like insulin. 

To Centralize… Or Not?

Some hail the benefits of a centralized, one-for-all, affordable, publicly-funded health care system (also referred to as a single payer system). After all, affordable and quality health services are a cornerstone of our well-being as a society. One of the biggest concerns brought about by critics is the lack of competition this could create, resulting in potentially fewer available resources (e.g., providers, supplies, services) and poorer quality of care as a result. In addition, this can also translate to longer wait times to receive health care services. 

As many individuals continue to struggle to afford health care in the US and other parts of the world, more people are pushing for a more comprehensive, centralized public health care system that could provide affordable services to more people. 

Current Payment Models Shape Outcomes

A large factor within a healthcare system is what the payment model to the providers looks like. An expert summary by the MMA Work Group to Advance Health Care Reform explains that there are several main models, each with its potential pros and cons. 

The fee-for-service payment system is one where reimbursement to the providers corresponds directly to the specific services rendered. This is the primary model that is used in healthcare models in the US. One major problem with this system is that getting reimbursement for each service or treatment can create a conflict of interest for providers, resulting in the potential to overtreat patients, losing focus on patient wellbeing, including preventative strategies. Also, this may limit comprehensive care for patients, as different providers may be less likely to coordinate care. On the other hand, this model can encourage productivity. It also offers a relatively direct way of reimbursement for various services. 

On the opposite side of the spectrum, capitation, refers to a carefully managed coordination of reimbursement for services. American College of Physicians explains:

Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided. Capitation rates are developed using local costs and average utilization of services and therefore can vary from one region of the country to another. In many plans, a risk pool is established as a percentage of the capitation payment. Money in this risk pool is withheld from the physician until the end of the fiscal year. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.”

This type of model may allow for more flexibility with respect to care delivery, including potentially more innovative and effective services. It may also allow for more collaboration between providers and benefit patients due to potentially shifting more focus to eliciting overall well-being as a goal. On the other hand, setting up this type of system is a complicated and arduous process, and may also limit access for high-risk patients, and possibly reduce patient options, including the providers and services available to them. 

There are multiple variations of coordinated payments within this broad spectrum, and more proposals are continuously being drawn up by various organizations. Some examples include pay-for-coordination, pay for performance, bundled payments, and various forms of comprehensive care.

Importantly experts warn of the potential effects of these systems on patients, as illustrated below –

Opinions Vary

What kind of system will work best to serve the public in a timely manner without sacrificing quality, while also being affordable? The verdict is still out, and there will likely never be a consensus. Lessons learned from different countries, and on a more local level, will likely continue to shape the dialogue and direct (typically slow-moving) policy changes. 

Some feel strongly that universal healthcare is a right, and not a privilege. Others worry that such a system will decrease the quality of services, increase wait times, and thus negatively affect the patients and their health outcomes. Some believe there is no one-size-fits-all, and that specific systems must be driven from the ground up at a very local level. 

***

What do you think? How is healthcare organized where you live and do you think it is an effective model? How do you think policy has affected your diabetes-related care? How do we go about effecting significant policy changes, when and where they’re needed?  

Source: diabetesdaily.com

A D-Mom’s Changed Perspective Using Basal IQ

Technology continues to make managing our diabetes easier. Continuous glucose monitors, apps for carb counting and insulin pumps have all alleviated some of the stress of managing our condition. Tandem Diabetes created Basal IQ technology, which allows us to spend less time worrying about going low and let our devices do the work. For a person living with diabetes, this means less stress and more sleep.

Basal IQ technology helps reduce the frequency and duration of lows by predicting glucose levels and suspending insulin if the blood sugar level is thought to go below 80 mg/dL or the Dexcom reading goes below 70 mg/dL. Insulin delivery will start automatically once the blood glucose starts to rise again.

Basal IQ is different than the newly released Control IQ, in that Control IQ can adjust insulin delivery, including the delivery of automatic correction boluses as needed, therefore helping patients avoid episodes of hyperglycemia. Using either one of these systems also means fewer fingerpricks, as you will no longer have to get manually take your blood glucose reading.

Basal IQ technology has given many people living with diabetes, and those who love them, a little more rest and some peace of mind. A pivotal study showed the use of Basal-IQ Technology on the t:slim X2 Insulin Pump demonstrated a 31% relative reduction in time spent below 70 mg/dL when compared with a CGM-enabled pump without Basal-IQ Technology. Important to note, the less amount of time spent at lower glucose levels did not mean more time spent at higher glucose levels. Maintaining your target range has become a lot easier thanks to Basal IQ technology.

Photo credit: Allison Hoffman

One woman, Allison Hoffman, who helps manage her 10-year-old daughter, Becca’s diabetes, raved about the changes to her overall well-being since switching over to Basal IQ technology after relying on Omnipod for the past few years.

Here is her story:

For 7 years my mornings were absolute hell. While I would see others sleeping in, meditating, going to the gym, etc, I was a slave to Becca’s whackadoodle blood sugar swings, which would often start around 5:00 AM. My body learned to wake up at this time, and that I doubt I’ll ever be able to change.

My mornings would include me running up and down the stairs entering the bedroom, praying I wouldn’t wake her and deny her the right to sleep in, suspending insulin (audible beep I couldn’t silence), sticking glucose tabs in her mouth, often with the pay-off of a horrible blood sugar spike. I would start 95% of my days this way.

And the frustration! No adjustments to her settings were right. If I reduced her insulin she’d go high; .35 too low, .4 too high. I would wake up at 3:00 am to set a temp basal to get the amount she needed that Omnipod didn’t have as a preset-still wouldn’t work. Nothing I did was right.

Since starting on t:slim pump with basal IQ, I finally have my mornings back. It allows more fine-tuned insulin delivery and suspends when it predicts her to go low. As long as her sensor is good, and her insulin settings aren’t way off (I will always need to determine her insulin needs, it isn’t automatic), I can have a pretty peaceful morning now.

I can watch the news, or another show, or read, and my coffee doesn’t go cold. I can sit with my dog on my lap and not have to jump up every ten minutes to go deal with diabetes. I can breathe. And Becca can sleep peacefully.

I’ve made four seesaw activities for my students this morning and she’s still sleeping.

7 years of hell. I finally have my mornings back.

If you are living with type 1 diabetes and are considering a pump, you may want to look into t:slim X2 pump along with the Dexcom G6 so you can make use of the new Basal IQ or Control IQ technology. Their slogan is “live more and worry less” and I am so glad this seems to be the case for so many.

Have you tried out this technology? How has your experience been?

Source: diabetesdaily.com

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