Tight hamstrings play an important role in plantar fasciitis, according to a study published in the June issue of Foot and Ankle Specialist.
“These findings show that while we always consider the tightness of the gastrocnemius/soleus complex and the subsequent restricted ankle motion from this equinus, we also need to consider the role of the hamstrings,” said Jonathan Labovitz, DPM, lead author and associate professor at Western University of Health Sciences, Pomona, CA.
The prospective cohort study included 105 participants (210 feet); 79 had plantar fasciitis, which researchers assessed with palpation, who measured popliteal angle with a tractograph and diagnosed hamstring tightness when the popliteal angle ≤160°.
Without controlling for covariates, body mass index (BMI), tightness in the hamstring, gastrocnemius/soleus, and gastrocnemius, and the presence of a calcaneal spur all had statistically significant associations with plantar fasciitis.
After controlling for covariates, participants (86 of 210 feet) with hamstring tightness were 8.7 times as likely to experience plantar fasciitis (p < .0001) as participants without hamstring tightness. Patients with a BMI >35 were 2.4 times as likely as those with a BMI <35 to have plantar fasciitis.
Researchers at Cappagh Orthopedic Hospital in Dublin, Ireland, first linked hamstring tightness with plantar fasciitis in a study published in the December 2005 issue of Foot & Ankle International. The Western University researchers now suggest that an increase in hamstring tightness may induce prolonged forefoot loading and, through the windlass mechanism, may be a factor that increases repetitive plantar fascia injury.
Triceps surae tightness was not included in the Western University covariate analysis, raising the possibility that hamstring tightness was not actually the cause of plantar fasciitis in patients wth tightness in both areas.
“People who have tight hamstrings are more than likely going to have a tight triceps surae,” said Michael T. Gross, PT, PhD, a professor in the Division of Physical Therapy at the University of North Carolina in Chapel Hill. “The investigators of this study admitted that 96% of subjects who had tight hamstrings also had tight triceps surae. Now there’s a cause and effect. If you can’t get dorsiflexion at your talo-crural joint, this often drives dorsiflexion at other joints and that is going to cause collapse of the longitudinal arch of the foot, loading the plantar fascia with increased tensile stress.”
In people with hamstring and triceps surae tightness and plantar fasciitis it’s not known whether the ankle equinus from a tight triceps surae causes hamstring tightness or vice versa, Labovitz said.
“There is no question that the tightness of the triceps surae will cause flattening of the arch and increase tensile stress on the plantar fascia,” Labovitz said. “The question becomes, are the hamstrings involved in this and, if so, to what effect?”
The timing of plantar fascia loading and hip kinematics during gait raise additional questions about possible hamstring involvement, Gross said.
“When loading is taking place at the plantar fascia, it’s mid to late stance. At mid to late stance, the hip is in extension and even hyperextension. Even though the knee is extended, extension/hyperextension at the hip will limit the amount of passive tension that could be developed in the hamstrings, so it is a mystery to me how tight hamstrings would cause trouble for the plantar fascia,“ he said.
Labovitz suggested, however, that a little hamstring tightness might go a long way in influencing the plantar fascia.
“The practical application is that since the hamstrings have been shown to be involved and possibly have more influence than equinus due to the longer lever arm, showing greater effect on the flattening of the foot and plantar fasciitis, less restriction is necessary to have the same effect as equinus,” he said.
The researchers suggest that treatment of plantar fasciitis should address hamstring tightness along with equinus and obesity. Night splints, orthoses, and gait retraining have been shown to be effective for managing plantar fasciitis pain but will not address hamstring flexibility, Labovitz noted.
“The hamstrings should be examined and treated,” Labovitz said. “Stretching is the best treatment for increasing flexibility.”
Tuesday, January 31, 2012
Monday, January 30, 2012
Shoe stiffness and pressure patterns
Pressure measurement technology can differentiate between the impact forces of a stability shoe and a flexible shoe during gait, according to a preliminary study presented in August at the annual meeting of the American Society of Biomechanics in Long Beach, CA.
Researchers from Indiana’s Valparaiso University found that walking in a flexible shoe was associated with increased duration of contact at the heel compared with a stability shoe.
“Shoes that are overly flexible in the midfoot region may delay the off-weighting or dorsiflexion of the calcaneus. This can have potential detrimental effects on foot and lower extremity function,” said Bruce Williams, DPM, one of the researchers and a podiatrist in private practice in Merrillville, IN.
The preliminary study of one 21-year-old man compared the impact force profiles produced throughout gait with two different running shoes from the same shoe company.
The flexible shoe featured flexion near the midfoot region of the shoe, while the stability shoe flexed closer to the ball of the shoe. An in-shoe pressure measurement system was used to map the force versus time profile for each shoe type as the participant walked 30 feet.
“In-shoe pressure had not been used to differentiate potential differences in function from shoes of these types and their potential effects on foot function,” Williams said.
In order to evaluate the transition between the heel and ball of the foot, force measurements were recorded for the heel, the ball, and the entire sole of the foot. Three trials for each shoe type were undertaken. To compare force profiles across trials, heel strike to toe off (one period) was truncated and normalized to the time associated with that period.
Force versus time was analyzed for the heel and the ball in order to observe slope variation and compare periods in which impact force was constant. This dwell in the gait cycle represents prolonged ground contact.
The results indicate a significantly longer dwell period in the heel region for the flexible shoe compared with the stability shoe (p < 0.05), at 0.1663 seconds compared with 0.0959 seconds. There were no significant dwell periods in the ball region for either shoe.
Prolonged pronation associated with a lack of midfoot support in the flexible shoe explains this dwell period, according to the researchers. They suggest this may be compensatory pronation in response to a lack of ankle joint dorsiflexion. Although no dwell period was evident for the ball of the foot, the researchers suggested this may not be the case in future studies with additional participants.
There is a definite clinical usage for the pressure measurement technology used in this study, said Williams. The technology holds potential for identifying effects of different shoe construction features on lower extremity mechanics and how those changes can result in pain and impaired function, he said.
The researchers plan to collect further data from a variety of subjects with varying foot types, gender, age, and weight.
“These studies may help design better shoes and help match the shoe construction to activity or foot type,” said Smita Rao, PhD, PT, assistant professor of physical therapy at New York University.
There are a number of questions that remain unanswered with regard to shoe stiffness and pressure patterns.
“Stability and flexible shoes may alter load distribution patterns. This may contribute to the user’s perceived comfort,” Rao said. “Differences in magnitude of regional loading are not discussed [in the pilot study]. It would be helpful if the authors related their findings to specific features of the shoes.”
Further trial data are being examined, said Williams. “Such data have the potential to clarify unanswered questions, such as ‘What other sporting shoe types potentially have an impact like this?’” he said.
Researchers from Indiana’s Valparaiso University found that walking in a flexible shoe was associated with increased duration of contact at the heel compared with a stability shoe.
“Shoes that are overly flexible in the midfoot region may delay the off-weighting or dorsiflexion of the calcaneus. This can have potential detrimental effects on foot and lower extremity function,” said Bruce Williams, DPM, one of the researchers and a podiatrist in private practice in Merrillville, IN.
The preliminary study of one 21-year-old man compared the impact force profiles produced throughout gait with two different running shoes from the same shoe company.
The flexible shoe featured flexion near the midfoot region of the shoe, while the stability shoe flexed closer to the ball of the shoe. An in-shoe pressure measurement system was used to map the force versus time profile for each shoe type as the participant walked 30 feet.
“In-shoe pressure had not been used to differentiate potential differences in function from shoes of these types and their potential effects on foot function,” Williams said.
In order to evaluate the transition between the heel and ball of the foot, force measurements were recorded for the heel, the ball, and the entire sole of the foot. Three trials for each shoe type were undertaken. To compare force profiles across trials, heel strike to toe off (one period) was truncated and normalized to the time associated with that period.
Force versus time was analyzed for the heel and the ball in order to observe slope variation and compare periods in which impact force was constant. This dwell in the gait cycle represents prolonged ground contact.
The results indicate a significantly longer dwell period in the heel region for the flexible shoe compared with the stability shoe (p < 0.05), at 0.1663 seconds compared with 0.0959 seconds. There were no significant dwell periods in the ball region for either shoe.
Prolonged pronation associated with a lack of midfoot support in the flexible shoe explains this dwell period, according to the researchers. They suggest this may be compensatory pronation in response to a lack of ankle joint dorsiflexion. Although no dwell period was evident for the ball of the foot, the researchers suggested this may not be the case in future studies with additional participants.
There is a definite clinical usage for the pressure measurement technology used in this study, said Williams. The technology holds potential for identifying effects of different shoe construction features on lower extremity mechanics and how those changes can result in pain and impaired function, he said.
The researchers plan to collect further data from a variety of subjects with varying foot types, gender, age, and weight.
“These studies may help design better shoes and help match the shoe construction to activity or foot type,” said Smita Rao, PhD, PT, assistant professor of physical therapy at New York University.
There are a number of questions that remain unanswered with regard to shoe stiffness and pressure patterns.
“Stability and flexible shoes may alter load distribution patterns. This may contribute to the user’s perceived comfort,” Rao said. “Differences in magnitude of regional loading are not discussed [in the pilot study]. It would be helpful if the authors related their findings to specific features of the shoes.”
Further trial data are being examined, said Williams. “Such data have the potential to clarify unanswered questions, such as ‘What other sporting shoe types potentially have an impact like this?’” he said.
Saturday, January 28, 2012
Diabetic shoes: Fashion and function
Every day, people willingly trade good foot health for stylish shoes—think stilettos, platforms, and pointy toeboxes. For some time, however, patients who wore diabetic footwear didn’t have the option of worrying about style versus substance.
“When I began practicing years ago there was only one style of [diabetic] shoe and you could tell from across the room it was an orthopedic shoe,” said Crystal Holmes, DPM, CWS, assistant professor in the Department of Internal Medicine at the University of Michigan in Ann Arbor.
Fortunately, diabetic shoes have come a long way, shedding, to some degree, their designation as clunky and unattractive, and are now available in a variety of styles and a rainbow of hues.
With diabetic shoes, the trade-off between fashion and function gets complicated. Holmes and Hillary Brenner, DPM, of Tribeca Private Medical Group in New York City, shared advice for balancing patients’ desire for fashion with clinical concerns.
Sources said women tend to be more focused on style than men. As a result, the Mary Jane has become a staple of diabetic footwear lines, and serves as an example of how aesthetic needs must be weighed against patients’ pathology and lifestyle.
On the whole, experts approve of this shoe style. Holmes said many of her patients like its versatility for everyday, special occasion, and professional looks.
The style can make extra depth look relatively attractive and is compatible with foot orthoses when they are needed. Mary Janes come in cloth or leather, which can accommodate foot deformities.
This style does have drawbacks: The strap across the front may not be suitable for patients with edema or bony prominences, Holmes said.
Brenner isn’t keen on the opening at the top of the shoe and insists patients wear the shoes with socks, stockings, or tights.
In addition, Holmes noted, the toebox can be very wide while the heel tends to be narrow, so foot slippage inside the shoe can be an issue, Holmes said.
Experts who talked with LER said they make a priority of discussing the clinical objectives of diabetic footwear with patients first, then move on to lifestyle issues.
“I certainly would not prescribe the same shoe for a 90-year-old diabetic patient who is a community ambulator who just goes to the market or walks around her home as for a 60-year-old farmer who still works daily on his farm,” Holmes said.
But it’s a safe bet the 90-year-old will be more concerned about fashion than the farmer.
Matching the shoes to the activity is also important, Brenner said. For example, a three-hour sit-down dinner may be a chance for the patient to don a less clinically appropriate, but more attractive, diabetic shoe. In contrast, a full day of walking at a museum calls for wearing prescribed footwear.
“You want to avoid completely taking away options from a patient,” Brenner said.
Options are key when negotiating fashion and fit with patients. Often, patients get their diagnosis and assume it means diabetic shoes are their only choice.
“Just because a person has diabetes doesn’t necessarily mean she’ll need the shoe with the extra depth or the rocker bottom,” Brenner explained. “A younger person with diabetes whose blood sugar is under control may not need that diabetic shoe. On the other hand, an older patient with some balance issues will need a shoe that offers stability and support. It’s not one-style-fits-all for diabetic patients.”
If a patient is determined to wear a certain style, Holmes tenders a compromise.
“I say to them, ‘I’ll let you wear this shoe for six months. During that time, we’ll check your feet regularly. If we see any problems—a spot of irritation—then you have to agree that you’ll stop wearing that shoe and wear the shoe that I prescribe for you,’” she said.
“When I began practicing years ago there was only one style of [diabetic] shoe and you could tell from across the room it was an orthopedic shoe,” said Crystal Holmes, DPM, CWS, assistant professor in the Department of Internal Medicine at the University of Michigan in Ann Arbor.
Fortunately, diabetic shoes have come a long way, shedding, to some degree, their designation as clunky and unattractive, and are now available in a variety of styles and a rainbow of hues.
With diabetic shoes, the trade-off between fashion and function gets complicated. Holmes and Hillary Brenner, DPM, of Tribeca Private Medical Group in New York City, shared advice for balancing patients’ desire for fashion with clinical concerns.
Sources said women tend to be more focused on style than men. As a result, the Mary Jane has become a staple of diabetic footwear lines, and serves as an example of how aesthetic needs must be weighed against patients’ pathology and lifestyle.
On the whole, experts approve of this shoe style. Holmes said many of her patients like its versatility for everyday, special occasion, and professional looks.
The style can make extra depth look relatively attractive and is compatible with foot orthoses when they are needed. Mary Janes come in cloth or leather, which can accommodate foot deformities.
This style does have drawbacks: The strap across the front may not be suitable for patients with edema or bony prominences, Holmes said.
Brenner isn’t keen on the opening at the top of the shoe and insists patients wear the shoes with socks, stockings, or tights.
In addition, Holmes noted, the toebox can be very wide while the heel tends to be narrow, so foot slippage inside the shoe can be an issue, Holmes said.
Experts who talked with LER said they make a priority of discussing the clinical objectives of diabetic footwear with patients first, then move on to lifestyle issues.
“I certainly would not prescribe the same shoe for a 90-year-old diabetic patient who is a community ambulator who just goes to the market or walks around her home as for a 60-year-old farmer who still works daily on his farm,” Holmes said.
But it’s a safe bet the 90-year-old will be more concerned about fashion than the farmer.
Matching the shoes to the activity is also important, Brenner said. For example, a three-hour sit-down dinner may be a chance for the patient to don a less clinically appropriate, but more attractive, diabetic shoe. In contrast, a full day of walking at a museum calls for wearing prescribed footwear.
“You want to avoid completely taking away options from a patient,” Brenner said.
Options are key when negotiating fashion and fit with patients. Often, patients get their diagnosis and assume it means diabetic shoes are their only choice.
“Just because a person has diabetes doesn’t necessarily mean she’ll need the shoe with the extra depth or the rocker bottom,” Brenner explained. “A younger person with diabetes whose blood sugar is under control may not need that diabetic shoe. On the other hand, an older patient with some balance issues will need a shoe that offers stability and support. It’s not one-style-fits-all for diabetic patients.”
If a patient is determined to wear a certain style, Holmes tenders a compromise.
“I say to them, ‘I’ll let you wear this shoe for six months. During that time, we’ll check your feet regularly. If we see any problems—a spot of irritation—then you have to agree that you’ll stop wearing that shoe and wear the shoe that I prescribe for you,’” she said.
Friday, January 27, 2012
CDC: Big Drop in Diabetes Amputations
65% Lower Rate of Foot, Leg Amputations in Just Over a Decade
Jan. 24, 2012 -- There has been a dramatic drop in the rate of diabetes-related amputations in the U.S., and experts attribute the improvement to better management of risk factors that lead to the loss of feet and legs.
The amputation rate declined by 65% among adults with diabetes in a little over a decade, the CDC reports.
Foot and leg amputations occurred in 4 out of every 1,000 adults with diabetes in 2008, compared to 11 out of every 1,00 in 1996, the CDC reports.
Non-injury-related amputation rates were still eight times higher among those with diabetes than adults without the disease.
Nevertheless, the decline shows that efforts to reduce the complications of diabetes are having a major impact, says American Diabetes Association President of Medicine and Science Vivian Fonseca, MD.
“This is very encouraging and important news for people with diabetes,” he says. “The decline confirms the tremendous progress we have made in translating research into practice."
What Your Feet Say About Your Health
Diabetes-Related Amputations Down
Nerve damage or neuropathy is a common complication of diabetes, especially among people who have had the disease for many years.
Poor control of diabetes, such as prolonged high blood sugar, low insulin levels, and high blood pressure, are believed to be major contributors to diabetes-related nerve damage.
According to this new study, foot and leg amputation rates serve as an important gauge of the effectiveness of efforts to reduce diabetes complications by controlling these risk factors.
Researchers analyzed data from two national surveys to determine the prevalence of diabetes-related leg and foot amputations in adults aged 40 and over.
Among the major findings:
· Between 1996 and 2008, the rate of leg and foot amputations among adults with diabetes declined by 65%, with men having three times the rate of amputations as women (6 per 1,000 vs. 2 per 1,000).
· Amputation rates were higher among blacks than whites (5 per 1,000 vs. 3 per 1,000).
· Those over the age of 75 had the highest rate of amputations.
The study will appear in the February issue of the journal Diabetes Care.
Keep a Close Eye on Your Feet
While the decline is encouraging, CDC epidemiologist Nilka Rios Burrows, MPH, says much more could be done to reduce amputation rates among diabetic people.
“The message to patients and their doctors is that addressing the modifiable risk factors for diabetes complications can have a huge impact,” she says.
That means aggressive medical management of blood pressure, blood sugar, and cholesterol, maintaining a healthy lifestyle, and keeping a close eye on your feet.
“A foot exam should be part of every medical visit,” Burrows says. “If the doctor doesn’t mention it, the patient should. And people with diabetes should check their own feet every day to look for sores or injury.”
Other recommendations for diabetic people from the CDC’s National Diabetes Education Program include:
· Wash your feet every day, keep feet soft with lotion or petroleum jelly, smooth corns and calluses gently, and trim toenails frequently.
· Wear shoes and socks at all times to minimize the risk of injury.
· Protect feet from extreme heat and cold.
· Remain active and do other things to promote blood flow to feet.
· Discuss foot care with your doctor.
Jan. 24, 2012 -- There has been a dramatic drop in the rate of diabetes-related amputations in the U.S., and experts attribute the improvement to better management of risk factors that lead to the loss of feet and legs.
The amputation rate declined by 65% among adults with diabetes in a little over a decade, the CDC reports.
Foot and leg amputations occurred in 4 out of every 1,000 adults with diabetes in 2008, compared to 11 out of every 1,00 in 1996, the CDC reports.
Non-injury-related amputation rates were still eight times higher among those with diabetes than adults without the disease.
Nevertheless, the decline shows that efforts to reduce the complications of diabetes are having a major impact, says American Diabetes Association President of Medicine and Science Vivian Fonseca, MD.
“This is very encouraging and important news for people with diabetes,” he says. “The decline confirms the tremendous progress we have made in translating research into practice."
What Your Feet Say About Your Health
Diabetes-Related Amputations Down
Nerve damage or neuropathy is a common complication of diabetes, especially among people who have had the disease for many years.
Poor control of diabetes, such as prolonged high blood sugar, low insulin levels, and high blood pressure, are believed to be major contributors to diabetes-related nerve damage.
According to this new study, foot and leg amputation rates serve as an important gauge of the effectiveness of efforts to reduce diabetes complications by controlling these risk factors.
Researchers analyzed data from two national surveys to determine the prevalence of diabetes-related leg and foot amputations in adults aged 40 and over.
Among the major findings:
· Between 1996 and 2008, the rate of leg and foot amputations among adults with diabetes declined by 65%, with men having three times the rate of amputations as women (6 per 1,000 vs. 2 per 1,000).
· Amputation rates were higher among blacks than whites (5 per 1,000 vs. 3 per 1,000).
· Those over the age of 75 had the highest rate of amputations.
The study will appear in the February issue of the journal Diabetes Care.
Keep a Close Eye on Your Feet
While the decline is encouraging, CDC epidemiologist Nilka Rios Burrows, MPH, says much more could be done to reduce amputation rates among diabetic people.
“The message to patients and their doctors is that addressing the modifiable risk factors for diabetes complications can have a huge impact,” she says.
That means aggressive medical management of blood pressure, blood sugar, and cholesterol, maintaining a healthy lifestyle, and keeping a close eye on your feet.
“A foot exam should be part of every medical visit,” Burrows says. “If the doctor doesn’t mention it, the patient should. And people with diabetes should check their own feet every day to look for sores or injury.”
Other recommendations for diabetic people from the CDC’s National Diabetes Education Program include:
· Wash your feet every day, keep feet soft with lotion or petroleum jelly, smooth corns and calluses gently, and trim toenails frequently.
· Wear shoes and socks at all times to minimize the risk of injury.
· Protect feet from extreme heat and cold.
· Remain active and do other things to promote blood flow to feet.
· Discuss foot care with your doctor.
Thursday, January 26, 2012
Stem Cell Therapy May Reverse Diabetes
An immune regulator from healthy cord blood stem cells (CB-SCs) can "educate" the T cells of a person with type 1 diabetes (T1D), enabling the pancreas to produce insulin....
Yong Zhao, MD, PhD, from the University of Illinois at Chicago, and colleagues base their "stem cell educator therapy" on observations that multipotent stem cells from human cord blood can alter regulatory T cells (Tregs) and islet B cell–specific T-cell clones. The new approach alters autoimmunity both in non-obese diabetic mice and in islet B cells from patients with diabetes.
In a small, open-label trial, a single treatment reduced the median daily dose of required insulin by 38% at 12 weeks for patients with moderate T1D and some B-cell function (36 ± 13.2 U/day at baseline vs 22 ± 1.8 U/day 12 weeks post-treatment), and by 25% in patients with severe T1D and no residual function (48 ± 7.4 U/day at baseline vs 36 ± 4.4 U/day 12 weeks post-treatment). The investigators saw no change in insulin requirements among the control group.
The researchers circulated lymphocytes from patients' blood in a closed-loop "stem cell educator," co-culturing the cells for 2 to 3 hours with adherent CB-SCs from healthy donors. The device sandwiches CB-SCs between 9 discs of a hydrophobic material, with a top cover plate and a lower collecting plate through which the lymphocytes exit. The investigators infused the "educated" lymphocytes into the patients and measured both levels of C-peptide and glycated hemoglobin and indicators of immune function at 4, 12, 24, and 40 weeks.
Investigators conducted this open-label, phase 1/2 clinical trial at the General Hospital of Jinan Military Command in China from October 2010 until January 2011, 15 patients (median age, 29 years [range, 15 - 41 years]; median diabetic history, 8 years [range, 1 - 21 years]) received a single treatment. Three control patients received a sham treatment lacking cells.
Primary endpoints were feasibility (change in C-peptide secretion), safety by 12 weeks, and preliminary evidence of improved B cell function by 24 weeks. Immune modulation was a secondary end point.
Overall, the treated individuals displayed better C-peptide and glycated hemoglobin A1c values, lower daily requirement for insulin, and decreased autoimmunity.
Patients with moderate T1D had improved fasting C-peptide levels at 12 and 24 weeks. Those with severe T1D showed successive improvement in fasting C-peptide levels.
A1c levels for patients with moderate T1D fell from 8.73% ± 2.49% at baseline to 7.67% ± 1.03% at 4 weeks (P = .036), and to 6.82% ± 0.49% at 12 weeks post-treatment. For those with severe T1D, A1c levels fell 1.68% ± 0.42% at 12 weeks post-treatment, with no change seen in the control group.
Stem cell education significantly increased the percentage of Tregs in peripheral blood, as well as levels of CD28 and inducible co-stimulator. Cytokine balance improved. The CB-SCs produce an autoimmune regulator which may eliminate autoreactive T cells.
"This innovative approach may provide CB-SC-mediated immune modulation therapy for multiple autoimmune diseases while mitigating the safety and ethical concerns associated with other approaches," conclude the researchers.
BMC Med. Published online January 10, 2012.
Yong Zhao, MD, PhD, from the University of Illinois at Chicago, and colleagues base their "stem cell educator therapy" on observations that multipotent stem cells from human cord blood can alter regulatory T cells (Tregs) and islet B cell–specific T-cell clones. The new approach alters autoimmunity both in non-obese diabetic mice and in islet B cells from patients with diabetes.
In a small, open-label trial, a single treatment reduced the median daily dose of required insulin by 38% at 12 weeks for patients with moderate T1D and some B-cell function (36 ± 13.2 U/day at baseline vs 22 ± 1.8 U/day 12 weeks post-treatment), and by 25% in patients with severe T1D and no residual function (48 ± 7.4 U/day at baseline vs 36 ± 4.4 U/day 12 weeks post-treatment). The investigators saw no change in insulin requirements among the control group.
The researchers circulated lymphocytes from patients' blood in a closed-loop "stem cell educator," co-culturing the cells for 2 to 3 hours with adherent CB-SCs from healthy donors. The device sandwiches CB-SCs between 9 discs of a hydrophobic material, with a top cover plate and a lower collecting plate through which the lymphocytes exit. The investigators infused the "educated" lymphocytes into the patients and measured both levels of C-peptide and glycated hemoglobin and indicators of immune function at 4, 12, 24, and 40 weeks.
Investigators conducted this open-label, phase 1/2 clinical trial at the General Hospital of Jinan Military Command in China from October 2010 until January 2011, 15 patients (median age, 29 years [range, 15 - 41 years]; median diabetic history, 8 years [range, 1 - 21 years]) received a single treatment. Three control patients received a sham treatment lacking cells.
Primary endpoints were feasibility (change in C-peptide secretion), safety by 12 weeks, and preliminary evidence of improved B cell function by 24 weeks. Immune modulation was a secondary end point.
Overall, the treated individuals displayed better C-peptide and glycated hemoglobin A1c values, lower daily requirement for insulin, and decreased autoimmunity.
Patients with moderate T1D had improved fasting C-peptide levels at 12 and 24 weeks. Those with severe T1D showed successive improvement in fasting C-peptide levels.
A1c levels for patients with moderate T1D fell from 8.73% ± 2.49% at baseline to 7.67% ± 1.03% at 4 weeks (P = .036), and to 6.82% ± 0.49% at 12 weeks post-treatment. For those with severe T1D, A1c levels fell 1.68% ± 0.42% at 12 weeks post-treatment, with no change seen in the control group.
Stem cell education significantly increased the percentage of Tregs in peripheral blood, as well as levels of CD28 and inducible co-stimulator. Cytokine balance improved. The CB-SCs produce an autoimmune regulator which may eliminate autoreactive T cells.
"This innovative approach may provide CB-SC-mediated immune modulation therapy for multiple autoimmune diseases while mitigating the safety and ethical concerns associated with other approaches," conclude the researchers.
BMC Med. Published online January 10, 2012.
Wednesday, January 25, 2012
Bariatric Surgery Not a Cure for Diabetes
According to Dimitrios Pournaras, MD as reported in the BMJ, "Bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) leads to complete remission in only about one third of patients with type 2 diabetes, and should be viewed as a means for improving glycemic control, not as a cure."...
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria.
Using data from 1006 patients, 209 of whom had type 2 diabetes at the time of gastric surgery, and a median follow-up of 23 months postsurgery, complete remission rates, using the new ADA standard, were 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). However, the authors explain, "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5 per cent; P = 0.003)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria.
The data, which were collected prospectively in 2 bariatric surgery centers in the United Kingdom and 1 center in Norway, also showed that on average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (compared with 7.5% before sleeve gastrectomy), and 6.3% (compared with 7.7% before gastric banding; P < .001 for each comparison).
The authors note that these findings are important for "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission.
The authors conclude, "The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. The findings of this study emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."
Br J Surg. 2012:88:100-103.
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria.
Using data from 1006 patients, 209 of whom had type 2 diabetes at the time of gastric surgery, and a median follow-up of 23 months postsurgery, complete remission rates, using the new ADA standard, were 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). However, the authors explain, "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5 per cent; P = 0.003)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria.
The data, which were collected prospectively in 2 bariatric surgery centers in the United Kingdom and 1 center in Norway, also showed that on average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (compared with 7.5% before sleeve gastrectomy), and 6.3% (compared with 7.7% before gastric banding; P < .001 for each comparison).
The authors note that these findings are important for "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission.
The authors conclude, "The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. The findings of this study emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."
Br J Surg. 2012:88:100-103.
Tuesday, January 24, 2012
Assessing PTTD: Linking the kinetic chain
Many studies of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot disorder, have focused on foot kinematics and benefits of bracing for pain relief and increased ambulation. But new findings from the University of Southern California in Los Angeles suggest clinicians also look higher along the kinetic chain when determining an effective treatment.
A September 2011 Journal of Orthopedic & Sports Physical Therapy study by USC researchers revealed women with PTTD performed significantly fewer single leg heel raises and repeated sagittal and frontal plane nonweight-bearing leg lifts; had at least 27% less hip abduction endurance; showed nearly 40% less hip extensor endurance; and reported a 50% increase in pain after a six minute walk test when compared with age-matched controls. Hip torque and calf muscle strength were also dramatically inferior, and, most interestingly, weakness was apparent in the involved and uninvolved limbs of participants with PTTD.
“The hip deficits that appeared bilaterally were surprising, as our hypothesis was that the hip deficits would be on the same side as the PTTD,” said Lisa M. Noceti-DeWit, DPT, ATC, adjunct instructor of clinical physical therapy at USC. Noceti-DeWit coauthored the study with university colleagues, including Kornelia Kulig, PhD, PT, a Catherine Worthingham fellow. “At this point, our research team is not yet able to speculate why the hip deficits are bilateral. We do feel that clinicians should assess hip strength in women with PTTD and provide appropriate intervention if deficits are found.”
Hip weakness may not be specific to women with PTTD, but reflective of general deconditioning or changes in motor control for a variety of reasons, explained Jeff Houck, PT, PhD, associate professor of physical therapy at New York’s Ithaca College, where he specializes in clinical biomechanics and orthopedics.
“One might ask about knee strength in these patients. If it is also lower, it would indicate more general deconditioning,” Houck said.
General strengthening approaches combined with functional exercises may be helpful, especially from a general health perspective, Houck suggested.
“However, the impact on clinical management of tendinopathy is not determined, therefore the weakness may not be specific to PTTD, but rather a secondary effect,” he said.
Women are three times as likely as men to be diagnosed with PTTD, and the disorder is most frequently found in women in their 50s. PTTD appears to peak during perimenopause, prompting research into female hormonal indicators, including estrogen receptors. A Pennsylvania State College of Medicine study, published in the December 2010 Foot & Ankle International, found no significant gender-related differences in estrogen expression in diseased posterior tibial tendons and no differences in estrogen receptors in diseased tibial tendons versus controls of healthy posterior tibial or flexor digitorum longus tendons. Larger studies may yet explain the role of estrogen in the overall health of tendons and connective tissues.
Houck suggested clinicians be cautious when employing ankle foot orthoses in women with PTTD unless the devices allow some ankle plantar flexion. His studies have shown more restrictive devices may lead to compensatory gait alterations that further weaken the ankle plantar flexors.
“The hip compensation to adapt to a decreased push off may be a stronger hip flexor contraction, resulting in a pull off rather than a push off. The further weakening of the ankle plantar flexors may aggravate the overall condition,” Houck said.
This overemphasis on hip flexion could help explain the reduced hip extensor endurance associated with PTTD in the USC study.
Changes in subtalar motion may also affect hip mechanics in patients with PTTD, Houck added.
“Subtalar inversion/eversion fine-tunes standing balance, and the hip abductors and adductors are major players in maintaining balance. Therefore, losing control at the subtalar joint as a result of PTTD may require some compensations at the hip. This may manifest as lower single leg stance time or increased trunk movements during single leg stance,” he said.
Future targeted studies exploring connections beyond the foot and ankle may elucidate whether existing hip weakness predisposes women to PTTD, or whether PTTD through its various stages complicates movement affecting both hips.
By Christina Hall Nettles
A September 2011 Journal of Orthopedic & Sports Physical Therapy study by USC researchers revealed women with PTTD performed significantly fewer single leg heel raises and repeated sagittal and frontal plane nonweight-bearing leg lifts; had at least 27% less hip abduction endurance; showed nearly 40% less hip extensor endurance; and reported a 50% increase in pain after a six minute walk test when compared with age-matched controls. Hip torque and calf muscle strength were also dramatically inferior, and, most interestingly, weakness was apparent in the involved and uninvolved limbs of participants with PTTD.
“The hip deficits that appeared bilaterally were surprising, as our hypothesis was that the hip deficits would be on the same side as the PTTD,” said Lisa M. Noceti-DeWit, DPT, ATC, adjunct instructor of clinical physical therapy at USC. Noceti-DeWit coauthored the study with university colleagues, including Kornelia Kulig, PhD, PT, a Catherine Worthingham fellow. “At this point, our research team is not yet able to speculate why the hip deficits are bilateral. We do feel that clinicians should assess hip strength in women with PTTD and provide appropriate intervention if deficits are found.”
Hip weakness may not be specific to women with PTTD, but reflective of general deconditioning or changes in motor control for a variety of reasons, explained Jeff Houck, PT, PhD, associate professor of physical therapy at New York’s Ithaca College, where he specializes in clinical biomechanics and orthopedics.
“One might ask about knee strength in these patients. If it is also lower, it would indicate more general deconditioning,” Houck said.
General strengthening approaches combined with functional exercises may be helpful, especially from a general health perspective, Houck suggested.
“However, the impact on clinical management of tendinopathy is not determined, therefore the weakness may not be specific to PTTD, but rather a secondary effect,” he said.
Women are three times as likely as men to be diagnosed with PTTD, and the disorder is most frequently found in women in their 50s. PTTD appears to peak during perimenopause, prompting research into female hormonal indicators, including estrogen receptors. A Pennsylvania State College of Medicine study, published in the December 2010 Foot & Ankle International, found no significant gender-related differences in estrogen expression in diseased posterior tibial tendons and no differences in estrogen receptors in diseased tibial tendons versus controls of healthy posterior tibial or flexor digitorum longus tendons. Larger studies may yet explain the role of estrogen in the overall health of tendons and connective tissues.
Houck suggested clinicians be cautious when employing ankle foot orthoses in women with PTTD unless the devices allow some ankle plantar flexion. His studies have shown more restrictive devices may lead to compensatory gait alterations that further weaken the ankle plantar flexors.
“The hip compensation to adapt to a decreased push off may be a stronger hip flexor contraction, resulting in a pull off rather than a push off. The further weakening of the ankle plantar flexors may aggravate the overall condition,” Houck said.
This overemphasis on hip flexion could help explain the reduced hip extensor endurance associated with PTTD in the USC study.
Changes in subtalar motion may also affect hip mechanics in patients with PTTD, Houck added.
“Subtalar inversion/eversion fine-tunes standing balance, and the hip abductors and adductors are major players in maintaining balance. Therefore, losing control at the subtalar joint as a result of PTTD may require some compensations at the hip. This may manifest as lower single leg stance time or increased trunk movements during single leg stance,” he said.
Future targeted studies exploring connections beyond the foot and ankle may elucidate whether existing hip weakness predisposes women to PTTD, or whether PTTD through its various stages complicates movement affecting both hips.
By Christina Hall Nettles
Thursday, January 19, 2012
Weight Loss Is Not The Answer for Preventing Diabetes
Richard Kahn, PhD, who was the chief scientific and medical officer of the ADA for nearly 25 years stated at a conference that, "Community-based weight-loss programs have not been shown to be effective at reducing the incidence of diabetes, so implementing a national program would likely be money down the drain."...
He stated that, "Community programs are ineffective at achieving weight loss."
Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."
He outlined his views in a published paper, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.
Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.
His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.
Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.
(However, a preliminary study presented at the American Diabetes Association meeting last year found that a short-term lifestyle modification program for overweight diabetic patients showed long-term benefits for many of the participants.)
"In sum, to date, we have not seen a demonstration of any program that results in a clinically meaningful weight loss that can be maintained for more than two to three years in the great majority of participants and at a low cost," Kahn wrote.
Kahn's remarks preceded those of Kenneth Thorpe, of Emory University, who outlined how the healthcare reform law laid the groundwork for a national, community-based diabetes prevention strategy modeled on the Diabetes Prevention Program.
Kahn said that would be a waste of money. "The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources." He also stated that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.
"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?" Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."
He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.
He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors. "While we wait for the time when lifestyle modification becomes practical, we might be better served by focusing more attention on improving our understanding of the processes that affect energy intake and expenditure and improving the medical management of diabetes," Kahn wrote.
Those medical management strategies include making an early diagnosis and administering "proven treatments that have been shown to reduce complications of diabetes and extend life," he said.
He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.
Health Affairs, Jan. 2012
He stated that, "Community programs are ineffective at achieving weight loss."
Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."
He outlined his views in a published paper, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.
Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.
His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.
Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.
(However, a preliminary study presented at the American Diabetes Association meeting last year found that a short-term lifestyle modification program for overweight diabetic patients showed long-term benefits for many of the participants.)
"In sum, to date, we have not seen a demonstration of any program that results in a clinically meaningful weight loss that can be maintained for more than two to three years in the great majority of participants and at a low cost," Kahn wrote.
Kahn's remarks preceded those of Kenneth Thorpe, of Emory University, who outlined how the healthcare reform law laid the groundwork for a national, community-based diabetes prevention strategy modeled on the Diabetes Prevention Program.
Kahn said that would be a waste of money. "The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources." He also stated that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.
"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?" Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."
He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.
He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors. "While we wait for the time when lifestyle modification becomes practical, we might be better served by focusing more attention on improving our understanding of the processes that affect energy intake and expenditure and improving the medical management of diabetes," Kahn wrote.
Those medical management strategies include making an early diagnosis and administering "proven treatments that have been shown to reduce complications of diabetes and extend life," he said.
He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.
Health Affairs, Jan. 2012
Wednesday, January 18, 2012
Paula Deen Announces She Has Diabetes
TV chef Paula Deen—the queen of deep-fried Southern cooking—joins Halle Berry, Randy Jackson, Dick Clark and 28.5 million other Americans in battling diabetes.
The Daily reported last week that the Food Network star--famed for artery-clogging fare as deep-fried macaroni and cheese—wrapped in bacon—would soon come clean about a “big fat secret," her type 2 diabetes diagnosis. Deen just announced the diabetes news with Today’s Al Roker.
Rumors about Deen’s diabetes first surfaced in April when both the National Enquirer and The Daily Mail reported that the bestselling cookbook author was keeping her disorder hidden due to concerns that it would harm her career. However, learning that she has a disease strongly linked to obesity and unhealthy eating would hardly shock fans who have watched her prepare such belly-busters as egg-and-bacon-topped burgers served between two glazed donuts.
Deen, who has described butter as “a little stick of smiles and happiness,” has already come under fire for the lavish amounts of fat and sugar in her cooking. Now that the diva of the deep fryer has confirmed a diabetes diagnosis, what might be ahead for her? Here’s a look at a disease that’s predicted to affect in one in three Americans in coming years if current trends continue.
Use these 7 diabetes tips to manage your condition
What triggers type 2 diabetes?
While the cause isn’t fully understood, type 2 diabetes starts when the body becomes insensitive to insulin, a hormone that acts like a key to let sugar—the body’s main source of fuel—into cells. This forces the pancreas to pump out higher and higher amounts of insulin, to try to keep up with demand. Ultimately, the pancreas becomes exhausted and blood sugar rises, leading to diabetes. A diet that’s high in saturated fats—such as the deep-fried dishes that figure prominently in Deen’s cooking—also increase insulin resistance.
Who’s at risk?
Like Paula Deen, about 90 percent of people who develop type 2 diabetes are overweight. And the more belly fat you have, the more likely you are to develop insulin resistance. A particular danger zone is a waist circumference of more than 35 inches for a woman and 40 inches for a man.
Other risk factors include family history, a couch potato lifestyle, age (risk rises significantly after age 45), and ethnicity, with African-Americans and Hispanics, Native Americans and Asian Americans facing a greater threat of the disease. Women who have had gestational diabetes during pregnancy or who have given birth to babies weighing over 9 pounds are also at higher risk.
Learn which foods can help diabetes patients manage their blood sugar
What are the symptoms?
One-third of the 28.5 million Americans with diabetes and the 87 million with pre-diabetes (an earlier stage) don’t know it because the disease may not cause symptoms until serious complications set in.
Warning signs include increased thirst, frequent urination, extreme hunger, blurred vision, slow-healing wounds, and frequent infections, such as gum infections, bladder infections, or yeast infections.
How dangerous is diabetes?
The disease triples the danger of heart attacks and strokes. Other complications, particularly if diabetes goes undiagnosed and untreated, include kidney damage, nerve damage, blindness, foot infections and lower leg amputation.
Recent research suggests that high blood sugar may also boost for Alzheimer’s disease in diabetes with a certain gene. A 2011 study linked high blood sugar to increased risk for colon cancer.
Read about how diet affects your children's risk of diabetes
What’s the best test to check for diabetes?
The American Diabetes Association (ADA) considers the oral glucose tolerance test the “gold standard” for diabetes detection. After an overnight fast, you’ll drink a sugary liquid, with blood samples taken at timed intervals to measure sugar levels. The ADA also recommends the A1C blood test, which measures your average blood sugar level for the past two to three months. Have your blood sugar checked every three years, starting at age 45, or at a younger age if you are overweight with at least one other risk factor.
Is there a diabetes diet?
There’s no specific diet advised for everyone with the disease. However, large studies show that focusing on low-fat, high-fiber foods—such as fruits, vegetables and whole grains—is the healthiest plan for diabetes.
Figuring out the what to eat can be complex for people who are newly diagnosed, so doctors advise working with a registered dietician to develop a meal plan that takes health goals, food preferences and lifestyle into account.
Find out about the top 5 diabetes-healing supplements
What’s the treatment?
Along with a healthy diet, therapies for type 2 typically include medication—which can include both diabetes drugs and statins to reduce heart disease risk--exercising at least 150 minutes per week, and weight loss. Deen may want to take cooking lessons from such chefs as Art Smith, who shed a whopping 85 pounds after getting a diabetes diagnosis.
And if you have pre-diabetes, a review of 28 previous studies, published in Health Affairs this month, finds losing 5 to 7 percent of your body weight (10 to 12 pounds if you weight 200), coupled with stepping up exercise and improving your eating habits, cuts the risk of progressing to full-blown diabetes by 50 percent.
Will Deen now revamp her famously fatty recipes to trim down calories? And if so, will her fans be willing to give up deep-fried Twinkies and eat more veggies? Stay tuned to see what the TV chef dishes up next.
The Daily reported last week that the Food Network star--famed for artery-clogging fare as deep-fried macaroni and cheese—wrapped in bacon—would soon come clean about a “big fat secret," her type 2 diabetes diagnosis. Deen just announced the diabetes news with Today’s Al Roker.
Rumors about Deen’s diabetes first surfaced in April when both the National Enquirer and The Daily Mail reported that the bestselling cookbook author was keeping her disorder hidden due to concerns that it would harm her career. However, learning that she has a disease strongly linked to obesity and unhealthy eating would hardly shock fans who have watched her prepare such belly-busters as egg-and-bacon-topped burgers served between two glazed donuts.
Deen, who has described butter as “a little stick of smiles and happiness,” has already come under fire for the lavish amounts of fat and sugar in her cooking. Now that the diva of the deep fryer has confirmed a diabetes diagnosis, what might be ahead for her? Here’s a look at a disease that’s predicted to affect in one in three Americans in coming years if current trends continue.
Use these 7 diabetes tips to manage your condition
What triggers type 2 diabetes?
While the cause isn’t fully understood, type 2 diabetes starts when the body becomes insensitive to insulin, a hormone that acts like a key to let sugar—the body’s main source of fuel—into cells. This forces the pancreas to pump out higher and higher amounts of insulin, to try to keep up with demand. Ultimately, the pancreas becomes exhausted and blood sugar rises, leading to diabetes. A diet that’s high in saturated fats—such as the deep-fried dishes that figure prominently in Deen’s cooking—also increase insulin resistance.
Who’s at risk?
Like Paula Deen, about 90 percent of people who develop type 2 diabetes are overweight. And the more belly fat you have, the more likely you are to develop insulin resistance. A particular danger zone is a waist circumference of more than 35 inches for a woman and 40 inches for a man.
Other risk factors include family history, a couch potato lifestyle, age (risk rises significantly after age 45), and ethnicity, with African-Americans and Hispanics, Native Americans and Asian Americans facing a greater threat of the disease. Women who have had gestational diabetes during pregnancy or who have given birth to babies weighing over 9 pounds are also at higher risk.
Learn which foods can help diabetes patients manage their blood sugar
What are the symptoms?
One-third of the 28.5 million Americans with diabetes and the 87 million with pre-diabetes (an earlier stage) don’t know it because the disease may not cause symptoms until serious complications set in.
Warning signs include increased thirst, frequent urination, extreme hunger, blurred vision, slow-healing wounds, and frequent infections, such as gum infections, bladder infections, or yeast infections.
How dangerous is diabetes?
The disease triples the danger of heart attacks and strokes. Other complications, particularly if diabetes goes undiagnosed and untreated, include kidney damage, nerve damage, blindness, foot infections and lower leg amputation.
Recent research suggests that high blood sugar may also boost for Alzheimer’s disease in diabetes with a certain gene. A 2011 study linked high blood sugar to increased risk for colon cancer.
Read about how diet affects your children's risk of diabetes
What’s the best test to check for diabetes?
The American Diabetes Association (ADA) considers the oral glucose tolerance test the “gold standard” for diabetes detection. After an overnight fast, you’ll drink a sugary liquid, with blood samples taken at timed intervals to measure sugar levels. The ADA also recommends the A1C blood test, which measures your average blood sugar level for the past two to three months. Have your blood sugar checked every three years, starting at age 45, or at a younger age if you are overweight with at least one other risk factor.
Is there a diabetes diet?
There’s no specific diet advised for everyone with the disease. However, large studies show that focusing on low-fat, high-fiber foods—such as fruits, vegetables and whole grains—is the healthiest plan for diabetes.
Figuring out the what to eat can be complex for people who are newly diagnosed, so doctors advise working with a registered dietician to develop a meal plan that takes health goals, food preferences and lifestyle into account.
Find out about the top 5 diabetes-healing supplements
What’s the treatment?
Along with a healthy diet, therapies for type 2 typically include medication—which can include both diabetes drugs and statins to reduce heart disease risk--exercising at least 150 minutes per week, and weight loss. Deen may want to take cooking lessons from such chefs as Art Smith, who shed a whopping 85 pounds after getting a diabetes diagnosis.
And if you have pre-diabetes, a review of 28 previous studies, published in Health Affairs this month, finds losing 5 to 7 percent of your body weight (10 to 12 pounds if you weight 200), coupled with stepping up exercise and improving your eating habits, cuts the risk of progressing to full-blown diabetes by 50 percent.
Will Deen now revamp her famously fatty recipes to trim down calories? And if so, will her fans be willing to give up deep-fried Twinkies and eat more veggies? Stay tuned to see what the TV chef dishes up next.
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