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

Metformin Pro and Con

August 5th, 2016 · Comments Off

Metformin, the most popular diabetes medicine, figured in about 200 of the presentations at the recent annual convention of the American Diabetes Association. Two of these presentations show good news for its likely role in degenerative nerve disease and in dispelling concerns about its possible role in neuropathy. One presentation, however, brought some disturbing results, and the rest are of less interest to most people with diabetes.

This convention, which the ADA calls its 76th Scientific Sessions, attracted more than 16,000 attendees, including more than 13,000 professionals who went to New Orleans to see and hear almost 3,000 presentations about diabetes. I represented HealthCentral there.

Dr. Liu presents her poster on metformin

(Photo by David Mendosa)

A team of researchers from Tulane University’s School of Public Health and Tropical Medicine presented one poster and one oral presentation about metformin. Shuqian Liu, MD, presented the poster and told me that she designed both of these studies. The poster 570-P reported a retrospective study that examined the effect of high doses of metformin on neuropathy, a complication for 60 to 70 percent of people with diabetes.

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Comments OffPosted in: Diabetes Medication

Exercise Harder, But Not Hard

August 1st, 2016 · Comments Off

Hard exercise, like high-intensity interval training, undoubtedly can provide metabolic, heart disease, and fitness benefits. But a leading expert on diabetes fitness says that it’s too hard for almost all people with diabetes.

The best exercise is the hardest exercise than you will do. High-intensity interval training may be the current fitness craze, says Sheri Colberg-Ochs. “Its health efficacy is not in question,” she says. But “despite its current popularity, there is no evidence supporting HIIT as a viable public health strategy.”

Sheri Colberg-Ochs, Left, Receives Outstanding Educator Award

Credit: American Diabetes Association

Dr. Colberg-Ochs addressed the recent annual convention of the American Diabetes Association in New Orleans on “The Feasibility of Doing High-intensity Interval Training (HIIT) in Persons with Diabetes” in a presentation that I had the opportunity to hear. Dr. Colberg-Ochs was diagnosed with Type 1 Diabetes almost 50 years ago, when she was 4. Recently retired from Old Dominion University in Norfolk, Virginia, where she was a professor of exercise science, Dr. Colberg-Ochs is best known for her book Diabetic Athlete’s Handbook. During the convention, Margaret Powers, the American Diabetes Association’s president health care, presented her with the 2016 Outstanding Educator in Diabetes award.

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Comments OffPosted in: Exercise For Diabetes

You Can Stop NASH Before Your Liver Fails

July 30th, 2016 · Comments Off

You may be able to stop a serious liver disease called nonalcoholic steatohepatitis, but better known as NASH, when you take the diabetes drug pioglitazone. NASH is a common complication of type 2 diabetes. But a three year long randomized, double-blind, placebo-controlled trial concludes that pioglitazone, sold here as Actos as well as in a generic version, is a safe and effective treatment.

Kenneth Cusi, MD, is the lead author of the study, which the journal Annals of Internal Medicine published online ahead of print. Only the abstract of the study is free online. But a spokesperson for the University of Florida, where Dr. Cusi is a professor of medicine, sent me the full-text.

My Wife Catherine Died of Liver Failure

NASH usually has few or no symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It is “usually a silent disease.”

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Comments OffPosted in: Diabetes Complications

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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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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