Tag Archives: Type 2 Diabetes

Maryland woman has her type 2 diabetes under control at 38, and her future is brighter!

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A Life-Saving Lesson That Took Decades to Learn.  Maryland woman has her type 2 diabetes under control at 38, and her future is brighter

Doctors diagnosed Ronda Keys with type 2 diabetes when she was 19 years old and a student at the University of Maryland.

Now 38 and living in Montgomery Village, Md., Keys had been suffering the classic symptoms before her diagnosis — fatigue, extreme thirst, frequent urination. “That prompted me to just go to the doctor,” she recalled. “That’s when I found out.”

But the news wasn’t completely out of left field. Her father was diabetic, as were her  grandmother and several aunts and uncles.

“There’s a long line of it in my family,” Keys said. “It wasn’t really a surprise once I was told that I had it, but I guess I had never thought of myself as getting it, especially that young.”

Nonetheless, Keys admits, she took the diagnosis with a small amount of resentment. “I was a little taken aback,” she said. “I didn’t do anything to go out and get this. I thought it was kind of unfair. You’re just told you have this, and oh, by the way, there’s no cure.”

Keys’s doctor put her on oral medication and encouraged her to exercise more and eat a healthy diet. But she was young and at college and found it hard to reconcile her diabetes treatment with her lifestyle.

“The issue for me was just being different from my friends,” she said. “I didn’t want to be the odd ball out. I just wanted to fit in with everyone else.”

Those college years established a pattern for Keys. She would half-heartedly pursue self-treatment for her diabetes, and then get serious about it when she began to feel really sick. “I would try for a while, and then I would fall off the wagon and stay off,” she said.

Things continued that way until three years ago, when Keys was hospitalized with a serious infection. Her body didn’t respond to treatment, which she was told was due to her diabetes.

“My blood sugar was fighting against the medicines the doctors were giving me,” she said. “I was very, very sick. As a result, I had to go on insulin, which I had been fighting.”

Keys was hospitalized for 14 days. The insulin helped save her life, but she hated having to resort to it. “It just felt like failure,” she said. “Insulin equals failure. You didn’t do what you were supposed to do, and now you have to take insulin.”

That feeling didn’t last long, though.

“I found out it was the best thing that could have happened to me,” Keys said. “I love to travel, and I’m very active, and I didn’t feel well. I was getting sick. I was having trouble with my kidneys. After going on insulin, it was an immediate turnaround for me.”

Since then, Keys also has become more serious about her exercise and diet, getting to the gym three times a week and practicing moderation when she eats.

“I’m doing a lot better than three years ago,” she said. “I feel better. I’m able to do everything I want to do. I’m very active. Diabetes is not stopping me now.”

By Dennis Thompson HealthDay Reporter
Story Link:  HEALTHDAY

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Vitamin D Deficiency Associated With Diabetic Retinopathy!!!

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A new study has found that patients with diabetic retinopathy, especially the proliferative type, are more likely to have insufficient serum vitamin D levels than people without diabetes, suggesting a link between vitamin D deficiency and one of the leading causes of blindness in adults. The principal investigator presented the findings in a poster here at the American Academy of Ophthalmology and Middle East Africa Council of Ophthalmology 2010 Joint Meeting.

Mean levels of 25-hydroxyvitamin D in adults with type 2 diabetes were well below 30 ng/mL, the cutoff the researchers used to define vitamin D “insufficiency” (deficiency), according to the lead author, John Payne, MD, a vitreoretinal fellow at Emory Eye Center, Atlanta, Georgia. More than 75% of patients with diabetic retinopathy were deficient in vitamin D, the data show.

“Vitamin D insufficiency was much more rampant than we thought it would be,” Dr. Payne told Medscape Medical News.

In this cross-sectional study, the researchers stratified 221 subjects into 5 groups: no diabetes or retinopathy, no diabetes but another eye disease, type 2 diabetes but no retinopathy, type 2 diabetes with nonproliferative diabetic retinopathy, and type 2 diabetes with proliferative retinopathy. They excluded patients with type 1 diabetes, vitamin D intake greater than 1000 IU/day, and disorders that change the metabolism of vitamin D. To minimize differences in sun exposure, the investigators performed vitamin D testing for all subjects from December 2009 through March 2010. Testing was done at a single time point.

People with diabetes had significantly lower mean 25-hydroxyvitamin D levels than people without diabetes (22.9 vs 30.3 ng/mL; P < .001), according to the poster. People with no eye disease had the highest serum vitamin D levels (mean, 31.9 ng/mL), and those with proliferative retinopathy had the lowest levels (mean, 21.1 ng/mL).

Multivitamin Use Linked to Higher Serum Vitamin D

After performing a linear multivariate analysis to control for potential confounders, the authors found only 1 factor that remained statistically significant: daily multivitamin use. “The use of daily multivitamins was somewhat protective against the development of vitamin D insufficiency,” Dr. Payne said.

People who took a daily multivitamin that included vitamin D (n = 102) had a mean serum vitamin D level of 31.1 ng/mL; those who did not take a multivitamin (n = 119) had vitamin D levels averaging only 22.0 ng/mL (P < .001), according to the poster. Dr. Payne noted that even those who took daily multivitamins had a 44% incidence of vitamin D insufficiency. The subjects’ mean intake of vitamin D from the multivitamins was less than the recommended daily intake of 400 IU, he said.

However, Dr. Payne cautioned that they did not ask subjects about their dietary intake, other than multivitamins. Another study limitation he mentioned was that the patient population was underpowered to control for multivitamin use.

He suggested several reasons that vitamin D might protect against retinopathy, including its beneficial role in maintaining normal glucose metabolism and lowering the production of inflammatory cytokines that are upregulated in type 2 diabetes.

Does Vitamin D Slow Retinopathy Progression?

An ophthalmologist who did not participate in the study, Zac Ravage, MD, said that “it lends support to the possible role of vitamin D” in diabetic retinopathy. Dr. Ravage, assistant professor of ophthalmology at Rush Medical College, Chicago, Illinois, told Medscape Medical News that the study does not attempt to answer whether vitamin D supplementation can prevent the progression of diabetic retinopathy. Such information is necessary before ophthalmologists can prescribe multivitamins to their patients with diabetic retinopathy, he suggested.

“One study isn’t going to be a game changer, but it would certainly be grounds for more research on whether supplemental vitamin D can lower the incidence of progression of diabetic retinopathy,” Dr. Ravage said.

Dr. Payne said that a national clinical trial is needed to study this issue. “But,” he said, “it would be hard to do a placebo control because there’s so much evidence on the benefits of vitamin D.”

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The #1 Thing That 26 Million Americans Have In Common…..Diabetes!

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The CDC says about 26 million adult Americans have diabetes and that 79 million more have prediabetes, a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke.

Prediabetes is a condition in which blood sugar levels are higher than normal, but not so high as to result in a diagnosis of diabetes.

“These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness,” Ann Albright, PhD, RD, director of CDC’s Division of Diabetes Translation, says in a news release. “We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes.”

The report says 8.3% of Americans of all ages and 11.3% of adults aged 20 and older are affected by diabetes. What’s more, about 27% of Americans with diabetes, or about 7 million people, do not know they have the disease.

About 35% of adults age 20 and over have prediabetes.

Diabetes Cases Rising

The number of people with diabetes is apparently rising, according to the CDC. It says that in 2008, about 23.6 million Americans, or 7.8% of the population, had diabetes and 57 million more had prediabetes.

The CDC’s new report says one reason more people have diabetes is that people are living longer with the disease. Better management of diabetes is improving cardiovascular disease risk factors and reducing such complications as amputations and kidney failure.

The CDC says as many as third of U.S. adults could have diabetes by the year 2050 if current trends don’t change.

According to the CDC, type 2 diabetes, in which the body gradually loses its ability to use insulin, accounts for 90% to 95% of diabetes cases. Risk factors include obesity, family history, older age, sedentary lifestyles, race, ethnicity, and having had gestational diabetes, which only occurs during pregnancy.

Groups at greatest risk include African-Americans, Hispanics, American Indians and Alaska natives, and some Asian-Americans and Pacific islanders.

A Costly Disease

A new fact sheet from the CDC says:

  • Most cases of diabetes among children and adolescents are type 1, once called juvenile diabetes. This disease develops when the body can’t make insulin.
  • About 215,000 Americans under age 20 have diabetes.
  • In 2010, about 1.9 million Americans were diagnosed with diabetes.
  • Diabetes rates were 16.1% for American Indians and Alaska natives, 12.6% for blacks, 11.8% for Hispanics, 8.4% for Asian Americans, and 7.1% for whites.
  • Half of Americans 65 and older have prediabetes and 27% have diabetes.

The CDC says diabetes is the seventh leading cause of death in the U.S. and that those with the disease are more likely to have heart attacks, strokes, high blood pressure, kidney failure, blindness, and to need amputations of feet and legs. The disease costs the country $174 billion a year.

The CDC says people with prediabetes can sometimes prevent or delay development of a diabetes diagnosis by increasing their physical activity and losing weight.

In addition to well-known health problems caused by diabetes, periodontal disease also is more common in people with diabetes. About one-third of people with diabetes have severe periodontal disease, according to the CDC fact sheet.

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Soda May Raise Risk of Type-2 Diabetes and Metabolic Syndrome!!!

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Numerous previous studies have found a direct and positive association between the consumption of sodas and sugar-sweetened beverages with the risks of diabetes and pre-diabetes.  Vasanti Malik, from Harvard School of Public Health (Massachusetts, USA), and colleagues completed a meta-analysis that pooled 11 studies, involving over 300,000 subjects, examining the association between sugar-sweetened beverages and Type-2 diabetes and Metabolic Syndrome.   The team found that drinking one to two sugary drinks per day increased the risk of type 2 diabetes by 26% and the risk of metabolic syndrome by 20%, as compared with those who consumed less than one sugary drink per month. Drinking one 12-ounce serving per day increased the risk of type 2 diabetes by about 15%. Explaining that: “In addition to weight gain, higher consumption of [sugar-sweetened beverages] is associated with development of metabolic syndrome and type 2 diabetes,” the researchers urge that: “These data provide empirical evidence that intake of [sugar-sweetened beverages ]should be limited to reduce obesity-related risk of chronic metabolic diseases.”

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Type 2 Diabetes Tied to Obesity!!!

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Attempts to find more effective therapeutic and preventive approaches to type 2 diabetes and obesity have been frustrated by inadequate understanding of the pathology. However, genetic variants associated with risk may provide insight into how these diseases develop, according to a review article published December 9 in the New England Journal of Medicine.

The article, by Mark I. McCarthy, MD, professor of diabetes, Oxford Centre for Diabetes, Endocrinology and Metabolism; the Oxford National Institute of Health Research Biomedical Research Centre; and the Wellcome Trust Centre for Human Genetics, University of Oxford, in the United Kingdom, describes genetic research on diabetes and obesity during the past decade.

Initial studies used family-based linkage analyses to identify genes causing familial forms and early-onset diabetes inherited as single-gene disorders. For severe childhood obesity, identifying the genes encoding leptin and the leptin receptor increased our understanding of energy balance, glucose homeostasis, and functions of pancreatic beta cells and the hypothalamus.

However, more powerful association studies were required to elucidate common forms of these diseases. Several genetic variants identified have a “modest” effect on susceptibility to type 2 diabetes — among these are KCNJ11and PPARG — and 2% to 3% of severe obesity was explained by variants of MC4R.

Although these studies focused on candidate genes, the newest research approaches involve unbiased investigation of links between genetic variants and diseases. These large-scale investigations found the association between type 2 diabetes and TCF7L2 variants, with the encoded protein affecting the function of pancreatic islets.

Since 2007, genomewide association studies have demonstrated that variants in 6 additional genes are associated with type 2 diabetes. In most cases, the allele conferring susceptibility increases diabetes risk 15% to 20%. At this time, variants of about 40 genes have been associated with type 2 diabetes risk.

The story is similar for genetic variants affecting the risk for obesity. To date, genomewide association studies have found around 30 genetic loci whose variants influence obesity risk and body mass index (BMI). FTO exerts the dominant effect, but variants in loci near NEGR1, SH2B1, and BDNF are also associated with obesity. Interestingly, these 3 genes are also involved in neural function, which supports the role of the hypothalamus in obesity risk.

Little Influence on Clinical Management

Although studies have identified 30 or 40 loci associated with obesity and type 2 diabetes, respectively, this information has little influence on clinical management of diabetes or obesity.

Dr. McCarthy points to several reasons for this: the modest effect size of the variants, the challenge of determining molecular effects of “noncoding” variants (ie, variants that affect gene regulation rather than amino acid sequence of a protein), and the difficulty of telling which transcript(s) within a locus mediate the effects on disease risk.

Several areas must be developed to realize the potential influence of genetic information on disease risk: characterize disease mechanisms accessible to treatment or prevention, improve processes of risk prediction and diagnosis, and develop individualized approaches to treatment and prevention.

In discussing disease mechanisms, the article mentions the “cluster of traits referred to as the metabolic syndrome” and observes that little or no genetic evidence supports the existence of such a “pathophysiological entity.”

“No doubt that these traits do tend to cluster in certain individuals,” Dr. McCarthy explained to Medscape Medical News in an email, “but [there is] some argument in the literature as to whether this really deserves designation of a syndrome. So far, we haven’t been very successful at finding variants influencing the metabolic syndrome as a whole.

“That may be because [the variants] are there and we didn’t find them yet,” added Dr. McCarthy, “or [because] the metabolic syndrome has more to do with environment and aging (perhaps via epigenetics) than with genetic variation.”

On the subject of prediction and diagnostics, Dr. McCarthy noted the value of genetic information in monogenic diseases but acknowledged the limitations of molecular diagnostic techniques that require sequencing because of its expense and because of causal mutations that are unique to an affected family. Fortunately, developing technologies and improved biomarkers promise more precise targeting for diagnostic sequencing of genetic variants.

For many individuals, however, risk can be determined by BMI or family history, and genetic information adds little that would guide long-term behavior modification. “There are pros and cons of family history, of course…. It integrates genetics and perhaps epigenetics and other aspects of shared family environment in a useful way that is predictive of risk,” said Dr. McCarthy.

“However, equally, it falls afoul of inaccurate diagnostics, inaccurate recollection, etc. I don’t think we should abandon family history as a clinical tool by any means, but I would hope that we will get better and better at using genetic and other tools to refine the individual risk predictions that come from family history,” Dr. McCarthy added.

We Still Have Much to Learn

Finally, discussing treatment and prevention, the article highlighted the importance of genetic testing in selecting a therapy for monogenic diabetes. However, the contribution of genetics is less clear in managing more common forms of obesity and type 2 diabetes. At present, the greatest influence of genetic information on therapy may be through drug discovery.

“Both [obesity and type 2 diabetes] are strongly heritable conditions influenced by environmental factors, and advances in risk prediction, prevention, and therapy are sorely needed,” commented W. Gregory Feero, MD, PhD, guest coeditor of the New England Journal of Medicine‘s series in genomic medicine, and special advisor to the director for genomic medicine, National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland, in an email to Medscape Medical News.

“Dr. McCarthy…is a leading investigator who has contributed tremendously to our understanding of the genomic underpinnings of these conditions,” noted Dr. Feero. “His work continues to shape the future of investigation in this area…. Though we have much yet to learn, these insights are helping to drive important downstream efforts to develop clinical tools to reduce morbidity and mortality from these conditions,” Dr. Feero said.

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Staying Active Lessens Age-Related Weight Gain, Especially in Women!!!

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Staying active in young adulthood appears to help individuals lessen the fattening effects of time, with results of a new study showing that physically active young adults do not put on as much weight as their less active counterparts. While some weight gain appears inevitable–even the most active individuals had increases in weight and waist circumference over a 20-year period–maintaining high activity levels lessens the weight gain as people move into middle age, report investigators.

“Preventing weight gain can be something that is appropriate for people who are overweight, normal weight, or obese, so it crosses weight classes,” lead investigator Dr Arlene Hankinson (Northwestern University, Chicago, IL) told heartwire . “And like many prevention strategies, it’s usually easier to prevent something from happening than to treat it after you’ve already developed the problem.”

The study is published in the December 15, 2010 issue of the Journal of the American Medical Association.

Analysis From the CARDIA Trial

To heartwire , Hankinson said there has been a lot of work looking at the association between physical activity and weight loss, with clinical trials testing different types of physical activity and their effects on helping obese individuals lose weight. Less is known, however, about what is required to prevent weight gain in the future.

Currently, public-health guidelines recommend regular physical exercise to prevent age-related weight gain. While this implies that higher physical-activity levels can prevent weight gain, said Hankinson, the data supporting the recommendation are based largely on cross-sectional observational and short-term clinical trials. Short-term studies, she noted, can’t account for the changing risk of gaining weight with age. The purpose of this study was to evaluate the relationship between habitual physical-activity levels and changes in body-mass index (BMI) and waist circumference over a 20-year period.

In this analysis, the researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) trial, a prospective, longitudinal study with 20 years of follow-up. The group used an algorithm to compute a total activity score that factored in the intensity, frequency, and duration of the physical activity over the previous 12 months. As a reference, a score of 300 exercise units corresponded to at least 150 minutes of moderate to vigorous intensity exercise per week, the approximate amount recommended by the US Department of Health and Human Services (HHS).

Men and women who had high physical-activity levels in young adulthood (ages 18 to 30 years) gained less weight than individuals with low measures of physical activity. Based on BMI, men who maintained high physical-activity levels in young adulthood gained 2.6 kg less than their less active peers over the 20 years of the study, while women who were most active gained 6.1 fewer kg than those with low physical-activity scores.

Similarly, over the 20 years, the most active men and women gained 3.1 and 3.8 fewer cm in waist circumference than individuals with the lowest physical-activity scores in young adulthood.

Overall, men and women who engaged in a high level of physical activity, exceeding the recommended HHS guidelines for duration, frequency, and intensity, gained approximately 9 kg, or roughly 20 lbs over 20 years. On the other hand, men who did not participate regularly in physical activity, those with a “low” physical-activity score, gained nearly 13 kg (28 lbs), while women with a low score gained 15 kg (33 lbs) over 20 years.

“It’s very possible that there are physiologic differences between men and women–the chief among them being pregnancy and menopause–that might account for the differences in weight gain, but there could be other reasons,” said Hankinson. “However, I think there are different ways that women behave compared with men, and we are not able to capture all of those behaviors and account for them in a way that explains the gender differences.”

The overall data showing weight gain in even the most active adults support previous studies suggesting that individuals might need to exercise more as they age to prevent incremental gains in weight over time, Hankinson told heartwire .

Of the 1338 individuals included in the analysis, more than one-third met the daily physical-activity requirements outlined by the HHS. These individuals experienced smaller annual increases in mean BMI and waist circumference than those who did not meet the recommended activity levels. Overall, men and women who exercised for more than 150 minutes per week at moderate to vigorous intensity gained 1.8 and 4.7 fewer kgs, respectively, that those who did not meet the HHS physical-activity requirements.

“The federal guidelines are a great starting point,” said Hankinson. “We used it as an alternative definition to high activity in our study, and we found really similar results. The benefit of those guidelines is to prevent weight gain, and not just weight loss for cardiovascular benefit.”

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Combining Resistance Training and Aerobic Exercise Reduces Diabetes Marker!!!

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A number of previous studies have suggested a range of health benefits for a combined resistance and aerobic exercise program. Timothy Church, from the Pennington Biomedical Research Center (Louisiana, USA), and colleagues conducted a nine-month long study known as HART-D — Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes, which included 262 sedentary men and women with type 2 diabetes and levels of hemoglobin A1c, a marker of blood sugar, at 6.5% or higher. Through nine months, the average hemoglobin A1c level increased by 0.11% in the control group, but declined in each of the three exercise groups. Compared with the control group, the absolute reduction in hemoglobin A1c level was significant in the combination training group: the combination of aerobic and resistance training reduced hemoglobin A1c levels by 0.34%.  The researchers conclude that: “Among patients with type 2 diabetes mellitus, a combination of aerobic and resistance training compared with the nonexercise control group improved HbA1c levels. This was not achieved by aerobic or resistance training alone.” The Journal of the American Medical Association

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New Guidelines for Exercise in Type 2 Diabetes!!!

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New guidelines issued jointly by the American Diabetes Association and the American College of Sports Medicine stress the crucial role that physical activity plays in the management of type 2 diabetes.

They replace recommendations made in the American College of Sports Medicine Position Stand “Exercise and Type 2 Diabetes” that were issued in 2000.

Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue ofMedicine & Science in Sports & Exercise and Diabetes Care.

“High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently,” the expert panel writes, “but it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life.”

Most of the benefits of exercise are realized through acute and long-term improvements in insulin action, accomplished with both aerobic and resistance training, the experts write.

For people who already have type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity. These recommendations take into account the needs of those whose diabetes may limit vigorous exercise.

“Most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopaedic or other health limitations,” said writing chair Sheri R. Colberg, PhD, professor of exercise science at Old Dominion University and adjunct professor of internal medicine at Eastern Virginia Medical School, Norfolk, Virginia, in a statement. “For this reason, the ADA [American Diabetes Association] and ACSM [American College of Sports Medicine] call for a regimen of moderate-to-vigorous activity and make no recommendation for a lesser amount of vigorous activity.”

The panel specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people with type 2 diabetes, brisk walking is a moderate-intensity exercise.

The expert panel also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week — ideally 3 times a week — on nonconsecutive days. The panel also recommends that people just beginning to do weight training be supervised by a qualified exercise trainer “to ensure optimal benefits to blood glucose control, blood pressure, lipids, and cardiovascular risk and to minimize injury risk.”

Regular use of a pedometer is also encouraged. In a meta-analysis of 8 randomized controlled trials and 18 observational studies, people who used pedometers increased their physical activity by 27% over baseline. Having a goal, such as taking 10,000 steps per day, was an important predictor of increased physical activity, according to the expert panel.

Finally, the new guidelines emphasise that exercise must be done regularly to have continued benefits and should include regular training of varying types.

Physicians should prescribe exercise, Dr. Colberg said in a statement. “Many physicians appear unwilling or cautious about prescribing exercise to individuals with type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity.”