Nonalcoholic fatty liver disease — and its more severe stage, nonalcoholic steatohepatitis, in particular — has surpassed alcoholism as a cause of cirrhosis and is on its way to becoming the No. 1 reason for liver transplantation in the United States. It is frequently associated with obesity, insulin resistance, diabetes and other metabolic risk factors.

Popular articles about NAFLD posted on Healio this year addressed screening, treatment and therapies in the pipeline.

Early action required for prevention, management of fatty liver in type 2 diabetes

At least half of all individuals with type 2 diabetes also have NAFLD, setting the stage for a worse metabolic profile and greater cardiovascular risks. Currently, there are no drugs approved to treat NAFLD.

READ

What is the best way to screen very high-risk patients for fatty liver or fibrosis?

Safe, accurate and easier-to-perform blood tests are needed to make diagnosis in the clinic easier.

READ

 

Nonalcoholic fatty liver disease — and its more severe stage, nonalcoholic steatohepatitis, in particular — has surpassed alcoholism as a cause of cirrhosis and is on its way to becoming the No. 1 reason for liver transplantation in the United States.

Source: Adobe Stock

AI tool for NAFLD could 'make biopsies history'

In this video exclusive, Christos S. Mantzoros, MD, PhD, discusses a new artificial intelligence and machine learning tool for nonalcoholic fatty liver disease prediction.

READ

Screen for fatty liver as a diabetes complication

In this Q&A, Kenneth Cusi, MD, FACP, FACE, discusses the recent rise in fatty liver disease and its connections with obesity and diabetes, describes how to screen for the condition and outlines current and future treatments.

READ

NASH more likely, liver fibrosis less likely with increasing C-peptide levels in type 2 diabetes

Adults with type 2 diabetes and higher C-peptide levels are more likely to develop simple nonalcoholic fatty liver disease and nonalcoholic steatohepatitis compared with those with lower levels.

READ

Blood test differentiates between NAFLD, NASH

A novel combinations of glycans, lipids and hormonal variables can simultaneously diagnose the presence of nonalcoholic fatty liver or nonalcoholic steatohepatitis with up to 90% accuracy.

READ

In 2020, it's time to put your health first. If you are at risk for type 2 diabetes, or have been diagnosed with diabetes, the Fanwood-Scotch Plains YMCA (FSPY) is offering two programs beginning in January to help you on your path to health and wellness.

FSPY recently received Full Recognition from the Centers for Disease Control and Prevention (CDC) for its YMCA's Diabetes Prevention Program. The program is designed for those with prediabetes, a condition in which a person's blood glucose is elevated, but not high enough for a diabetes diagnosis. According to the CDC, 86 million adults have prediabetes and 9 out of 10 individuals with prediabetes don't know they have it. Without weight loss and moderate physical activity, 15 to 30 percent of people with prediabetes will develop type 2 diabetes within five years.

The year-long YMCA's Diabetes Prevention Program starts with 16 weekly sessions led by a trained lifestyle coach. This gradually eases to two sessions per month and then one session per month. The program helps adults lose weight through healthier eating and increased physical activity, potentially preventing or delaying the onset of type 2 diabetes. A group-based lifestyle intervention, it has been shown to reduce the number of new cases of diabetes by 58 percent overall and by 71 percent in adults over 60.

To receive Full Recognition as part of the CDC's National Diabetes Prevention Program, FSPY's program had to effectively deliver a quality, evidence-based program that met all of the standards for CDC recognition, including program participants having an average weight loss of 5 percent over one year; meeting attendance parameters, and participants keeping food/activity records.

"We are excited to have received CDC Full Recognition for our YMCA's Diabetes Prevention Program and are looking forward to helping even more people in our community achieve their goals," said Sheri Cognetti, Senior Program Director at the F anwood-Scotch Plains YMCA. "Our program has been shown to reduce people's chances of developing diabetes and to improve their overall health and wellness. Through group support and our trained facilitators, we offer a comprehensive approach to tackling the diabetes epidemic."

In addition, FSPY offers the Diabetes Self-Management Program (DSMP) for those who have already been diagnosed with Type 2 Diabetes. This program helps them manage the disease through lifestyle changes, including healthy eating, exercise, developing goals and problem solving, as well as through group support. The program consists of several workshops totaling 16 hours that help participants understand diabetes and its risks. DSMP teaches participants how to live healthier in a fun, positive environment. It does not replace other programs or treatment, and participants are referred to their physicians for all medical questions.

Individuals can assess their risk for prediabetes and type 2 diabetes by taking a simple test at YMCA.net/diabetes. Through this assessment, visitors also can learn how lifestyle choices and family history help determine the ultimate risk for developing the disease. Several factors that could put a person at risk for type 2 diabetes include race, age, weight and activity level. If a person is at risk, a diabetes screening conducted by a physician can confirm a diabetes or prediabetes diagnosis.

For more information about how to qualify for the YMCA's Diabetes Prevention Program or the Diabetes Self-Management Program, contact Donna Peart at dpeart@fspymca.org or 908-889-8880. Both programs will begin in mid-to-late January with days/times to be determined by enrollment. The programs are open to the community; you do not have to be an FSPY member to participate.

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About the Fanwood-Scotch Plains YMCA

The Fanwood-Scotch Plains YMCA is dedicated to improving the quality of life of the individuals, families and communities it serves through programs and services that build wholeness of spirit, mind and body. The YMCA is a not-for-profit organization founded on Christian principles, serving people of all ages, races, faith, cultures and socio-economic conditions. For information on membership or programs, or to request a schedule of classes, please call the Fanwood-Scotch Plains YMCA at (908) 889-8880 or visit https://fspymca.org. Financial assistance is available for those who qualify.

These included record-breaking opioid settlements, a new treatment for cystic fibrosis, the promise and peril of large IT brands like Google and Apple moving into the healthcare space, and a devastating outbreak of serious lung disease in healthy young persons from vaping illicit THC.

But in terms of the health story with the greatest potential for taming sickness and the ballooning cost of healthcare, a case can be made for the recognition by health officials in 2019 of the ketogenic diet as a first line-treatment for type 2 diabetes.

The ketogenic diet, as many by now know, is a low-carb diet on steroids, a calorically-unrestricted eating pattern in which just 10-20% of daily calories (or less than 50 grams) come from carbohydrates, with dietary fat making up the majority of remaining energy (roughly 70% of daily calories).

Type 2 diabetes, on the other hand, is an acquired metabolic disorder affecting 340,000 Minnesotans and 30 million Americans, one that currently extracts $250 billion in direct costs each year in the US, and which can lead to heart disease, hypertension, Alzheimer's, amputation, blindness and cancer.

Because it is often accompanied by obesity, type 2 diabetes is routinely attributed to overeating and lack of exercise, but a more precise description of its mechanism comes down to an elevation of the body's hormone insulin. Given that the body only releases insulin in response to dietary carbohydrates, type 2 diabetes is arguably a food-borne illness, with the food in question being carbohydrates. That is the rationale, in any event, for treating the predominant illness of our time with a ketogenic diet.

"We need to recognize that conventional diets have not worked well, and reduce the scientific barriers to studying novel approaches, like the ketogenic diet," says Dr. David Ludwig, an endocrinologist at Boston Children's Hospital and professor of pediatrics at Harvard Medical School, in an email to Forum News Service. "These long-term studies will provide the definitive data to understand effectiveness for various chronic conditions, and potential side-effects."

Ludwig recently authored a paper in the Journal of Nutrition compiling the evidence for ketogenic diets, past and present, a paper complete with a section heading noting there is no human requirement for dietary fiber or carbohydrate. "A century ago," he reminds readers, "the ketogenic diet was a standard of care in diabetes, used to prolong the life of children with type 1 diabetes and to control the symptoms of type 2 diabetes in adult."

It was only following the discovery of insulin in the 1920s, Ludwig writes, that high carbohydrate diets gave us our present day medication protocols for type 2 diabetes, treatments anchored by the use of pricey commercial insulin analogs and daily ingestion of glucose-control medications.

Ludwig says he wrote the article to counter "a spate of negative articles (that) have been rewritten about the ketogenic diet by nutrition experts," articles focusing on rare side-effects.

The case for keto in 2019 kicked off in May, when the American Diabetes Association released a Consensus Report calling low carbohydrate or very low carbohydrate diets a "a viable approach" for certain patients with T2D, including those hoping to reduce medications.

Describing the diets as "among the most studied eating patterns for type 2 diabetes," the nation's diabetes authorities added the caveat that ketogenic therapy for diabetes generally requries medical oversight to prevent hypoglycemia. In other words, keto can work so effectively in diabetics that should patients fail to carefully taper medications with medical guidance as their condition improves, they can become dangerously overmedicated.

June of 2019 saw the release of still more arguments for keto, in the form of second-year trial results by researchers from Indiana University Health and Verta Health. Their non-randomized clinical trial of the diet produced data showing that more than half of 262 patients studied had reversed their illness on a remote-monitored ketogenic diet, with many having discontinued the need for all medications except for Metformin.

While noting that the Verta Health results should be interpreted with caution, Ludwig says these "exceptional outcomes at two years, with many participants coming off diabetes medications and improving blood glucose control, highlights the exciting possibility that diabetes can be reversed without bariatric surgery."

The arrival of keto for type 2 diabetes comes along at a time when the standard of care is increasingly coming up short. The year saw widespread shortages and price hikes for insulin, leading politicians to threaten price control legislation and stirring insurers to issue competing press releases touting their full- or highly discounted insulin coverage packages.

As endocrinology researchers from Mayo Clinic recently wrote in the journal BMJ, "the body of evidence shows no meaningful benefit" for intensive glucose-lowering regimens when it comes to the health outcomes that matter most to patients. And as researchers from Norway confirmed in 2018, telling high-risk individuals the advice to eat more "fiber and polyunsaturated fat," plus the familiar five servings of fruit and vegetables with "plentiful intake" of beans, wholegrain and low-fat dairy, produced no improvement either.

For its part, the device industry is taking steps to build a ketogenic diabetes care product line, offering portable ketone breath meters and continuous glucose monitors allowing patients to see the effects on their blood sugar of carbohydrate rich foods in real time.

Still to be determined is whether dietary officials will heed the call by groups like the Low-Carb Action Network to include a true low-carbohydrate diet in the next installment of the dietary guidelines. Under the current USDA definition, diets up to 45% carbohydrates, are deemed low-carbohydrate, a too-high allowance for carbohydrates potentially washing out the ability of researchers to accurately test the intervention for disease reversal and prevention.

Its new research on an old method. As Ludwig notes, "before insulin was discovered, a very-low-carbohydrate diet was considered the standard of care for diabetes. From this perspective, modern nutrition science may be in the process of ‘rediscovering the wheel,’ so to speak."

Researchers at Karolinska Institutet in Sweden have deciphered the diabetogenic role of a certain type of calcium channel in insulin-secreting beta cells. The researchers believe that blockade of these channels could be a potential new treatment strategy for diabetes. The study is published in the scientific journal PNAS.

CaV3.1 channels have a marginal role in healthy insulin-secreting beta cells in the endocrine pancreas but become hyperactive along with the occurrence of diabetes. This raises a critical question of whether the hyperactivation of these calcium channels is a cause or consequence of diabetes. Now, researchers at Karolinska Institutet have found that increased expression of CaV3.1 leads to excessive calcium influx, impairing the genomic expression of exocytotic proteins in beta cells.

"This leads to a reduced insulin-secretion capacity of beta cells and aberrant glucose homeostasis," explains Dr. Jia Yu, first author of the study and Senior researcher at the Department of Molecular Medicine and Surgery, Karolinska Institutet.

The role of CaV3.1 in the development of diabetes was investigated with a series of approaches, including experiments on rat and human pancreatic islets and diabetic rats. The experimental models used suggest that the results apply to both type 1 and type 2 diabetes, but more studies are needed to verify this.

"Over a long period of time, the pathological role of beta cell CaV3.1 channels in the development of diabetes and its complications has been neglected," says Dr. Shao-Nian Yang, Associate professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet, and senior author of the study. "Our work pinpoints an increased expression of these channels as a critical pathogenic mechanism in diabetes, meaning that CaV3.1 channels should not be neglected in diabetes research."

Now, the researchers want to work out if increased expression of CaV3.1 also alter transcriptomic profiles in other types of cells, such as vascular smooth muscle cells and T cells of the immune system to contribute to the development of diabetes and its complications.

"The selective blockade of CaV3.1 channels may have potential as a new mechanism-based treatment strategy," says Professor Per-Olof Berggren, Director of the Rolf Luft Research Center, Karolinska Institutet, and senior author of the study. "Clinical trials with CaV3.1 channel blockers in patients with diabetes will be one of our future study priorities."

More information: Jia Yu el al., "Enhanced expression of β cell CaV3.1 channels impairs insulin release and glucose homeostasis," PNAS (2019). www.pnas.org/cgi/doi/10.1073/pnas.1908691117

Citation: Calcium channels play a key role in the development of diabetes (2019, December 23) retrieved 29 December 2019 from https://medicalxpress.com/news/2019-12-calcium-channels-key-role-diabetes.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

If you or a loved one has diabetes, you know the devastating effects it can have - pain or neuropathy in the feet, slow-healing wounds, kidney failure, blindness and more. Diabetes is a progressive disease, so it worsens over time and with age.

Cutting Edge Technology for Diabetes

An exciting new program is bringing relief to diabetics in astounding ways. Called Diabetes Relief, it has been available for five years in other parts of the country, and many have traveled from other states to get it.

Diabetes Relief is not a cure for diabetes, but it can provide tremendous benefits by reversing many of the disease’s typical side effects.

Patients who began their treatment in wheelchairs now walk into their appointments. Those who became blind can see again. Others are no longer tied down to the demands of dialysis.

How it Works

Unlike traditional diabetes treatment, Diabetes Relief acts as a hormone in the body, rather than a drug. It stimulates the pancreas and liver to communicate again.

Infusions lasting 2-3 hours start at twice weekly, but over a 10-week period, the need for them decreases to a maintenance level. Meanwhile, patients begin to see the effects of the disease scaling back as they can walk without assistance and are free from pain.

Beginning January 1, the Diabetes Relief program will be available right here in Green Valley. For your consultation, contact Nature Cure Clinic at (520) 399-9212.

Five thousand obese patients will be handed a daily soup or shake when the programme starts in April. The NHS currently issues advice on how to eat more healthily and exercise. If successful the diet could become a new intervention for a condition that currently costs the NHS £14billion a year. Professor Roy Taylor, of Newcastle University, said: "This means we can now see Type 2 as a simple condition where the individual has accumulated more fat than they can cope with.

"Importantly, this means through diet and persistence patients are able to lose the fat and potentially reverse their diabetes.

"The sooner this is done after diagnosis the more likely it is remission can be achieved."

In tests overseen by the medicine and metabolism expert, one quarter of those on the 800-calorie liquid daily diet for 12 months lost 33lb or more and almost nine in 10 of this group put Type 2 into remission.

Generally, the NHS recommended daily calorie intake is 2,000 calories a day for women and 2,500 for men.

One in 10 aged over 40 is now battling a lifelong condition (Image: Getty)

Professor Roy Taylor, expert in diabetes research (Image: Getty)

Almost 4 million are blighted by the disease, with that number set to rocket to 5.5 million by 2030.

One in 10 aged over 40 is now battling a lifelong condition that can lead to blindness, amputations, heart disease and kidney failure.

Another 12.5 million are at increased risk because of chronically unhealthy lifestyles.

In studies carried out at Newcastle University's Institute of Translational and Clinical Research, Prof Taylor and Prof Mike Lean, of Glasgow University, proved Type 2 was triggered when fat spills from the liver into the pancreas.

The discovery was made in studies on those who previously had the disease but lost weight and successfully reversed the condition as part of the pioneering Diabetes Remission Clinical Trial study.

The biggest ever research investment was funded with a £2.8million injection from Diabetes UK.

More than one third were free of diabetes and off all medication for at least two years but a small group went on to regain weight and redeveloped Type 2.

Prof Taylor said: "We saw that when a person accumulates too much fat, which should be stored under the skin, then it has to go elsewhere in the body.

"The amount that can be stored under the skin varies from person to person.

Ten years ago no child in Britain had Type 2 diabetes (Image: Getty)

"When fat cannot be safely stored under the skin, it is then stored inside the liver, and over-spills to the rest of the body, including the pancreas.

"This clogs up the pancreas, switching off the genes which direct how insulin should effectively be produced, and this causes Type 2."

The study confirms his so-called Twin Cycle Hypothesis – that Type 2 is caused by excess fat gradually building up within both the liver and pancreas, but that the process is reversible.

Type 2 is much more aggressive in children and young people than adults, with a higher overall risk of complications appearing much earlier.

The risk of developing the condition is significantly increased by being overweight or obese.

Symptoms include going to the lavatory regularly, being thirsty, feeling more tired than usual and weight loss – all of which can be easily missed.

By the time it is diagnosed one in three people already have complications with their eyes, feet, kidneys or nerves, with some needing amputations.

Of major concern to health chiefs is that the proportion of young adults diagnosed with Type 2 has risen by a third since 2000. 

Around one in eight new cases is in someone aged between 18 and 40.

Ten years ago no child in Britain had Type 2, but there are now hundreds with the disease. 

How to avoid diabetes (Image: Daily Express)

Nine in 10 sufferers are overweight or obese and do not produce enough insulin – the hormone regulating blood glucose levels – or the insulin they produce does not work properly.

In Type 2, the pancreas becomes unable to produce insulin fast enough and the cells do not react to it properly, meaning glucose remains in the bloodstream and is not used as fuel for energy.

Tam Fry, of the National Obesity Forum, said: "The age of diagnosis is tumbling and of the 5.5 million diagnoses projected for 2030, thousands will still be children. That will be truly shocking." 

Just a century ago, a type 1 diabetes diagnosis was essentially a death sentence. As treatment has improved, though, people with T1D are living long and full lives, and thriving. Over the last few decades, the number of celebrities and luminaries with this illness has grown, and many are using their fame to draw attention to the condition and raise funds for diabetes research and support.

Actress Mary Tyler Moore, considered the first celebrity with type 1 diabetes, set the tone with her advocacy work on behalf of what was then called the Juvenile Diabetes Foundation (now JDRF). Other celebrities, like rock star Nick Jonas of the Jonas Brothers and pageant queen Sierra Sanderson who served as Miss Idaho, have raised awareness, as well, by displaying their insulin pumps and continuous glucose monitors (CGMs) in the spotlight.

Here are 20 celebrities and luminaries with type 1 diabetes you might not know about, and what they are doing for the cause.

Who's Included

NOTE: Some celebrities like Tom Hanks, Paula Deen, and Larry King are not on this list because they have type 2 diabetes, which is different.

Type 1 diabetes is a life-threatening autoimmune condition in which patients' bodies no longer produce insulin so they must take insulin via shots or an infusion pump in order to survice.

Type 2 diabetes is a resistance to the insulin produced in patients' bodies, and can often be treated with pills and/or lifestyle changes.

Cricket star Wasim Akram Wasim Akram

Wasim, a world-renowned cricket bowler from Pakistan, was diagnosed with type 1 diabetes at the height of his career. He is considered to have been one of the fastest bowlers in cricket's history. While the diagnosis was a shock, he recovered to take more than 250 wickets before his retirement – an impressive feat.

Watch this video on Akram.

Jay Cutler

Jay Cutler is best known as a starting quarterback for the Chicago Bears in the NFL. Cutler, who was diagnosed when he was in the NFL, amassed 35,000 passing yards and has worked to help the diabetes community with JDRF. He now appears on wife Kristen Cavallari's reality show, "Very Cavallari."

Watch this video on Cutler.

Max Domi

Max Domi is considered a rising star on the ice for the Montreal Canadiens in the NHL. The center recently released a book about balancing blood sugar management and hockey, and is establishing The Max Domi Fund for Type 1 Diabetes on behalf of Canadians with diabetes.

Watch this video on Domi.

Pamela Fernandes

Pamela Fernandes' athletic career began after she was diagnosed with type 1 diabetes, began to lose her sight, and had a kidney transplant. Competing as a tandem cyclist, Fernandes has medaled in the 1996 and 200 Paralympics. She also has served as a board member with Joslin Diabetes Center.

Sara Groenewegen

Sara is an elite softball pitcher who has helped Team Canada medal in multiple international competitions. An insulin pump user who was diagnosed at the age of 9, Sara holds the University of Minnesota record for most strikeouts. She regularly participates in JDRF One Walks.

Watch this video on Groenewegen.

Kris Freeman

In 2014, Kris joined a small club of athletes who have competed in four Olympics. A cross-country skier and multisport athlete, he has recently won several triathlons. Kris regularly attends and competes in JDRF and American Diabetes Association events.

Watch this video on Freeman.

Sam Fuld

For those who think athletes with type 1 diabetes are timid, Sam Fuld is the counterargument. The outfielder made a Major League Baseball career out of diving for hard hit balls for several teams, as well as Team Israel in the World Baseball Classic. Sam has been active with JDRF and SlamT1D, among other organizations.

Watch this video on Fuld.

Kelly Kuehne

Kelly Kuehne began playing golf at the age of 10, the same year she was diagnosed with type 1 diabetes. She balanced blood sugar management and a successful amateur and pro golf career for over a decade, and was inducted into the Texas Sports Hall of Fame.

Brandon Morrow

Few Major League Baseball pitchers enter three games in a row. But Brandon Morrow, who was diagnosed with type 1 diabetes in high school, once pitched in seven games straight during the World Series. The veteran right-hander often meets with aspiring young athletes with type 1 diabetes, and is active with JDRF.

Read our featured interview with Brandon Morrow.

Watch this video on Morrow.

Kendall Simmons

Like Jay Cutler (above), Kendall Simmons was diagnosed with type 1 diabetes while already in the NFL. While learning blood sugar management, he went on to become starting tackle for the Pittsburgh Steelers during the year they last won the Super Bowl.

Singer Crystal Bowersox Crystal Bowersox

Singer Crystal Bowersox is perhaps one of the most visible type 1 diabetes advocates, as she is a regular performer at diabetes conferences. Since finding success on American Idol in 2010, Crystal has released two albums while continuing to perform, and to advocate on behalf of JDRF Advocacy, Beyond Type 1, and other diabetes-focused organizations.

Read our 2010 interview with Crystal Bowersox (her first time talking publicly about diabetes).

Watch this video on Bowersox.

George Canyon

George Canyon is a Canadian country singer who rocketed to fame as a runner-up in the 2004 Nashville Star 2 reality TV competition. Since then, he's had several blockbuster albums and won the Juno Award for Country Recording of the Year. He's become a huge public proponent for JDRF, traveling the U.S., Canada, and the world spreading the "gospel" of "you can do anything with diabetes!"

Read our featured interview with Canyon here.

Kevin Covias

In 2006, Kevin Covias competed in American Idol while in high school. His time on the show came just a few years after his type 1 diabetes diagnosis. He has since pivoted to acting, and can be seen most recently on This is Us. Initially reluctant to speak much about his diabetes during his time on Idol, Kevin is now active in advocacy with Children with Diabetes and the Diabetes Research Institute.

Read our featured interview with Kevin Covias.

Watch this video on Covias.

Dame Dash

His name may not immediately ring a bell for everyone, but Damon "Dame" Dash is an American music mogul who's best known for launching the Roc-A-Fella Records label with hip-hop rapper Jay-Z back in the 90s, along with numerous businesses he's helped launch over the fewt couple decades. He was diagnosed with T1D at age 15, and a few years ago he launched the Dash Diabetes Network (DDN), a "lifestyle network" supporting those with diabetes.

Read our featured interview with Dash here.

Valerie June

Valerie June is an American singer-songwriter and multi-instrumentalist from Memphis, TN, who was diagnosed with type 1 diabetes at age 27 in 2009. Rolling Stone named her 2013 album one of its 50 best albums of the year, and she's been hailed by the New York Times as one of America's "most intriguing, fully formed new talents." She's been very open talking about diabetes in media interviews.

Read our featured interview with June here.

Brett Michaels

Brett Michaels shot to fame with the hair-rock band Poison in the late 1980's, and will tour with the band again in 2019. A steady solo performer as well, Brett was diagnosed with type 1 diabetes as a child. In 2010, he won Celebrity Apprentice and earned a quarter of a million dollars for the American Diabetes Association.

Watch this video on Michaels.

Eric Paslay

Eric Paslay is a GRAMMY-nominated country star and songwriter, and his 2011 album "Never Really Wanted" cracked the Billboard Country Top 10. His best-known songs include "Friday Night," "Song About a Girl," and "She Don't Love You." He is a Dexcom ambassador at Friends for Life conferences and serves on the board of directors for JDRF Middle Tennessee.

Read our featured interview with Eric Paslay.

Watch this video on Paslay.

Ben Rue

Country singer Ben Rue has been topping the Billboard Country Charts for the past few years. He grew up on a family farm in Oregon, where he was diagnosed with type 1 diabetes at age 14. Since makinghis way to Nashville to pursue his country music dream, he's become an advocate. In 2018, he partnered with Roche Diabetes Care to launch a campaign promoting a medication cost-savings program that also supports donations to diabetes nonprofits.

Read our featured interview with Rue here.

Elliott Yamin

On the fifth season of American Idol, viewers got to know Elliot Yamin's voice, and his visible insulin pump. The vocalist has since enjoyed continued success with several gold-certified records. He also has been open about his early struggles with type 1 diabetes as a teenager, and has been active with JDRF and the International Diabetes Federation's Life For A Child Program.

Watch this video on Yamin.

Former Miss America and actress Vanessa Williams Vanessa Williams

Vanessa trail-blazed as the first African-American to serve as Miss America, and has enjoyed a long singing and acting career since she first wore the crown. She is one of the few celebrities who was diagnosed with type 1 diabetes as an adult, and has been active with many health-related charities, including the American Heart Association.

Watch this video on Williams.

Brec Bassinger

Brec Bassinger is a Texas teenager who was hailed as one of the next big stars when she began appearing on Nickelodeon TV. She's had roles in The Goldbergs, Bella and the Bulldogs and Liar Liar Vampire — and has even been featured on billboards on Sunset Boulevard and in Times Square! Diagnosed at age 8, she's recently become a JDRF Ambassador and dedicated advocate.

Read our featured interview with Bassinger here.

Victor Garber

This prolific Broadway and film actor, who was diagnosed with type 1 diabetes at the age of 12, has had memorable roles in Titanic, Legally Blonde, and recently in Dark Waters. The Canadian actor also has been an integral advocate for Beyond Type 1 and JDRF Canada, and his portrait hangs in Banting House.

Watch this video clip on Garber.

Elizabeth Perkins

This veteran actress is best known for her role opposite Tom Hanks in Big, but has been a steady presence in many films and series, including Weeds and How to Live With Your Parents. Perkins was diagnosed with Latent Autoimmune Diabetes in Adults (LADA) in her forties, and has been open about her early struggles with type 1 diabetes.

Watch this video clip on Perkins.

Jim Turner

Jim Turner is an actor, comedian, and "one fun diabetes advocate." He played fictional character Randee of the Redwoods on MTV in the 1980s, and had vignettes in movies like The Lost Boys and St. Elmo's Fire. His TV appearances over the years include Grey's Anatomy, Castle, and Criminal Minds. He co-hosted the CNBC D-Life diabetes TV show for many years before that series eventually ended, and has remained a passionate advocate working with diabetes industry partners on various campaigns.

Read our featured interview with Turner here.

UK Prime Minister Theresa May, shown wearing the Abbott FreeStyle glucose monitor Theresa May

In 2016, Theresa May became only the second woman to serve as Prime Minister of the United Kingdom. She was diagnosed with type 1 diabetes late in life, and may indeed be the first world leader to serve after a type 1 diabetes diagnosis. She has been very open about her diabetes, and has even been seen in public with a continuous glucose monitor (CGM) on her arm.

Sonia Sotomayor

Justice Sotomayor is the first Latina to serve on the U.S. Supreme Court. Diagnosed with type 1 diabetes as a child, she has been open to talking about the condition and recently released a children's book that encourages children to embrace their differences.

Watch this video on Sotomayor.

New Delhi, Dec 24 (PTI) Drug firm Nectar Biopharma on Tuesday said it has launched the generic version of diabetes treatment drug vildagliptin, under the brand name Galvilda, in India.

The patent for vildagliptin, used for treatment of uncontrolled type 2 diabetes mellitus, expired on December 9, 2019, Nectar Biopharma said in a statement.

The company will also sell the combination drug containing vildagliptin and metformin under the brand name Galvildamet, it added.

'Riding on the success of our generics business, we are looking to garner a 5 per cent share in the Rs 1,500-crore market for vildagliptin and its combination drugs,' Nectar Biopharma Executive Director Saurabh Goyal said.

Vildagliptin offers a high-volume and high-growth market, he added.

By means of its extensive pan-India network of 450 distributors, 10,000 stockists and 2 lakh retailers, the company makes its products available all over the country through on-ground retail, Nectar Biopharma said. PTI AKT SHW SHW

A strong recurring message of individualizing patient care is echoed throughout the American Diabetes Association's Standards of Medical Care in Diabetes—2020 published recently. Based on the latest scientific diabetes research and clinical trials, the Standards of Care includes new and updated recommendations and guidelines for caring for people with diabetes, including individualized recommendations for treatment of cardiovascular disease based on patients' pre-existing conditions, special considerations for older adults with type 1 diabetes, and revised recommendations and additional supporting evidence for use of rapidly changing diabetes technology.

Also, the ADA released: 2019 Update to Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), which includes complimentary information on the treatment of type 2 diabetes based on important research findings from large cardiovascular outcomes trials published in 2019 and has been incorporated into the Standards of Care—2020.

John Buse, MD, Ph.D., the Verne S. Caviness Distinguished Professor of Medicine, Division Chief of Endocrinology and Metabolism, and Director of the NC Translational and Clinical Sciences (TraCS) Institute, led the writing of the update, which includes:

The decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target;

GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and

SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD to prevent the progression of CKD, hHF, MACE, and cardiovascular death.

The recommendations for treatment of cardiovascular disease, which is the leading cause of morbidity and mortality for individuals with diabetes, have now been individualized based on patients' risks, including the presence of atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, diabetic kidney disease, or heart failure.

More information: John B. Buse et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care (2019). DOI: 10.2337/dci19-0066

Citation: ADA releases 2020 standards of medical care in diabetes (2019, December 24) retrieved 25 December 2019 from https://medicalxpress.com/news/2019-12-ada-standards-medical-diabetes.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

New CGM system combined with Basal-IQ™ technology predicts and prevents lows with 'No Fingersticks*' for people living with diabetes

EDINBURGH, Scotland , Dec. 23, 2019 /PRNewswire/ -- DexCom, Inc. (NASDAQ: DXCM), a leader in continuous glucose mo nitoring (CGM), has partnered with Tandem Diabetes Care in the UK, Sweden, Italy and Spain to distribute the Dexcom G6 CGM System integrated with the Tandem Diabetes Care t:slim X2 insulin pump for people with diabetes. 

Tandem's t:slim X2 insulin pump with Basal-IQ™ technology uses Dexcom G6 CGM readings to predict glucose levels 30 minutes ahead and suspend insulin delivery when glucose is predicted to go low. Insulin delivery resumes as soon as sensor glucose values begin to rise. Use of the integrated system reduced the time spent below 3.9 mmol/L (70 mg/dL) by 31 percent compared to use of a CGM-integrated pump without automated insulin suspension1. 

"Combining the Dexcom G6 with Tandem's t:slim X2 insulin pump will meaningfully improve diabetes management. Not only does the system eliminate the need for fingersticks*, but it also helps patients reduce the frequency and duration of low-glucose events," said Erik Bjorkman, Dexcom's General Manager for EMEA.

Furthermore, with the Dexcom G6 app, users can share their glucose information with up to five people 2. Whether you are a parent of a child with diabetes or an adult, the Dexcom G6 lets you seamlessly keep track of glucose levels and enables the user's care team to remotely monitor their loved ones for extra peace of mind. 

"The t:slim X2 insulin pump with Basal-IQ technology, combined with the Dexcom G6, presents a meaningful advancement in the automated insulin delivery category, offering people with diabetes a simple-to-use system that predicts and helps prevent lows with zero fingersticks," said Brian Hansen, Executive Vice President and Chief Commercial Officer for Tandem Diabetes Care.

The groundbreaking Dexcom G6 encompasses features that empower users to take control of their diabetes:

Elimination of fingersticks* for calibration or diabetes treatment decisions.

·  Customisable alarms and alerts to warn users and their designated followers of dangerous glucose levels, even while they are asleep – a particularly useful feature for children and those with impaired hypoglycaemia awareness.

An extended 10-day sensor.

An auto-applicator designed to make sensor insertion very simple and painless with the touch of a button.

Continuous glucose readings sent automatically using Bluetooth technology to any compatible smart device3, or to an optional Dexcom receiver, at five-minute intervals.

New sensor membrane that enables Paracetamol4 use without any effect on glucose readings.

The CE Marking confirms that the G6 system meets the Essential Requirements of the Medical Device Directive MDD 93/42/EEC as amended by 2007/47/EC. The powerful and ground-breaking new system is also the first CGM system to receive the US Food and Drug Administration's (FDA) De Novo classification. With this new classification, the Dexcom G6 CGM system is indicated for use as both a stand-alone CGM and for integration into automated insulin dosing (AID) systems. For more information on Dexcom G6, visit www.dexcom.com/global.

About Dexcom G6 

The Dexcom G6 is a stand-alone CGM system for MDI users, which represent the vast majority of the type 1 population, and can also be used by anyone on insulin pump therapy. With the G6, the sensor is worn separately from an insulin pump and is inserted under the skin to measure the level of glucose in the interstitial fluid (fluid in the tissue). The sensor is disposable and should be changed every 10 days.

About DexCom, Inc.

Founded in 1999, DexCom, Inc. has corporate offices in San Diego, California, EMEA headquarters in Edinburgh, Scotland and users in 39 countries around the world. At Dexcom, we are transforming diabetes care and management by providing superior continuous glucose monitoring (CGM) technology to help people with diabetes and healthcare professionals better manage diabetes. Since our inception, we have focused on better outcomes for people with diabetes, caregivers, and clinicians by delivering solutions that are best in class-while empowering our community to take control of diabetes. For more information on Dexcom CGM, visit www.dexcom.com/global.

About the Tandem Diabetes Care t:slim X2 Insulin Pump with Basal-IQ Technology

The simple-to-use t:slim X2 insulin pump with Basal-IQ technology uses glucose values from an integrated Dexcom G6 continuous glucose monitor to predict and help prevent lows with zero fingersticks*. It is up to 38 percent smaller than other insulin pumps, holds up to 300 units of insulin, and is capable of remote software updates using a personal computer, offering the potential for in-warranty users to acces s new features as they meet necessary regulatory requirements.

Story continues

Tandem Diabetes Care, Basal-IQ and t:slim X2 are trademarks of Tandem Diabetes Care, Inc., registered in the U.S. and other countries.

Footnotes

*If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.

1Forlenza GP, Li Z, Buckingham BA, Pinsker JE, et al. Predictive low-glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: Results of the PROLOG trial. Diabetes Care. 2019;41(10):2155-2161. doi:10.2337/dc18-0771.

2For a list of compatible smart devices, please visit www.dexcom.com/compatability. Internet connectivity required for data sharing. Following requires the use of the Follow App. The Dexcom Follow App is not included as part of the De xcom G6 Mobile CGM System. Followers must download the Dexcom Follow App separately. Internet connectivity required to access Dexcom Follow. Followers should always confirm readings on the Dexcom G6 Mobile App or Receiver before making treatment decisions.

3For a list of compatible smart devices, visit dexcom.com/compatibility.

4Calhoun P, Johnson TK, Hughes J, Price D, Balo AK. Resistance to Acetaminophen Interference in a Novel Continuous Glucose Monitoring System. J Diabetes Sci Technol. 2018:1932296818755797.

 

December 20, 2019, 5:34 PM

3 min read

A gap in what we know about diabetes in the United States was filled on Friday, when researchers published the first national estimates about diabetes rates among Hispanic and Asian Americans.

Researchers at the Centers for Disease Control and Prevention analyzed national health and nutrition survey data between 2011 and 2016, and found that 22% of Hispanics and 19% of Asians in the U.S. are living with either diagnosed or undiagnosed diabetes.

In comparison, 20% of black Americans and 12% of white Americans have the disease, the CDC said.

Diabetes, which affects the body's ability to process sugar, can lead to serious complications, such as cardiovascular disease, nerve damage, skin conditions, depression and Alzheimer's disease.

In addition to demographic risks, other risk factors for diabetes include family history, weight, age and high blood pressure, according to the Mayo Clinic.

A person receives a test for diabetes during a fee medical clinic in Los Angeles, Sept. 11, 2014.

A person receives a test for diabetes during a fee medical clinic in Los Angeles, Sept. 11, 2014.Mario Anzuoni/Reuters, FILE

"This landmark diabetes survey provides essential data that will better inform public health efforts to reach more Americans with tailored, effective prevention and treatment strategies," Dr. Robert Redfield, director of the CDC, said in a statement.

Better understanding diabetes' prevalence among Hispanic and Asian demographic groups could help doctors and patients reduce their disease risk, he explained.

The researchers at the CDC further broke down the data into subgroups, and found that 25% of Mexicans, 22% of Puerto Ricans, 21% of Cubans and Dominicans, 19% of Central Americans and 12% of South Americans are living with diabetes. Among Asian subgroups, 23% of South Asians, 22% of Southeast Asians and 14% of East Asians have diagnosed or undiagnosed diabetes.

The new data was published Friday in the Journal of the American Medical Association.

ARLINGTON, Va., Dec. 20, 2019 /PRNewswire/ -- A strong recurring message of individualizing patient care is echoed throughout the American Diabetes Association's Standards of Medical Care in Diabetes—2020(Standards of Care) published today. Based upon the latest scientific diabetes research and clinical trials, the Standards of Care includes new and updated recommendations and guidelines for caring for people with diabetes. The Standards of Medical Care in Diabetes—2020 includes simplified figures and tables that more easily guide providers through treatment options and individualized recommendations for treatment of cardiovascular disease based on patients' pre-existing conditions. Special considerations for older adults with type 1 diabetes have also been added to address the treatment of this growing population, as well as revised recommendations and additional supporting evidence for use of rapidly changing diabetes technology.  

The 2019 Update to Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) was also published and includes complimentary information on the treatment of type 2 diabetes based on important research findings from large cardiovascular outcomes trials published in 2019 and has been incorporated into the Standards of Care—2020.

The Standards of Medical Care in Diabetes—2020 provides the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2, or gestational diabetes, strategies for the prevention or delay of type 2 diabetes, and therapeutic approaches that can reduce complications, mitigate cardiovascular and renal risk, and improve health outcomes. The Standards of Care is available online today, December 20, 2019, at 2:00 p.m. ET at https:///care.diabetesjournals.org and is published as a supplement to the January 2020 issue of Diabetes Care.

Some notable updates and additions to the Standards of Medical Care in Diabetes—2020 include:

Cardiovascular disease in diabetes

The recommendations for treatment of cardiovascular disease, which is the leading cause of morbidity and mortality for individuals with diabetes, have now been individualized based on patients' risks, including the presence of atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, diabetic kidney disease, or heart failure (Section 10, page S122–123, Recommendations 10.43A. 10.43B, and 10.43C).

Use of SGLT2 inhibitors and GLP-1 receptor agonists in patients with or at high risk for cardiovascular disease, kidney disease, or heart failure is now recommended regardless of patients' current A1C or A1C target.

Pharmacologic updates

Figure 9.2 has been simplified to more easily guide providers through intensification of injectable glucose-lowering therapies (Section 9, page S104).

Oral semaglutide, which was approved by the FDA in September 2019, is now included in the discussion of combination therapies (Section 9, page S105).

Recommendation 11.3 was modified to provide more detail on the use of SGLT2 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes and diabetic kidney disease (Section 11, page S135, Recommendation 11.3).

Due to the FDA approval of liraglutide in children 10 years of age or older, there is a new recommendation added to the pharmacologic management of type 2 diabetes information in the "Children and Adolescents" section (Section 13, page S172, Recommendation 13.67).

Glycemic targets

Based on the 2019 publication "Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range," new recommendations were added on the use of an ambulatory glucose profile (AGP) report and time in range for assessment of glycemic management (Section 8, page S68, Recommendations 6.4 and 6.5). Additionally, an example of an AGP report was added (Section 6, page S69, Figure 6.1).

Table 6.1 is updated to reflect a simplified estimated average glucose table (Section 6, page S67) and intranasal glucagon and glucagon solution for subcutaneous injection have been added in the "Hypoglycemia" section due to the medications' recent FDA approval (Section 6, page S73).

Personalizing patient care

As diabetes management improves, people with type 1 diabetes are living longer; thus, there is a newly added subsection within Section 12 focusing on special considerations for older adults with type 1 diabetes (Section 12, page S158).

The previously titled "Lifestyle Management" section was changed to "Facilitating Behavior Change and Well-being to Improve Health Outcomes," to better emphasize how effective behavior management and psychological well-being are foundational to achieving treatment goals for people with diabetes (Section 5, pages S48­–S65).

On the basis of a new consensus report, "Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report," the "Lifestyle Interventions" information in Section 3 was updated and a new recommendation was added to recognize that a variety of eating patterns are acceptable for people with prediabetes (Section 3, page S33, Recommendation 3.3). Additionally, the "Nutrition Therapy" information within Section 5 reflects updates based upon the consensus report (Section 5, pages S50–S54).

Due to the rapidly changing field of diabetes technology, the "Diabetes Technology" section has been reorganized and recommendations within the section have been revised with an emphasis on the fact that there is no "one-size-fits-all" approach to technology use in people with diabetes (Section 7, pages S77–S88).

Additional information was added to the "Prevention or Delay of Type 2 Diabetes" section regarding the risk reduction certain groups experienced with metformin use, as indicated by the 15-year follow-up data of the Diabetes Prevention Program Outcomes Study (Section 3, pages S34).

Updates to the Standards of Care are established and revised by the ADA's Professional Practice Committee (PPC). The committee is a multidisciplinary team of 16 leading U.S. experts in the field of diabetes care and includes physicians, diabetes educators, registered dietitians, and others whose experience includes adult and pediatric endocrinology, epidemiology, public health, cardiovascular risk management, microvascular complications, preconception and pregnancy care, weight management and diabetes prevention, and use of technology in diabetes management. Two designated representatives of the American College of Cardiology (ACC) reviewed and provided feedback on the "Cardiovascular Disease and Risk Management" section, and this section received endorsement from ACC.

"The American Diabetes Association has developed and provided diabetes care standards, guidelines and related documents since 1989, and its clinical practice recommendations are integral resources for health care professionals," said PPC chair Joshua J. Neumiller, PharmD, CDE, FASCP, Vice Chair and Allen I. White Distinguished Associate Professor of Pharmacotherapy at Washington State University. "As diabetes research and care methods continue to evolve, so do the recommendations and clinical guidelines set forth by the ADA. Through the Standards of Care, the Living Standards and other supplemental tools, the ADA and its Professional Practice Committee strive to ensure care providers, patients, researchers, health plans, and policymakers stay abreast of the most current, research driven components of diabetes care."

The online version of the Standards of Care, or the Living Standards will continue to be annotated in real-time with necessary updates if new evidence or regulatory changes merit immediate incorporation through the living Standards of Care process. The ADA also publishes the abridged Standards of Care yearly for primary care providers in its journal, Clinical Diabetes, and offers a convenient Standards of Care app as well as a Standards of Carepocket chart. Other Standards of Care resources, including a webcast with continuing education credit and a full slide deck, can be found on DiabetesPro.

About Diabetes Care®Diabetes Care, a monthly journal of the American Diabetes Association (ADA), is the highest-ranked, peer-reviewed journal in the field of diabetes treatment and prevention. Dedicated to increasing knowledge, stimulating research and promoting better health care for people with diabetes, the journal publishes original articles on human studies in clinical care, education and nutrition; epidemiology, health services and psychosocial research; emerging treatments and technologies; and pathophysiology and complications. Diabetes Care also publishes the ADA's recommendations and statements, clinically relevant review articles, editorials and commentaries. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators and other health care professionals. 

About the American Diabetes AssociationEvery day more than 4,000 people are newly diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

Contact: Sabrena Pringle, 703-299-2014press@diabetes.org 

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SOURCE American Diabetes Association

Joslin Diabetes Center's Board of Trustees announced Wednesday that Roberta Herman has been selected as the center's new president and chief executive officer, effective Jan, 9. 2020.

Herman replaces Peter Amenta, who announced earlier this fall that he would be stepping down at the end of this year, after 10 years with Joslin, including more than four as president and CEO.

"Roberta's professional experience with both clinical and executive leadership positions at varied health care organizations makes her the ideal candidate to lead Joslin," said Ann Lagasse, chair of Joslin's Board of Trustees. "As a compassionate internist, Roberta's focus has always been on quality care, accessibility and patient experience. She has worked on both the provider and payer side of healthcare, and understands the deep human and financial challenges of the diabetes epidemic. As Joslin continues to grow to address the prevalence of diabetes both nationally and globally, the Board looks forward to Roberta's commitment to lead our researchers, clinicians, educators and staff so that we may continue to improve the lives of people with diabetes while supporting prevention and researching towards a cure."

Joslin is known for its expertise in diabetes treatment and research and is dedicated to finding a cure for diabetes and ensuring that people with diabetes live long, healthy lives. Joslin is an independent, non-profit institution affiliated with Harvard Medical School, and one of only 16 NIH-funded Diabetes Research Centers in the U.S.

Herman comes to Joslin after nearly four years as executive director of the Group Insurance Commission (GIC), which provides and administers health insurance and other benefits to more than 450,000 employees and retirees of the Commonwealth, and their dependents. While there, Herman oversaw successful efforts to revamp the offerings of the GIC, created multiple new capabilities and efficiencies to improve interactions with GIC stakeholders and presented a strategic plan to optimize and grow the quasi-independent state agency.

"It has been my privilege to work with Dr. Roberta Herman for years, most recently during her service to the Commonwealth in her capacity as Executive Director of the Group Insurance Commission," said Massachusetts Governor Charlie Baker. "Dr. Herman is an asset to the healthcare industry, and brings with her to Joslin a wealth of knowledge and experience that I am confident will prove invaluable in the fight against diabetes."

"My career has frequently been focused on addressing population health challenges and I am honored to serve as the next President and CEO of this storied institution singularly devoted to addressing one of the most pressing national and international public health challenges of our time," said Herman. "Since Dr. Joslin treated his first patient in Boston, people with diabetes have looked to Joslin for the latest in research discoveries, treatments and most importantly hope for the future. I am excited to be joining the extraordinary Joslin team and look forward to supporting Joslin's very important mission."

Previous to her service at GIC, Herman was the chief medical officer and then chief operating officer for Harvard Pilgrim Health Care, one of New England's largest non-profit managed health care organizations. Before that, she had been chief of internal medicine at Harvard Community Health Plan's Cambridge Center.

Prior to being selected as president and CEO, Herman also served as a trustee of Joslin Diabetes Center for six years. She has been a clinical instructor at Harvard Medical School with hospital appointments at Mount Auburn Hospital and Beth Israel Deaconess Medical Center and a guest lecturer at the Harvard School of Public Health. She also has been a faculty mentor in Brigham and Women's Internal Medicine Residency.

Eliot Lurier, CPA, Joslin's CFO/COO, will serve as Interim President and CEO in the short time prior to Dr. Herman's start date.

(HealthDay)—There are significant differences in rates of diagnosed and undiagnosed diabetes between subgroups of Hispanic and Asian Americans, a federal government study finds.

Hispanics and Asians represent 23% of the U.S. population and are expected to account for 38% by 2060.

And, these groups may be at higher risk for type 2 diabetes due to genetic, lifestyle and environmental factors, the researchers said.

The U.S. Centers for Disease Control and Prevention (CDC) study analyzed federal health survey data for 2011 through 2016. Among Hispanics, 25% of Mexicans, 22% of Puerto Ricans, 21% of Cuban/Dominicans, 19% of Central Americans, and 12% of South Americans were living with diagnosed or undiagnosed diabetes, the study found.

Among Asians, the percentages were 23% for South Asians, 22% for Southeast Asians, and 14% for East Asians, according to findings published Dec. 20 in JAMA Internal Medicine.

As in previous research, this study found that Asians tend to have a lower body mass index (BMI) than other racial/ethnic groups. BMI is an estimate of body fat based on weight and height. The higher the BMI, the greater the risk of type 2 diabetes.

"This landmark diabetes survey provides essential data that will better inform public health efforts to reach more Americans with tailored, effective prevention and treatment strategies," CDC director Dr. Robert Redfield said in an agency news release.

"This defined data on the prevalence of diabetes among Hispanic and Asian demographic groups can help health care providers and patients reduce the risk for type 2 diabetes," he added.

Ann Albright, director of CDC's division of diabetes translation, said the findings establish a baseline for future estimates and highlight differences in the diabetes burden among Hispanic and non-Hispanic Asian subgroups.

"These data also provide insights that allow us to reach groups at higher risk and provide opportunities to strengthen diabetes detection and type 2 diabetes prevention and care in these groups," she said in the news release.

More information: The American Academy of Family Physicians has more on diabetes.

Copyright © 2019 HealthDay. All rights reserved.

Citation: CDC study breaks down diabetes risk for hispanic, asian subgroups (2019, December 21) retrieved 21 December 2019 from https://medicalxpress.com/news/2019-12-cdc-diabetes-hispanic-asian-subgroups.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

MARKET PULSE

Shares of Lexicon Pharmaceuticals Inc. (lxrx) are down 5% in premarket trading on Friday after the biopharmaceutical company said that its experimental Type 2 diabetes treatment met its primary and secondary endpoints in a late-stage clinical trial. The therapy, Zynquista, is already approved in Europe. Earlier this month, Lexicon said that the Food and Drug Administration had denied a company appeal that the regulator reconsider approving Zynquista as a Type 1 diabetes treatment. The company said Dec. 2 it plans to appeal the decision again. Lexicon's stock is down 33% year-to-date, compared to the S&P 500 (spx) which is up 27%.

Speaker of the House of Commons Lindsay Hoyle heads to the Lords chamber through the Central Lobby during the State Opening of Parliament at the Palace of Westminster in London, Britain December 19, 2019. Adrian Dennis/Pool via REUTERS

(Reuters) - The new Speaker of Britain's House of Commons Lindsay Hoyle said on Friday he had been shocked to learn he has diabetes, probably type 1, just days before this month's general election, but refused to miss the campaign for treatment.

The 62-year-old was urged to stay in hospital after losing nearly three stones (42 lb) in the lead-up to polling day, but insisted he felt well enough to fulfill his new role.

"I'm going to get through this. The House of Commons elected me to be the Speaker and there's nothing that's going to stop me from doing that," Hoyle added in a statement.

Left untreated, type 1 diabetes can be life-threatening and can develop at any time. The pancreas stops producing insulin, leading to weight and muscle loss and fatigue. 

Hoyle cited fellow type 1 diabetic and former Prime Minister Theresa May as an inspiration and said Commons' staff have been very supportive.

His openness in talking about the condition was praised by the charity Diabetes UK.

Chief Executive Chris Askew said: "Living with type 1 diabetes can be hard, but as Sir Lindsay's experiences have shown, with the right support from your health care team and careful management, people can live full and healthy lives following their diagnosis."

Hoyle was unanimously re-elected as Speaker - in which role he referees and moderates parliamentary debates - five days after the Dec. 12 election, having first won the race to replace former Speaker John Bercow in November.

He is now undergoing further treatment.  

Reporting by Joanna Taylor; editing by Stephen Addison

IMAGE: Alzheimer's Association logo view more 

Credit: Alzheimer's Association

CHICAGO, DECEMBER 18, 2019 -- More than ever before, Alzheimer's researchers understand that a variety of approaches will be needed - most likely used in combination - for effective treatment of the disease.

With the recent influx of new funding - including more than $2 billion annually at the National Institute on Aging - researchers are expanding the exploration of new treatment avenues. At the same time, scientists are more extensively testing the potential benefits of drugs approved for other diseases for the treatment of dementia.

As an example, through newly-awarded grants from the Alzheimer's Association Part the Cloud Translational Research initiative, scientists are evaluating the use of existing HIV/AIDS, diabetes and organ transplant drugs as possible therapies for Alzheimer's dementia. Other research funded by the recent grants will investigate novel drugs that might alleviate, delay or slow the brain changes associated with Alzheimer's.

"To drive the field forward and create new therapies for people living with Alzheimer's and all dementia, the Alzheimer's Association believes it is important to fund innovative science that explores both new mechanisms and the repurposing of existing drugs," said Maria C. Carrillo, Ph.D., Alzheimer's Association chief science officer. "The Part the Cloud program is vital to advancing high-risk, high-reward research that might not otherwise be explored without this financial support."

Repurposing existing drugs for new uses can speed up the research process. Since scientists are building on previous research, much is already known about the drugs' potential side effects, it may take less time for the drugs to be tested, and the clinical trials may be less expensive. For many of the same reasons, repurposing can also speed review by the U.S. Food and Drug Administration.

The 2020 Part the Cloud: Translational Research Funding for Alzheimer's Disease grants provide essential support for early-phase clinical studies in people. Each researcher will receive up to $750,000 over two years. Part the Cloud awards are specifically designed to accelerate translation of findings from the laboratory, through trials, into possible therapies.

"No stone can be left unturned. We must advance all potential avenues of treatment, and explore methods for combining successful approaches," Carrillo said. "Alzheimer's and all dementia are complex, and their effective treatment and prevention will likely also be a complex but achievable task."

Research Evaluating Repurposing of Drugs

Steven Arnold, M.D., Massachusetts General Hospital, Boston

Biomarker and Neural System Effects in Calcineurin Inhibition with Tacrolimus

A Phase Ib/IIa study to evaluate whether Tacrolimus - a Food and Drug Administration (FDA)-approved drug to prevent organ transplant rejection - can be repurposed as a potential therapy for Alzheimer's.

Paul Edison, M.B.B.S., F.R.C.P., Ph.D., Imperial College, London

Evaluating oral semaglutide as a treatment for Alzheimer's disease A Phase IIa clinical trial to evaluate a type 2 diabetes medication as a potential treatment for Alzheimer's disease. Type 2 diabetes is a risk factor for Alzheimer's disease. Researchers believe that semaglutide, a drug that helps the body to maintain appropriate levels of sugar, may also support brain function by improving thinking and memory.

John Sedivy, Ph.D., Brown University, Providence, Rhode Island

Stephen Salloway, M.D., Brown University and Butler Hospital, Providence, Rhode Island

Repurposing Nucleoside Reverse Transcriptase Inhibitors for Treatment of Alzheimer's Disease A Phase I clinical trial to evaluate whether an HIV/AIDS medication might be repurposed to reduce brain inflammation in individuals with Alzheimer's and other brain diseases.

Research Evaluating New Mechanisms

James Kirkland, M.D., Ph.D., Mayo Clinic, Rochester, Minnesota

ALSENLITE: An Open-Label Pilot Study of Senolytics for Alzheimer's Disease

A Phase IIa clinical trial to determine if a novel drug targeting the removal of certain aging brain cells in regions impacting cognition, language and memory can benefit people with age-related brain disorders, including Alzheimer's disease.

Maurice Zauderer, Ph.D., Vaccinex, Inc., Rochester, New York

SEMA4D Blockade Safety and Brain Metabolic Activity in Alzheimer's Disease A Phase I clinical trial to evaluate a new experimental drug that may reduce inflammation in the brain.

###

The Part the Cloud global research grant program led by visionary philanthropist Mikey Hoag recently announced a $10 million award of support from Bill Gates. The Gates' award will stimulate an additional $20 million in funding by the Alzheimer's Association, through Part the Cloud, doubling the program's total clinical research investments to $60 million in just one year.

Part the Cloud is part of the Alzheimer's Association robust research platform, the largest nonprofit research program focused on Alzheimer's and dementia globally. Currently, the Association is investing $167 million in more than 500 active best-of-field projects in 27 countries.

About the Alzheimer's Association®

The Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's®. Visit http://www. alz. org or call 800.272.3900.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Eli Lilly and Dexcom announced a global commercialization agreement to integrate DexCom's continuous glucose monitoring devices into a personalized diabetes management system currently in development to advance the treatment of diabetes, according to a press release from the companies.

The nonexclusive agreement with Dexcom will build on Lilly's efforts to provide a comprehensive system that integrates connected insulin delivery devices, software and analysis to equip people with type 1 and type 2 diabetes and their health care providers with personalized information and guidance to help simplify diabetes management, according to the release.

"Even with all of the advances in diabetes technology, insulin therapy is still overwhelming and complex," Mike Mason, senior vice president of connected care and insulins for Lilly Diabetes, said in the release. "We're excited to include Dexcom's technology in the solutions we deliver to people with diabetes to help improve health outcomes by delivering actionable insights in one connected system. As we integrate our expertise and insights with those from our partners, like Dexcom, we are aiming to not only transform the way we develop and deliver medicine, but to transform how people manage their diabetes."

The personalized diabetes management system in development will include both pen- and insulin pump-based platforms, according to Lilly. The pen-based platform will integrate personalized data from a prefilled, disposable insulin pen with data from glucose-sensing technologies into a compatible software application. Personalized data are transferred from the pen via an optional attachment.

 

Eli Lilly and Dexcom announced a global commercialization agreement to integrate DexCom's continuous glucose monitoring devices into a personalized diabetes management system currently in development to advance the treatment of diabetes.

Source: Adobe Stock

The pump-based platform in development, which is a hybrid closed-loop system, will use integrated devices — an insulin pump, CGM and a dedicated hand-held controller or smartphone application that controls the system — to automate insulin dosing.

"CGMs provide people with diabetes and their health care team with important, real-time data that can help alleviate the burden of diabetes management, including overall glucose level trends and information on time spent in target blood glucose range," Rick Doubleday, executive vice president and chief commercial officer of Dexcom, said in the release. "We're looking forward to expanding our collaboration with Lilly as we integrate our technology into their system and believe it will help reduce some of the complexity that can come from managing diabetes every day."

The announcement follows several recent FDA marketing authorizations designed to make devices more interoperable for people with diabetes. On Friday, the FDA announced that it authorized marketing of the Tandem Diabetes Care Control-IQ interoperable, automated insulin dosing algorithm, the first dosing controller that can be used with other interoperable diabetes devices and allow people with diabetes to create a customizable automated insulin delivery system. The FDA authorization paves the way for integrated CGM systems and alternate controller enabled (ACE) infusion pumps to be used with an interoperable automated glycemic controller as a complete automated insulin dosing system, also known as an artificial pancreas.

In September, the agency cleared Insulet to market its tubeless Omnipod DASH Insulin Management System as an integrated ACE insulin pump, allowing it to be part of an interoperable, automated insulin delivery system. The Omnipod pump was the second device to be classified under a new de novo premarket review pathway, a regulatory pathway for novel, low- to moderate-risk devices of a new type, according to the FDA. – by Regina Schaffer

Disclosures: Doubleday is executive vice president and chief commercial officer of Dexcom. Mason is senior vice president of connected care and insulins for Lilly Diabetes.

LOS ANGELES â€" Until the recent approval of liraglutide for the treatment of children and adolescents with type 2 diabetes, investigators like Sonia Caprio, MD, were at their wits' end watching the beta-cell function of their patients decline on metformin treatment.

"The kids were not doing well. It was like they were being treated with water," Dr. Caprio, a pediatric endocrinologist at Yale University, New Haven, Conn., said at the annual World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease.

For example, in the NIH-funded TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study that began enrollment in 2004, 699 patients aged between 10 and 17 years and with type 2 diabetes were treated with metformin (1,000 mg, twice daily) to attain a glycated hemoglobin level of less than 8% and were then randomly assigned to continued treatment with metformin alone or to metformin combined with rosiglitazone (4 mg, twice a day) or a lifestyle-intervention program that focused on weight loss through modifying eating and activity behaviors (N Engl J Med.  2012;366:2247-56).

Over the course of 11 months, the researchers found that 46% of the children were failing treatment. "The worst arm was the metformin arm," said Dr. Caprio, who was involved with the study. "Kids were not responding to the drug at all. About 52% of children failed to do better using metformin â€" a classic drug that we all start kids on when we diagnose them with type 2 diabetes."

Findings from a follow-up study, TODAY2, showed that these young patients were prone to serious diabetes-related events, such as heart attacks, chronic kidney disease, retinal disease, neuropathy, and complications in the offspring of pregnancies.

In addition, results from the RISE (Restoring Insulin Secretion) Pediatric Medication Study found that, in youth with impaired glucose tolerance or recently diagnosed type 2 diabetes, neither 3 months of insulin glargine followed by 9 months of metformin nor 12 months of metformin alone halted the progressive deterioration of beta-cell function (Diabetes Care. 2018;41:1717-25).

"The uniqueness of RISE is that we employed very sophisticated techniques to measure insulin secretion and sensitivity while they were being treated with these usual drugs," said Dr. Caprio, who was one of the study investigators. "The beta cell is unresponsive to metformin and other treatments. The question is, why?"

Despite these findings, 2018 consensus guidelines from the American Diabetes Association on the evaluation and management of youth-onset diabetes (Diabetes Care. 2018;41:2648-68) call for the administration of metformin twice daily in youth with new-onset diabetes who have a hemoglobin A1c (HbA1c) level of less than 8.5%. "I argue that is not the way. We need better ways to treat [these patients] because they are moving fast to having complications," she said.

Enter the Ellipse Trial, a pivotal multicenter, randomized study that evaluated the effect of the glucagonlike peptide-1 receptor agonist liraglutide in children and adolescents with type 2 diabetes (N Engl J Med. 2019;381:637-46).

Researchers, led by William V. Tamborlane, MD, chief of Yale Medicine Pediatric Endocrinology, also in New Haven, randomized 135 patients to one of two arms: 66 to subcutaneous liraglutide (up to 1.8 mg/day) and 69 to placebo for a 26-week, double-blind period, followed by a 26-week open-label extension period. All patients received metformin during the trial. More than half of the study participants (62%) were female, the mean age was 15 years, 65% were white, the mean body mass index was 33.9 kg/m2, their mean fasting glucose was 8.4 mmol/L, and their mean HbA1c was 7.8%.

At 26 weeks, the mean glycated hemoglobin level had decreased by 0.64 percentage points with liraglutide and increased by 0.42 percentage points with placebo, for an estimated treatment difference of âˆ'1.06 percentage points (P less than .001). By 52 weeks, the difference increased to âˆ'1.30 percentage points.

"There was also a significant drop in BMI z score in patients treated with liraglutide, which is important," Dr. Caprio said. "This medication is having an impact on weight, which is a key driver of the onset of type 2 diabetes in youth. This is a remarkable achievement because weight loss is hard to achieve in obese adolescents, as we showed in the TODAY study."

The number of adverse events reported by patients was similar in the treatment and placebo groups (85% and 81%, respectively), but the overall rates of adverse events and gastrointestinal adverse events were higher with liraglutide.

"I use liraglutide just for weight reduction because I mainly see a lot of kids with obesity. Many kids are not responding because of the GI effects of this drug. I think the weight loss could have been better had the investigators moved to a dose of 1.8 mg, which we use in adults."

A fasting plasma glucose of 6.1 mmol/L was the primary reason for participants remaining on a lower dose of liraglutide, she said. At the same time, liraglutide concentration data indicated a high rate of noncompliance, which was expected in this population. "That's a big problem we face with children," Dr. Caprio said. "Some of them are not constantly taking the medication. They skip doses a lot. But that happens with patients in this age group."

"Finally, we have something else to help children and teenagers to delay the complications we are seeing," Dr. Caprio said. "To me, I think this is a new era. I have hope. It will be interesting to see whether liraglutide and perhaps SGLT2 [sodium-glucose transporter 2] inhibitors can delay the onset of type 2 diabetes in children. In my view, we will be doing this with drugs. I don't think the weight loss [concerns are] going to go away without medication, unfortunately."

Dr. Caprio reported having no financial disclosures.

This article originally appeared on MDEdge.com.

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Children with type 1 diabetes show subtle but important differences in brain function compared with kids who don't have the disease, according to new research.

The study in PLOS Medicine is the first to evaluate what happens in the brains of children with diabetes during a cognitive task.

On functional magnetic resonance imaging scans, when their brains were at work, children with diabetes displayed a set of abnormal brain-activity patterns seen in many other disorders, including cognitive decline in aging, concussion, attention-deficit hyperactivity disorder, and multiple sclerosis.

The study also shows that the abnormal brain-activity patterns are more pronounced in children who had diabetes longer.

"Our findings suggest that, in children with type 1 diabetes, the brain isn't being as efficient as it could," says lead author Lara Foland-Ross, senior research associate at the Center for Interdisciplinary Brain Sciences Research at Stanford University.

"The takeaway from our study is that, despite a lot of attention from endocrinologists to this group of patients, and real improvements in clinical guidelines, children with diabetes are still at risk of having learning and behavioral issues that are likely associated with their disease," says senior author, Allan Reiss, professor of psychiatry and behavioral sciences.

Brain behavior

Type 1 diabetes occurs when the pancreas fails to make insulin, a hormone that helps regulate blood sugar. Patients are given insulin via injections or an insulin pump. But even with treatment, their blood levels of glucose, the main sugar in blood, fluctuate much more than in healthy individuals.

"Kids with diabetes have chronic swings in blood-glucose levels, and glucose is important for brain development," Foland-Ross says. Brain cells need a steady supply of glucose for fuel.

Earlier work revealed brain-structure changes and mild performance impairment on cognitive tasks in children with type 1 diabetes, but no one has studied the mechanism. "It was important to capture what is going on in the brains of these kids functionally," she says.

The researchers conducted fMRI brain scans on 93 children with type 1 diabetes recruited at five sites: Nemours Children's Health System in Jacksonville, Florida; Stanford; Washington University in St. Louis; the University of Iowa; and Yale. An additional 57 children who did not have the disease composed the control group. All participants were 7-14 years old. Researchers gave standard behavioral and cognitive tests to all the children before brain scanning.

Then, in the fMRI scanner, the children performed a cognitive task called "go/no-go": The researchers showed the children different letters of the alphabet in random order and asked them to press a button in response to every letter except "X." The task is often used in brain-scanning studies to evaluate what is happening in the brain while participants concentrate.

Although the children with diabetes performed the task as accurately as those in the control group, their brains behaved differently, the researchers found.

In children with diabetes, the default-mode network, which is the brain's "idle" system, didn't shut off during the task. To compensate for the abnormal activation of the default-mode network, the brain's executive control networks, responsible for aspects of self-regulation and concentration, worked harder than normal in the children with diabetes.

These abnormalities were more pronounced in children who had been diagnosed with diabetes at younger ages, suggesting that the problem may worsen with time.

"The longer the exposure you have to dynamic changes in blood-glucose levels, the greater the alterations in brain function with respect to the default-mode network," Foland-Ross says. Studies in adults with diabetes suggest that in the later stages of the disease, the brain eventually loses its ability to compensate for this problem, she says.

Better blood glucose

Next, scientists want to study whether achieving better blood glucose concentrations through treatment with a closed-loop artificial pancreas benefits children's brain function. These devices electronically couple a blood glucose sensor to an insulin pump that automatically adjusts insulin delivery.

"We hope that with improvements in devices for diabetes treatment, these findings will either decrease in severity or go away," Reiss says, adding that with better blood sugar control, children's brains might be able to recover normal activity.

"Young brains have the most potential for plasticity and repair," he says. "But children also have a long time to live with the consequences if problems with brain function persist."

Researchers at all study sites contributed to the work. The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Research Resources funded the work.

Source: Stanford University