Diabetics Tips and Solutions!!!

Wednesday, 26 July 2017

Study finds 90 percent of American men overfat

Source: Frontiers
Summary:: Researchers reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world's population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings that up to 90 percent of adult males and 50 percent of children may be overfat.

FULL STORY

Rather than thinking of these disorders as separate, individual clinical problems, it might be best to consider the relationships between overfat, its various risks, and its associated downstream diseases as a spectrum or progression where the vicious cycle of overfat, insulin resistance and chronic inflammation lies at one end, (constituting the population with early measurable abnormality), while the presence of chronic conditions resides at the other end.

Credit: Maffetone, Rivera-Dominguez and Laursen; CC BY

Does your waist measure more than half your height?

If so, you may be part of the global overfat pandemic. A recent article, published in Frontiers in Public Health, suggests it to be even more prevalent in developed countries where up to 90 percent of adult males and 50 percent children may suffer from this condition. In the top overfat countries, 80 percent of women fall into this category.
The problem is particularly pervasive in the English-speaking countries of the United States and New Zealand, but also in Iceland and even Greece where people are generally thought to be healthy. This trend may be bad news for developing countries as well, since they have followed the trend of developed nations in the growing overfat pandemic.
            The term overfat refers to the presence of excess body fat that can impair health, and may include even normal-weight non-obese individuals. Excess body fat, especially abdominal fat, is associated with increased risk of chronic diseases, increased morbidity and mortality, and reduced quality of life.
Researchers Philip Maffetone, Ivan Rivera-Dominguez and Paul B. Laursen reported earlier this year in the journal Frontiers of Public Health that up to 76 percent of the world's population may be overfat. Now these same researchers have focused their efforts on data from 30 of the top developed countries, with even more alarming findings.
            In addition, a recent rise in the incidence of abdominal adiposity, the unhealthiest form of excess body fat, has been observed in both adults and children, indicating a direct link to insulin-resistance, the body's natural propensity to convert and store carbohydrate foods as fat.
The relationship between the overfat condition and poor health is a spectrum or progression in which the vicious cycle of excess body fat, insulin resistance and chronic inflammation lie at one end, causing abnormal blood fats (cholesterol and triglycerides) and glucose, and elevated blood pressure, which then produces a variety of common diseases at the other end.
          Being overfat is linked to hypertension, dyslipidemia, coronary heart disease, stroke, cancer, Type 2 diabetes, gallbladder disease, osteoarthritis and gout, pulmonary diseases, sleep apnea and others.
Many physically active people, including professional athletes in various sports and active U.S. military personnel, also may fall into the overfat category.
Traditional means of assessment, such as stepping on a scale or calculating Body Mass Index (BMI), are ineffective at determining whether someone is overfat. Instead, researchers recommend taking a measure of the waistline (at the level of the belly button) and comparing it to height: The waist measure should be less than half a person's

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Saturday, 15 July 2017

USPSTF recommendation regarding behavioral counseling for cardiovascular disease prevention

Source: The JAMA Network Journals
Summary:: The US Preventive Services Task Force recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have high blood pressure, abnormal cholesterol or blood sugar levels or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of cardiovascular disease in this population.

FULL STORY

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have high blood pressure, abnormal cholesterol or blood sugar levels or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of cardiovascular disease (CVD) in this population. The report appears in the July 11 issue of JAMA.

            This is a C recommendation, indicating that the USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
Cardiovascular disease, which includes heart attack and stroke, is the leading cause of death in the United States. Adults who adhere to national guidelines for a healthful diet and physical activity have lower rates of cardiovascular illness and death than those who do not. All persons, regardless of their CVD risk status, can gain health benefits from healthy eating behaviors and appropriate physical activity. To update its 2012 recommendation, the USPSTF reviewed the evidence on whether primary care-relevant counseling interventions to promote a healthful diet, physical activity, or both improve health outcomes, intermediate outcomes associated with CVD, or dietary or physical activity behaviors in adults.
          The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.
                                                                                                                                                          Benefits of Behavioral Counseling Interventions
            The USPSTF found adequate evidence that behavioral counseling interventions provide at least a small benefit for reduction of CVD risk in adults without obesity who do not have the common risk factors for CVD (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes). Behavioral counseling interventions have been found to improve healthful behaviors, including beneficial effects on fruit and vegetable consumption, total daily caloric intake, salt intake, and physical activity levels.
Behavioral counseling interventions led to improvements in systolic and diastolic blood pressure levels, low-density lipoprotein cholesterol (LDL-C) levels, body mass index (BMI), and waist circumference that persisted over 6 to 12 months. The USPSTF found inadequate direct evidence that behavioral counseling interventions lead to a reduction in death or CVD rates.
                                                                                                                                                                       Harms of Behavioral Counseling Interventions
           The USPSTF found adequate evidence that the harms of behavioral counseling interventions are small to none. Among 14 trials of behavioral interventions that reported on adverse events, none reported any serious adverse events.
                                                                                                                                                                          Summary
           The USPSTF concludes with moderate certainty that behavioral counseling interventions to promote a healthful diet and physical activity have a small net benefit in adults without obesity who do not have specific common risk factors for CVD. Although the correlation among healthful diet, physical activity, and CVD incidence is strong, existing evidence indicates that the health benefit of behavioral counseling to promote a healthful diet and physical activity among adults without obesity who do not have these specific CVD risk factors is small.

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Machine-learning techniques used to unlock hidden benefit of weight loss interventions for overweight patients with type 2 diabetes

Source: Mount Sinai Health System
Summary:: Losing weight reduces the risk of long-term cardiovascular illness and mortality for the majority of patients with type 2 diabetes, but for a small subgroup, weight-loss intervention can lead to dramatically worse outcomes.

FULL STORY

Losing weight reduces the risk of long-term cardiovascular illness and mortality for the majority of patients with type 2 diabetes, but for a small subgroup, weight-loss intervention can lead to dramatically worse outcomes, according to new research published in The Lancet Diabetes & Endocrinology.

A team of data science researchers at The Arnhold Institute for Global Health of the Icahn School of Medicine at Mount Sinai reached these conclusions by applying new, advanced machine learning techniques to data collected during a trial that was halted in 2012 because its results lacked statistical significance.
The Arnhold Institute team, led by James H. Faghmous, PhD, Chief Technology Officer at the Institute, reanalyzed data from the trial known as Look AHEAD (Action for Health in Diabetes). They found that, despite the overall null findings of the trial, 85 percent of the study sample did experience a clinically meaningful, significant reduction in cardiovascular mortality and morbidity from the trial's intensive weight loss intervention.
            "Our analysis demonstrates that recent advances in machine learning for causal inference can increase the quantity of clinically relevant findings generated from large randomized trials," said Aaron Baum, PhD, Lead Economist, The Arnhold Institute for Global Health; Assistant Professor, Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai; and lead author of the study. "As researchers and data scientists, we are always concerned that an overall study result could mask important disparities in benefit or harm among different types of patients, which is exactly what this study revealed. Being able to identify individuals that could benefit from an intervention is fundamental to patient care."
"In addition to its clinical findings, this work shows the promise advanced machine learning methods can have on precision medicine beyond genetics," said James H. Faghmous, PhD, the study's senior author and an expert in machine learning and healthcare.
            The Look AHEAD study enrolled more than 5,000 overweight and obese patients with diabetes with a planned follow-up period of up to 13 years. Its intent was to determine whether modest weight loss through a lifestyle intervention reduced the rate of mortality and serious events like heart attacks and strokes. The trial was halted early by the National Institutes of Health (NIH) after finding no difference in the rates of cardiovascular events between the two groups.
"This research strengthens the role for data science and precision medicine as essential tools that can transform the way health care is delivered," said Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health and Chair of the Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai. "Identifying individuals that could benefit from an intervention is crucial for practicing clinicians, while ignoring subgroups that benefit might lead to lack of reimbursement for weight loss programs, which would neglect vulnerable populations."
             The team's findings indicated that 15 percent of subjects had substantially increased risk of cardiovascular events such as heart attack or stroke as a result of weight loss interventions. This could be the first suggestive evidence of an adverse reaction to what is generally considered a common-sense and innocuous intervention. This subgroup was defined by a combination of two baseline characteristics: mild or well treated diabetes (HbA1c less than 6.8 percent) and a negative perception of their health status (SF-36 general health score less than 48). The latter is strongly correlated to depression. This subgroup also:
• Reported substantially poorer compliance with the exercise portion of the intervention, which is consistent with the importance of assessing patients' readiness for change when recommending behavioral interventions;
• Experienced less improvement in several intermediate health outcomes, including blood sugar, mental health, and blood pressure.
"This analysis restores my faith in basic common sense," said Ronald Tamler, MD, Medical Director, Mount Sinai Clinical Diabetes Institute, and co-author of the study. "For the vast majority of people with diabetes, a healthy lifestyle with weight loss carries significant benefits; however, it's not for everyone. Thanks to this work, clinicians can infer which patients will benefit the most from such a lifestyle intervention."

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Diabetes causes shift in oral microbiome that fosters periodontitis, Penn study finds

Source: University of Pennsylvania
Summary:: People with diabetes are susceptible to periodontitis, a gum infection that can result in tooth loss. New research helps explain why: Diabetes triggers changes in the oral microbiome that enhance inflammation and the risk of bone loss

FULL STORY

Researchers found that diabetes (panel on right) shifts the oral microbiome, transforming it into a more inflammatory environment and promoting bone loss, characteristics of the gum disease periodontitis.

Credit: University of Pennsylvania

A new study led by University of Pennsylvania researchers has found that the oral microbiome is affected by diabetes, causing a shift to increase its pathogenicity. The research, published in the journal Cell Host & Microbe this week, not only showed that the oral microbiome of mice with diabetes shifted but that the change was associated with increased inflammation and bone loss.

"Up until now, there had been no concrete evidence that diabetes affects the oral microbiome," said Dana Graves, senior author on the new study and vice dean of scholarship and research at Penn's School of Dental Medicine. "But the studies that had been done were not rigorous."
Just four years ago, the European Federation of Periodontology and the American Academy of Periodontology issued a report stating there is no compelling evidence that diabetes is directly linked to changes in the oral microbiome. But Graves and colleagues were skeptical and decided to pursue the question, using a mouse model that mimics Type 2 diabetes.
               "My argument was that the appropriate studies just hadn't been done, so I decided, We'll do the appropriate study," Graves said.
Graves co-authored the study with Kyle Bittinger of the Children's Hospital of Philadelphia, who assisted with microbiome analysis, along with E Xiao from Peking University, who was the first author, and co-authors from the University of São Paulo, Sichuan University, the Federal University of Minas Gerais and the University of Capinas. The authors consulted with Daniel Beiting of Penn Vet's Center for Host-Microbial Interactions and did the bone-loss measurements at the Penn Center for Musculoskeletal Diseases.
The researchers began by characterizing the oral microbiome of diabetic mice compared to healthy mice. They found that the diabetic mice had a similar oral microbiome to their healthy counterparts when they were sampled prior to developing high blood sugar levels, or hyperglycemia. But, once the diabetic mice were hyperglycemic, their microbiome became distinct from their normal littermates, with a less diverse community of bacteria.
                 The diabetic mice also had periodontitis, including a loss of bone supporting the teeth, and increased levels of IL-17, a signaling molecule important in immune response and inflammation. Increased levels of IL-17 in humans are associated with periodontal disease.
"The diabetic mice behaved similar to humans that had periodontal bone loss and increased IL-17 caused by a genetic disease," Graves said.
The findings underscored an association between changes in the oral microbiome and periodontitis but didn't prove that the microbial changes were responsible for disease. To drill in on the connection, the researchers transferred microorganisms from the diabetic mice to normal germ-free mice, animals that have been raised without being exposed to any microbes.
These recipient mice also developed bone loss. A micro-CT scan revealed they had 42 percent less bone than mice that had received a microbial transfer from normal mice. Markers of inflammation also went up in the recipients of the diabetic oral microbiome.
               "We were able to induce the rapid bone loss characteristic of the diabetic group into a normal group of animals simply by transferring the oral microbiome," said Graves.
With the microbiome now implicated in causing the periodontitis, Graves and colleagues wanted to know how. Suspecting that inflammatory cytokines, and specifically IL-17, played a role, the researchers repeated the microbiome transfer experiments, this time injecting the diabetic donors with an anti-IL-17 antibody prior to the transfer. Mice that received microbiomes from the treated diabetic mice had much less severe bone loss compared to mice that received a microbiome transfer from untreated mice.
The findings "demonstrate unequivocally" that diabetes-induced changes in the oral microbiome drive inflammatory changes that enhance bone loss in periodontitis, the authors wrote.
               Though IL-17 treatment was effective at reducing bone loss in the mice, it is unlikely to be a reasonable therapeutic strategy in humans due to its key role in immune protection. But Graves noted that the study highlights the importance for people with diabetes of controlling blood sugar and practicing good oral hygiene.
"Diabetes is one of the systemic disease that is most closely linked to periodontal disease, but the risk is substantially ameliorated by good glycemic control," he said. "And good oral hygiene can take the risk even further down."

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Wednesday, 12 July 2017

Genome sequence of a diabetes-prone rodent

Genome sequence of a diabetes-prone rodent reveals a mutation hotspot around the ParaHox gene cluster

Source: University of Oxford
Summary:: Sequencing the genome of the sand rat, a desert rodent susceptible to nutritionally induced diabetes, revealed an unusual chromosome region skewed toward G and C nucleotides. This region includes the Pdx1 homeobox gene, a transcriptional activator of insulin, which has undergone massive sequence change, likely contributing to diabetes and adaptation to low caloric intake, implying that mutation rate varies within a genome and that hotspots of high mutation rate may influence ecological adaptation and constraint.

FULL STORY

The sand rat Psammomys obesus is a gerbil species native to deserts of North Africa and the Middle East, and is constrained in its ecology because high carbohydrate diets induce obesity and type II diabetes that, in extreme cases, can lead to pancreatic failure and death. We report the sequencing of the sand rat genome and discovery of an unusual, extensive, and mutationally biased GC-rich genomic domain.

This highly divergent genomic region encompasses several functionally essential genes, and spans the ParaHox cluster which includes the insulin-regulating homeobox gene Pdx1. The sequence of sand rat Pdx1 has been grossly affected by GC-biased mutation, leading to the highest divergence observed for this gene across the Bilateria. In addition to genomic insights into restricted caloric intake in a desert species, the discovery of a localized chromosomal region subject to elevated mutation suggests that mutational heterogeneity within genomes could influence the course of evolution.

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Promising target to protect bone in patients with diabetes

Source:
New York University
Summary:: Utilizing metabolomics research techniques, researchers investigated the underlying biochemical activity and signaling within the bone marrow of hyperglycemic mice with hopes of reducing fracture risks of diabetics.

FULL STORY

Researchers at New York University College of Dentistry (NYU Dentistry) have described a new target that may open the door to developing therapies for preventing bone fractures in people with type 2 diabetes.

In a study published in Nature Communications, the investigators report that hyperglycemic mice (or mice with type 2 diabetes) have a 24-fold higher accumulation of succinate, an intermediate metabolite, in the metabolic pathways of their bone marrow stromal cells. In comparison, succinate was barely detectable in the normal mice. An intermediate metabolite is a compound that is both a product of one-step in a biochemical pathway or cycle, as well as the substrate for the next step.
In the study, "Succinate and its G-protein-coupled receptor stimulate osteoclastogenesis," the researchers took samples of bone marrow from hyperglycemic male mice and healthy mice. They studied the bone metabolism at the cellular level using advanced imaging and computational techniques, which allowed them to identify 142 metabolites that were significantly altered by more than 1.5 times in the diabetic mice. Of 142 metabolites, 126 were upregulated (or increased) and 16 were downregulated (or decreased).
Succinate was the first metabolite in the energy pathway, and with its more than 20-fold increased concentration, it overwhelmed the energy pathways. Additionally, the diabetic mice had considerably lower spongy bone mass, known as trabecular bone, making it easy to fracture.
           "The bottom line is that the high level of succinate combined with the finding of more fragile bone points to a new target to protect bone," said Yuqi Guo, MD, associate research scientist at NYU Dentistry, and the study's first author.
"The results are important because diabetics have a significantly higher fracture risk and their healing process is always delayed," said Xin Li, PhD, associate professor of basic science and craniofacial biology at NYU Dentistry, and the study's senior investigator. "In our study, the hyperglycemic mice had increased bone resorption [the breakdown and absorption of old bone], which outpaced the formation of new bone. This has implications for bone protection, as well as for the treatment of diabetes-associated collateral bone damage."
            Dr. Guo and his team utilized a relatively new field of research called metabolomics to examine the bone marrow. The technique examines the small molecules, or metabolites, within cells, bio-fluids, tissue, or organisms and their interactions within the larger system, called a metabolome. Metabolomics is an extremely powerful tool because it can depict the underlying biochemical activity and signaling between cells and tissues. It is proving invaluable in identifying biomarkers and pinpointing potential drug targets for many diseases.
            This study builds on previous research by Dr. Li's laboratory that showed, for the first time, significant accumulation of succinate in the bone marrow and serum of hyperglycemic mice. It opens the door to pursuing regulating succinate for protecting bone in diabetics.
Diabetes affects 29.1 million Americans or 9.3% of the population in the United States, according to 2012 Centers for Disease Control and Prevention data. Bone complications, such as hip or back fractures, can be devastating. The Women's Health Initiative found that type 2 diabetes was linked to a 20% risk increase in fractures.

Diabetes complications are a risk factor for repeat hospitalizations, study shows

Source: Mayo Clinic
Summary:: For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia high blood sugar, or hypoglycemia low blood sugar), says new research.

FULL STORY

For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia -- high blood sugar, or hypoglycemia -- low blood sugar), says new research published in the Journal of General Internal Medicine.

People who were previously hospitalized for severe hypoglycemia or hyperglycemia are at highest risk for recurrent dysglycemic episodes in the short term (within 30 days of the prior episode) and over the long term. In addition, having multiple diabetes complications significantly increased the risk of readmission not only for severe dysglycemia, but also for all causes that are seemingly unrelated to diabetes.
                                                                                                                                                                     Are these hospitalizations preventable?
            Any illness or procedure requiring hospitalization carries with it the risk of unplanned hospital readmission after discharge. Readmission is costly, harmful and burdensome to the patient -- and it is potentially preventable. Thus, readmission within 30 days is one factor used to rate hospitals on quality of care and determine reimbursement.
Understanding what causes readmissions can lead toward improved patient outcomes and quality of care, and lower costs. New interventions can improve outcomes for patients, resulting in less readmissions.
Rozalina McCoy, M.D., an internal medicine physician and endocrinologist at Mayo Clinic and study lead author, researches ways to improve care and outcomes for patients with diabetes.
"We already knew that adults with diabetes carry a high risk for hospitalization and unplanned readmission," she says. "But the big question was why? And what role did episodes of very high and very low blood sugar play in this risk? Because if we knew what the problem was, and ultimately why it might be happening, we could then try to prevent it."
                                                                                                                                                              Finding answers
             Using the OptumLabs Data Warehouse, a database of de-identified, linked clinical and administrative claims information, Dr. McCoy and her team examined administrative data of 342,186 adult patients with diabetes who were hospitalized for various reasons nearly 600,000 separate times between Jan. 1, 2009, and Dec. 31, 2014.
The researchers determined that patients with diabetes are admitted to the hospital and experience unplanned readmissions for a wide range of reasons -- similar to patients without diabetes. The most common reason (5.5 percent) for these initial, or index, hospitalizations, was congestive heart failure. Severe dysglycemia caused 2.6 percent of the initial hospitalizations for these patients.
When their initial condition was treated or stabilized, and the patients were discharged, 10.8 percent of them found themselves back in the hospital within 30 days. Of these 68,212 readmissions, 2.5 percent were for severe dysglycemia -- regardless of the initial reason for hospitalization. But if their index hospitalization was also for severe dysglycemia, the risk of a recurrent episode requiring hospitalization was nearly ninefold higher after a severe hyperglycemic event and fivefold higher after a severe hypoglycemic event.
The research also found that younger patients (18-44) were twice as likely to be readmitted for severe dysglycemia than were older patients.
                However, most troubling to the researchers was the fact that a severe dysglycemic episode was a strong predictor of readmission for another dysglycemia event.
"Severe dysglycemic events can be prevented with good diabetes outpatient care and careful discharge planning for diabetic patients who have been hospitalized for any reason not just for severe hypoglycemia or hyperglycemia," says Dr. McCoy.
"We were especially concerned to find that, for patients whose index hospitalization was because of severe dysglycemia, if they were readmitted within 30 days, it was very likely to be for another dysglycemia event. Nearly 30 percent experienced back-to-back dysglycemia, rather than readmission for any other cause," she says.
                                                                                                                                                                     The rest of the story
              The study helps providers identify patients at highest risk for readmission, allowing intervention and prevention.
Dr. McCoy encourages health care providers of hospitalized diabetic patients to develop discharge plans that include follow-up with their primary care provider immediately after discharge, and discuss with patients not only the reasons for their hospitalization but their diabetes management, as well.
"The hospital follow-up visit allows patients and their providers to discuss the reason for hospitalization, any medication changes, their ability to take care of themselves at home, and potential ways to prevent readmission if problems arise in the future," Dr. McCoy says. "It also provides an opportunity to review the patient's diabetes management plan and blood sugar levels."
              Dr. McCoy also notes that, "Inpatient diabetes education has been shown to reduce risk of readmission, as have medication reviews, care transition programs, and other efforts to incorporate diabetes care into discharge planning and post hospital follow-up."
While this is true for all patients, it may be especially important for patients with diabetes, she says.
"Patients can do their part by learning to recognize severe dysglycemic episodes when they happen and reporting events to their care providers. They can work with their care providers to develop a plan on how to manage dysglycemia early, so symptoms don't become so severe as to require hospitalization," says Dr. McCoy.