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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Doctors For and Against Patient-centered Care

July 28th, 2016 · Comments Off

It seemed obvious to me that everyone now favors patient-centered care. Then I went to New Orleans in June for the convention of the American Diabetes Association. It’s the world’s largest annual meeting of diabetes professionals.

In a mini-symposium on “Patient-centered care: Is there too much of a good thing?” one medical doctor argued that there is. Another one supported patient-centered care.

René Rodríguez-Gutiérrez, MD, Wants Patient-centered Care

Shouldn’t your diabetes care be focused on the kind of treatment that you want? Aren’t you the one who has the most at stake from your treatment? Aren’t you the person who pays for it?

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Comments OffPosted in: Psychosocial

Cut Your Risk of Retinopathy

July 27th, 2016 · Comments Off

Cut your risk of diabetic retinopathy in half! You can when you keep your blood glucose level below 6.

This is the powerful message of a study announced at the recent annual convention of the American Diabetes Association in New Orleans. It’s published in the July 2016 issue of Diabetes Care.

Dr. Chew Examines a Woman’s Eyes

The study also showed that one drug, a cholesterol medicine called fenofibrate, might be worth taking to control the progression of diabetic retinopathy. But the drug loses its effectiveness after people stop taking it, unlike the continued benefits from near-normal blood glucose levels below 6 after this intensive control stopped.

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Comments OffPosted in: Diabetes Complications

Why You Aren’t Managing Your Diabetes Better

July 24th, 2016 · Comments Off

With so many new diabetes drugs available, we could be managing our blood glucose a lot better. In the past 10 years alone, the U.S. Food and Drug Administration has approved more than 40 different diabetes treatments. In some clinical trials of these drugs more than half of the participants reduced their A1C level from an average of 8.4 percent to the American Diabetes Association’s suggested goal of 7 percent.

Yet in this decade there has been virtually no change in the overall percentage of people with diabetes in this country who have an A1C level of less than seven. Only about half of us had an A1C below 7 in the most recent study.

I Interview Dr. William Polonsky

These sobering facts formed the basis of a joint presentation in June 2016 by Steven Edelman, MD, and William Polonsky, PhD, in New Orleans at the American Diabetes Association’s annual convention, the largest annual meeting in the world of diabetes professionals. They addressed a crowd of hundreds of medical professionals on “The Efficacy Mirage in Type 2 Diabetes –Why Do Clinical Trial Results Disappear in Real-World Practice?” in a presentation that I had the opportunity to hear.

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Comments OffPosted in: Diabetes Basics

Vitamin D May Help Prevent Diabetic Retinopathy

June 27th, 2016 · Comments Off

If you have a low level of vitamin D, taking this inexpensive supplement may help you prevent diabetic retinopathy, one of the most serious complications of diabetes. This is the most common reason why some people with diabetes lose their vision.

A meta-analysis just presented at the Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists, in Orlando, Florida, from May 25 to 29, found “a statistically significant association between diabetic retinopathy and vitamin D deficiency.” Three researchers presented their findings in an abstract, “The Relationship Between Vitamin D Deficiency and Diabetic Retinopathy: A Systematic Review and Meta-Analysis.” The Canadian Journal of Ophthalmology is expected to publish the full report soon, one of the study’s authors told me.

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Comments OffPosted in: Diabetes Complications, Diabetes Medication

Diabetes Drug Might Stop Beta Cell Loss

June 24th, 2016 · Comments Off

When you have diabetes, you don’t have enough functioning beta cells. People with Type 1 diabetes have quickly lost almost all of these cells that make insulin, and if you have Type 2, you will typically experience a progressive decline in the number and size of your beta cells.

One type of diabetes drugs has been shown in animal studies to stop this progression. It may do this for humans too, but because the drug is so new researchers don’t know yet if it will work the same way for us.

The technical name for this drug class is a mouthful:  glucagon-like peptide-1 receptor agonists. Researchers often shorten it to GLP-1 receptor agonist or even to GLP-1. The newest brand of these drugs is Trulicity. The others that are available in the United States are Tanzeum, Victoza, Bydureon, and Byetta, which was the first.

These drugs to help us manage Type 2 diabetes have only been available for just over 10 years. While they haven’t been approved for people with Type 1, some of these people apparently benefit from using them too, when their doctors prescribe them off-label.

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Comments OffPosted in: Diabetes Medication

How Much Protein Do You Need?

June 23rd, 2016 · Comments Off

One of the most important diet questions for people with diabetes is to decide how much protein you need to eat each day. Yet it’s something that few people consider.

While the debate still rages over how many grams of carbohydrates and fats that we should eat, people with diabetes tend to ignore the key role that this third macronutrient plays. Your body uses protein to build and repair bones, muscles, cartilage, skin, and blood as well as to make key chemicals in our bodies, including enzymes and hormones.

Not until a couple of years ago did I pay much attention to how much protein my body needs. Only when I adopted a vegetarian diet in addition to the low-carb lifestyle that I have followed for years to manage my Type 2 diabetes, did I realize I would need to get more protein now that I don’t eat fish or meat.

If you are a vegetarian, like me, or a vegan, you are a part of a large group of people who need to make a special effort to get enough protein.  The people who are trying to lose weight also need to give attention to how much protein they consume. But if you have kidney disease, one of the potentially most serious complications of diabetes, the amount of protein you eat can be even more important.

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You Can Keep Off the Weight You Lose

June 16th, 2016 · Comments Off

The “Biggest Losers” didn’t keep off the pounds they lost. If you believe the stories in the media how 14 of them regained most of their weight, you could give up hope of ever being able to maintain a normal weight.

But their failure doesn’t mean that you can’t succeed.

If you have type 2 diabetes, nothing makes it harder for you to manage it than being overweight or obese. This extra weight stops the glucose in your blood from getting to the rest of your body that needs it for energy. When you don’t keep your blood glucose level in the normal range — below 6.0 percent — you increase your risks of complications exponentially.

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Comments OffPosted in: Diabetes Diet

Metformin: Best Oral Drug for Type 2 Diabetes

June 15th, 2016 · Comments Off

Metformin is the type of pill that your doctor should prescribe for you when you begin to manage type 2 diabetes. This is the key recommendation of a huge new meta-analysis. Of the six classes of oral drugs that the U.S. Food and Drug Administration approves when people take only one drug for diabetes, metformin ranks first in overall safety and effectiveness.

“We concluded that metformin looks better for cardiovascular mortality than sulfonylureas,” says lead author Nisa Maruthur, MD, of Johns Hopkins University School of Medicine in Baltimore. “It has a long-term safety profile. Metformin is weight neutral or helps people lose weight, and its gastrointestinal side effects are avoidable or tolerable. Its effect on A1C is similar to other medications.”

Until now, researchers didn’t have any firm evidence that one class of drugs was best at reducing cardiovascular risk — heart attacks and strokes. If you have uncontrolled blood glucose, this is your the most serious diabetes risk. But the researchers concluded that metformin reduces the relative risk of a patient dying from heart disease by about 30 to 40 percent compared to its closest competitor drug, the sulfonylurea class.

The Annals of Internal Medicine, a peer-reviewed journal of the American College of Physicians, just published the study online ahead of print as “Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes.” It is comprehensive meta-analysis of more than 200 studies with more than 1.4 million people with diabetes. Those studies made head-to-head comparisons of the six drug classes: metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors.

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Comments OffPosted in: Diabetes Medication

With this Meter You Will Just Press Once

June 14th, 2016 · Comments Off

It may be the biggest step forward in blood glucose meter technology in years. It is the Pogo Automatic Blood Glucose Monitoring System, and the company that makes it is Intuity Medical in Sunnyvale, California.

The company just received clearance from U.S. Food and Drug Administration to market the Pogo meter here. When we will finally be able to get our hands on one, we will have the quickest, simplest, most discreet blood glucose meter ever made. It’s taking a long time, but it will be worth the wait.

In fact, we will still have to wait a few more months to buy one. Robin Gaffney, Intuity Medical’s Head of Marketing, tells me that they plan to launch the Pogo sometime next year. They haven’t finalized pricing nor have I yet been able to get a device for review.

Credit: Intuity Medical

But I still remember how impressed I was when I saw a prototype of the Pogo almost eight years ago at the American Diabetes Association’s annual convention in San Francisco. In fact, as long ago as April 2003, in my “Blood Glucose Meters” directory I listed Intuity Medical by its former name, Rosedale Medical, as working on a blood glucose meter. So I asked Ms. Gaffney why it took Intuity Medical so long to get FDA clearance for its first meter.

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Comments OffPosted in: Diabetes Testing

Berberine Is a Diabetes Drug in Disguise

May 27th, 2016 · 2 Comments

Berberine might be the best supplement that you can take to reduce your blood glucose. But first you need to consider the disadvantages of any supplement.

Berberine has apparently been an important herbal remedy in Chinese medicine for hundreds, if not thousands, of years. Now, it is becoming increasingly well known in the West.

Growing interest in berberine

The U.S. National Library of Medicine indexes about 4,000 studies in professional journals that include berberine. This is far more than the 800 on bitter melon and the 200 on gymnema sylvestre, which quite a few people have told me they use to manage their blood glucose. It’s clear that interest in berberine is growing fast: more than 1,500 of the 4,000 studies were published in the last five years.

But people use berberine for many conditions. Just 243 of these studies are about berberine and diabetes, and 79 of them are human studies (the others are studies of berberine in animals or in test tubes).

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→ 2 CommentsPosted in: Diabetes Medication

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