Study Sheds Light on How High Blood Sugar Can Cause Complications Years Later

People with all types of diabetes are at a higher risk for numerous health complications, in particular for various vascular problems. While it is known that consistently tight glycemic management can greatly minimize these health risks, there are numerous factors which will determine long-term health outcomes.

One interesting concept is that of “metabolic memory,” a phenomenon that suggests high blood glucose levels experienced early on (for instance, before and some time after diagnosis) may still play a role in the development of complications years later, even if blood glucose has been generally well-managed. Several theories have been proposed as to why this may be, and most recently, researchers at the City of Hope conducted a study that may help explain why. The results of the study were recently published in Nature Metabolism.

Researchers selected patients from the DCCT/EDIC trials and compared their DNA to identify differences as they relate to glycemic management histories. The scientists were looking at something called DNA methylation, a process that involves the attachment of chemical groups (methyl groups) to specific regions of DNA.

The addition of certain chemical groups to DNA can change its function. This is one example of epigenetic regulation, a way that gene expression can be altered without a change in the actual DNA sequence (i.e., a mutation). These chemical groups that bind to the DNA can change the way that gene behaves, may affect the function of other genes and alter various physiological events downstream.

In this study, the authors report that they uncovered a connection between the HbA1c levels of patients at the end of the DCCT, their DNA methylation patterns, and the development of complications later in life. They believe that these differences in DNA methylation may promote the development of diabetes-related retinopathy and neuropathy (and likely other complications as well). In fact, many of these changes were occurring in genes that are directly relevant to the development of complications.

Rama Natarajan, PhD, one of the authors of the study, had this to say in a recent press release:

“This comprehensive study has systematically compared the epigenetic states of a large number of type 1 diabetic subjects with their glycemic history and their future development of key diabetic complications over 18 years. While the link between epigenetics and diabetes and related complications has been reported before, this is the first large scale study in type 1 diabetes showing that a prior history of high glucose levels can cause persistent changes in DNA methylation to facilitate metabolic memory and trigger future diabetic complications. This study provides the first evidence in humans supporting the link between DNA methylation in inflammatory and stem cells, a patient’s blood sugar history and development of future complications.”

Having a better understanding of detectable “markers” for complications before they even develop may mean earlier detection (i.e., via blood test) and more timely treatment of diabetes complications in the future. This research group is currently continuing to explore these findings, in collaboration with other research groups. They are planning to evaluate the relationship of DNA methylation and other diabetes-related complications, as well as investigate whether these changes may be a reliable biomarker for early detection. They are also investigating what other epigenetic changes may be relevant in metabolic memory.

Source: diabetesdaily.com

10 Most Common Questions Answered After a Type 2 Diagnosis

Facing a new diagnosis of type 2 diabetes can be a difficult and confusing time. Many ask “why me?”,  some may feel shame due to the stigma surrounding type 2,  while others want to know what they can proactively do to better their health. I asked people living with type 2 diabetes what their initial questions were at diagnosis. Hopefully, this can help some of you who are learning how to live with this new condition.

1. What is type 2 diabetes?

Type 2 diabetes is the presence of excess sugar in your blood due to your body’s resistance to insulin and, in many cases, production of too little insulin. You can think of insulin as the key that opens cells and allows glucose (i.e. sugar) to enter your cells. If your body is insulin resistant, then it cannot use the insulin effectively enough to allow the correct amount of sugar to enter your cells. In this case, it builds up in the blood, causing high blood sugar levels.

2. Why did this happen to me?

We know that there are both environmental and genetic factors associated with a type 2 diagnosis. We also know that obesity can lead to diabetes, but not everyone who is obese winds up with type 2 diabetes. Age, ethnicity and numerous other factors also come into play. Try not to be discouraged by your diagnosis. Instead, use it as an opportunity to start or maintain a healthy lifestyle. This will help you to avoid issues down the road, and can help turn the diagnosis into a positive change in your life.

3. What should my blood sugars be?

The American Diabetes Association (ADA) recommends a fasting or before meal blood glucose of 80-130 mg/dL and 1-2 hours after the beginning of the meal (postprandial) of less than 180 mg/dL. There are of course factors related to food and insulin doses that can affect these numbers. Fasting numbers should ideally be under 100 mg/dL, but this will vary from person to person. Talk to your healthcare provider to learn what their specific recommendations are for your unique situation.

4. Are there alternative treatments?

While there are complementary and alternative treatment options available, they do not claim to cure diabetes. However,  they may be beneficial in many ways that can indirectly improve your diabetes health. With that said, traditional medicine prescribed by your doctor should always be taken, and alternatives could be an addition to your regular treatment protocol.

One alternative approach that is a surefire way to help your overall health and improve your blood sugars is improving diet and exercise. Eating healthy — making sure you get plenty of protein and focus on unprocessed and nutritious foods, like plenty of vegetables — and making sure to stay active can help you to stay maintain optimal shape and blood sugars.

Other alternative treatments to consider are meditation and aromatherapy, both of which may help to alleviate stress, a contributor to high blood sugars. Also, be sure to explore acupuncture and acupressure if you have neuropathy-induced pain, as both of these are known to alleviate pain and improve circulation.

While some herbs and supplements may help prevent heart disease and have other health benefits, there is no evidence that they can actually help a person manage their diabetes. The ADA, in its 2017 Standard of Medical Care in Diabetes statement, stated the following, “There’s no evidence that taking supplements or vitamins benefits those with diabetes who do not have vitamin deficiencies.”

5. Will I have to go on insulin?

At diagnosis and in the early stages of type 2 diabetes, your doctor will likely advise you to incorporate lifestyle modifications, like diet and exercise, to help lower your blood sugar. If that doesn’t help, or if you are not diagnosed early on, then oral medication is often recommended. If your blood sugars aren’t at an optimal level, it is possible that your doctor may suggest going insulin.

While some people will think going on insulin means they failed at controlling their blood sugars on their own, that is not the case and oftentimes, people prefer to be on insulin as you can be more flexible with what you eat and when. Insulin may also help your pancreas to make insulin longer and has been shown to help control blood sugars better than oral medications alone. It doesn’t matter how, but that you maintain healthy blood sugars to avoid complications such as vision loss, nerve and kidney damage and heart disease.

6. What doctors should I see annually?

Living with diabetes could mean complications down the road so it is important to stay on top of your diabetes care so you can flag issues before they worsen. You should visit your eye doctor annually, such as an optometrist or ophthalmologist, to check for potentially serious conditions, such as: glaucoma, cataracts, diabetic retinopathy and diabetic macular edema.

Patients who have been living with type 2 diabetes for a long time are at a greater risk for kidney disease and may also need to be under a nephrologist’s care. They can also administer dialysis, for those patients undergoing dialysis treatment.

Photo credit: Adobe Stock

Podiatrists are also important doctors to routinely visit as nerve damage can ensue over time for patients living with diabetes. People with diabetes can also be more susceptible to wounds not healing properly, and podiatrists can check for infections that could worsen and lead to gangrene and even amputation.

Other specialists to consider are a dietician and personal trainer, if you feel you need help with reaching your diet and fitness goals.

7. How much should I expect this disease to cost me?

Living with type two diabetes places a significant economic burden on the individual. Costs vary depending on what country you live in. A study conducted by the National Library of Medicine concluded that the average medical costs over someone’s lifetime were $85,200, of which 53% was due to treating diabetes complications, and 57% of the total attributed to macrovascular complications. Making sure to see your doctors regularly and staying on top of your diabetes management can result in long term savings in healthcare costs.

8. Can I manage it just through diet and exercise? Can it be reversed?

Remission of type 2 diabetes is possible.

While you can’t necessarily “reverse it” you can certainly control it and some can even put it into remission. This depends on the individual, their overall health, how far into the condition they are along with other factors such as beta-cell function and insulin resistance. However, with healthy eating and regular exercise, many are able to free themselves from medications, and maintain normal blood glucose levels, thus preventing complications.

Be wary of fad diets and gimmicks that promise to cure you of type 2 diabetes. Reversing and prolonging the progression of this disease is up to the individual and their dedication to a healthy lifestyle and numerous other health factors (like co-existing health conditions and access to the most appropriate and affordable healthcare) may help or hinder their efforts.

9. Does having diabetes lower my life expectancy?

Diabetes is historically known for shortening a person’s lifespan but the good news is that with medication, technology, and a little effort, this doesn’t have to be the case. According to the CDC, diabetes is the 7th most common cause of death in the United States. This statistic doesn’t distinguish type 1 from type 2 diabetes and it also doesn’t take into account all of the complications that could be the main cause for death.

If you are actively managing your diabetes, you are less likely to develop these issues that could lead to a shorter life span. And, on a positive note, many find that they are actually healthier once diagnosed, as it helps them to make better choices for a healthier lifestyle.

10. Are my children at risk?

While genetics do play a strong role, this only means you are more at risk of developing diabetes, not that you will necessarily be diagnosed. Many other factors come into play, and while diabetes runs in families, developing healthy habits, maintaining a healthy weight and keeping active can help stave off a diagnosis as well.

A diagnosis of type 2 diabetes doesn’t have to be a death sentence. With a little determination and support from your medical team and loved ones, you can manage this condition. Asking questions and staying on top of your diabetes care is key to maintaining long term success.

Source: diabetesdaily.com

How Racial Bias Impacts Health Outcomes

COVID-19 is killing black Americans at three times the rate of white Americans. But it is not just COVID-19. Four hundred years of systematic discrimination has created systems that leave black people with dramatically worse health outcomes than others. Many living with diabetes have faced discrimination in their lifetime. Diabetes still poses barriers to getting fair treatment in our society, whether in school or work, exclusion from sports teams, or mismanagement in the hospital setting. All too often, living with diabetes as a person of color will compound these barriers.

Studies have shown that there are systemic, negative biases against people of color embedded in our healthcare system. This is layered on top of inequitable social determinants of health that people of color face, leading to poorer health outcomes, additional complications, and earlier deaths.

Black People Have a Higher Rate of Diabetes

Black people are more likely to have diabetes. There are 4.9 million non-Hispanic African Americans aged 20 years or older who have diabetes in the United States, according to the CDC. They are 77% more likely to have diabetes than non-Hispanic Caucasians. Part of this trend may be genetic, but one’s environment and socioeconomic status play a significant role in the development of type 2 diabetes, especially in a society without a robust social safety net.  Among racial and ethnic groups, African Americans have the highest poverty rate at 27.4% (compared to Hispanics at 26.6% and whites at 9.9%). Additionally, 45.8% of young black children under the age of 6 live in poverty, compared to 14.5% of white children.

There are many factors that contribute to this, but a history of institutionalized racism (the legacy of slavery, redlining and Jim Crow laws) have largely prevented African Americans from cultivating intergenerational wealth (which for most Americans comes from buying and selling real estate), and breaking the cycle of poverty proves to be nearly impossible in most circumstances.

Poorer, segregated (de facto segregation) black neighborhoods are more likely to face food deserts (areas where there are few or no grocery stores), lack access to healthy foods (including fresh fruits and vegetables), families may lack access to reliable meals (especially in the summer, when schools are no longer serving children breakfast and lunch), and unsafe streets and a lack of green space (few or no public parks). Neighborhoods of lower socioeconomic status are all risk factors for obesity and the eventual development of type 2 diabetes. 

Black People Have Higher Rates of Complications and Death

Black children and families are more likely to develop diabetes, and when they do, they face graver health outcomes. One recent study found that black youth have an average HbA1c of 10.6% compared to 8.3% for their white peers, and black children are twice as likely as white children to die from diabetes. Blacks are also more likely to experience greater disability from diabetes complications such as amputations, blindness, kidney failure, and increased risk of heart disease and stroke. Diabetic retinopathy is 46% more prevalent in African Americans than non-Hispanic whites, and African Americans are at least 2.6 times more likely to have end-stage renal disease due to diabetes than Caucasians. Most telling: the premature death rates for blacks with diabetes are 27% higher than for whites with diabetes.

racism and diabetes

Photo credit: iStock

Racism Is Built into Our Healthcare System

Implicit bias plays a large role in the unfair treatment of black people in the health care setting. In 2005, the National Academy of Medicine released a study that found that “racial and ethnic minorities receive lower-quality health care than white people, even when insurance status, income, age, and severity of conditions are comparable.” This suggests that poverty and lower socioeconomic status does not account for the whole picture of poorer health outcomes in black people with diabetes.

The report continued, “…minority persons are less likely than white persons to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments for stroke, cancer, or AIDS. It concluded, “some people in the United States were more likely to die from cancer, heart disease, and diabetes simply because of their race or ethnicity, not just because they lack access to health care.” Simply put: people are dying at higher rates just because the color of their skin is darker.

One study of 400 hospitals in the United States showed that black patients with heart disease received older, cheaper, and more conservative treatments than white patients presenting with the same disease and symptoms. Black patients with diabetes have higher rates of amputations than white patients, even when less invasive interventions are available. Additionally, another study showed that physicians were more likely to prescribe pain medications to white patients, mistakenly believing that black people “feel less pain”.

COVID-19 is killing black Americans at three times the rate of white Americans.

Where Do We Go from Here?

Social determinants of health, physician and healthcare workers’ implicit bias and systemic racism in our healthcare system all contribute to higher rates of disease, complications, and death. Neighborhoods and schools remain dramatically segregated and unequally funded.

The United States has a two-tiered health care system that provides fantastic care to those who can afford private health insurance, and little to none to those who cannot (aside from Emergency Department visits). We, as a society, do not value or fund preventive health care as much as we should. We don’t prioritize feeding our babies healthy food, or making sure they have space and safety to exercise regularly. We step in with too little too late for those who need help the most. We are biased in our healthcare decisions and have not fought against institutionalized racism early or long or loud enough. Now is not the time to “not be racist”, but to actively dismantle institutionalized racism from the inside out.

We need more black physicians, and nurses, and emergency medical technicians. We need to put our dollars into segregated neighborhoods and schools and prevent diabetes before it devastates underserved communities even more. We need to listen to black patients in hospitals. We need to trust black people when they voice their health concerns. We need more black voices in the diabetes online community. We need to lift up the voices of black people.

We need to do more for those that we have failed for far too long. We have already lost so much, and we need to act before it is too late.

Source: diabetesdaily.com

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

Your Eye Health During COVID-19 — What You Should Know

This content originally appeared on diaTribe. Republished with permission.

By Kira Wang

While the global pandemic has interrupted many healthcare services, eye care is still essential and available under certain circumstances

Diabetes can lead to changes or problems in your vision, making annual eye appointments a necessity for every person with diabetes. One can prevent complications with vision for many years, even many decades, with some luck – it’s about glucose management as well as genes. For people who already have eye complications, treatment may be required as often as every few months in order to keep eyesight as strong as possible. But COVID-19 has disrupted many aspects of our daily lives, including the ability to visit eye care professionals for regular appointments. Although providers may not be able to see you in person at this time, there are still ways for you to access the care you need and keep your eyes as healthy as possible.

Can I still see my eye care provider in person?

We reached out to diaTribe’s network of healthcare professionals and learned that eye care providers are still treating emergencies and people with advanced cases of diabetes-related retinopathy and diabetes-related macular edema. Emergencies might include cases of trauma, infection, or sudden changes in vision (e.g., flashing lights, floaters, blurriness) – if you have experienced any of these situations, talk to your healthcare team right away.

If you have been diagnosed with diabetes-related retinopathy or diabetes-related macular edema, delaying treatment can risk worsening vision, and you may need to receive in-person care. If your treatment has been rescheduled, double-check with your healthcare team to make sure your vision is not at risk. For more mild cases of diabetes-related retinopathy or diabetes-related macular edema, your healthcare professional may consider the risks of exposure to COVID-19 versus how your vision will be affected without scheduled treatment.

Planning ahead is important, and every person is different – ask your doctor in advance about what specific plan works for you. If you do visit your eye care provider in person, remember to wear a face covering—this will help keep you and your healthcare team safe!

Telemedicine and eye care: when can I talk to my healthcare professional virtually? 

For problems with the outside of your eye, video visits can help you connect with your provider right from your home. Issues outside your eye might include redness, discharge, or swollenness. Explaining your symptoms to your provider over video can help them determine whether you’ll need to be seen in person.

What should I know about scheduling eye appointments in the midst of COVID-19?

For those who already have regularly scheduled eye appointments, your check-ups may be delayed during these times. If your visit is delayed, you should still pay attention to any changes in your vision. You can do this by giving yourself an at-home eye test.  If you don’t already have annual visits with an eye care professional, try to set up an appointment as soon as eye care clinics are back up and running.

Remember: keeping your blood sugar levels in range is central to maintaining healthy eyes.

In these challenging times, we are impressed by the use of telemedicine, for eye care and beyond. For more information on telemedicine during COVID-19, check out these nine tips by longtime diaTribe advisor Dr. Francine Kaufman. To the many healthcare professionals out there, we are grateful for your service and support. Mark your calendars—July is Healthy Vision Month, and we’ll have more articles on eyes coming your way soon!

About Kira

Kira Wang graduated from Duke University summa cum laude with a degree in psychology and minors in biology and chemistry. She wrote a senior thesis on the transactional coping strategies of parents and youths with chronic illness and spent time researching eye imaging techniques in the Duke Eye Center.

Source: diabetesdaily.com

Keys to Long Term Success and Preventing Complications

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

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

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

What Causes Complications?

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

Keys to Long Term Success

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

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

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

Source: diabetesdaily.com

Research Trends with Dr. Maria: Cholesterol Benefits & More

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

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

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Allergen in Diabetes Tech Adhesives

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

Bariatric Surgery May Worsen Retinopathy

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

Super Healthy Probiotic Fermented Food Sources

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Benefits of Probiotics for Type 2 Diabetes

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

Herbal Therapies Gaining Attention

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

Low HDL Cholesterol Linked to Beta Cell Decline

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

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

Source: diabetesdaily.com

Diabetes Eye Screenings: Why They Are Important and Challenging

This content originally appeared on diaTribe. Republished with permission.

By Renza Scibilia and Chris ‘Grumpy Pumper’ Aldred

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

What Causes Diabetes-Related Retinopathy?

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

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

The importance of eye screenings

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

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

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

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

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

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

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

The challenges of eye screenings

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

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

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

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

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

What works and how can we do better?

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

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

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

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

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

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

Source: diabetesdaily.com

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