A national online survey of more than 2,530 adults living with Type 2 diabetes in the US reveals that many patients remain uneducated about the risks for hypoglycemia....
The survey also highlighted why hypoglycemia may be more of a health hazard than previously reported, as patients said they often experience low blood sugar during daily activities such as working and driving.
In the survey, 55% of respondents said they had experienced at least one episode of hypoglycemia. Of 702 patients with diabetes who reported hypoglycemia, 42% had experienced low blood sugar symptoms while working, 26% while exercising, and 19% while driving.
The fact that patients with diabetes experience hypoglycemia while working and driving is especially problematic, as these activities require focus and concentration, and experiencing hypoglycemia during driving can be life-threatening.
Many patients were unable to name the leading causes of hypoglycemia, which is a great cause for concern. Twenty-seven percent of those surveyed did not know that the leading causes of hypoglycemia included skipping meals, and 35% did not know that some diabetic medications may enhance the risk for hypoglycemia. Forty-six percent of patients with Type 2 diabetes also remained unaware that excessive exercise may bring on hypoglycemia, particularly when combined with certain medications for Type 2 diabetes.
Although the study clearly showed that at least half (52%) of the patients surveyed were concerned about experiencing a future episode of hypoglycemia, some did not know that the most common symptoms are dizziness (22%) and shakiness (17%), and 39% incorrectly thought that thirst was the primary symptom of hypoglycemia.
Although hypoglycemia has long been known to be a risk associated with diabetes and its treatment, it often falls under the radar of busy physicians, particularly those in primary care, who may be treating patients for other conditions stated, stated Etie Moghissi, MD, vice president and president-elect of AACE, and an associate clinical professor of medicine at the University of California–Los Angeles. Yet hypoglycemia has clear risks, as well as being an expensive burden for the healthcare system. Indeed, the survey showed that 6% of patients who responded to the online survey had to be treated for hypoglycemia in the emergency room.
Dr. Moghissi noted that, "The survey shows that it's important to inform patients about the causes, symptoms, and how to address hypoglycemia." To achieve that goal, the American College of Endocrinology recently launched a program called Blood Sugar Basics, an educational program with an interactive website that includes fact pages on how patients with diabetes can best manage their blood sugar levels.
The results of the survey were announced at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress. April 15, 2011.
Thursday, June 9, 2011
Wednesday, June 8, 2011
A1c of 5.8 Percent in Children a Better Diagnostic Target to Diagnose Diabetes
Utility of A1c of 6.5% for diagnosing pre-diabetes and diabetes in obese, questioned....
Hemoglobin A1c has emerged as a recommended diagnostic tool foridentifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1c with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.
Researchers studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1c measurement. These tests were repeated after a follow-up time of 2 years in 218 subjects.
At baseline, subjects were stratfied according to A1c categories: 77% with normal glucose tolerance (A1c ,5.7%), 21% at risk for diabetes (A1c 5.7–6.4%), and 1% with diabetes (A1c .6.5%). In the at-risk-for-diabetes category, 47% were classfied with pre-diabetes or diabetes, and in the diabetes category, 62% were classified with Type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1c was 0.81 (95% CI 0.70-0.92).
The threshold for identifying Type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1c and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.
In a large clinic based multiethnic cohort of obese children and adolescents, regardless of age and sex, an A1c of 6.5% had relatively low sensitivity and specificity for classifying Type 2diabetes. There was poor agreement between A1c and OGTT criteria in classifying subjects with glucose values suggestive of Type 2 diabetes. The optimal threshold of A1c was 5.8% for identifying Type 2 diabetes, with a specificity of 87.64% and sensitivity of 67.7%, and 5.5% for identifying IGT. The diagnostic utility of A1c was examined according to ADA criteria with OGTT as the reference. Researchers observed that the use of an A1c of 6.5% would largely underestimate the prevalence of pre-diabetes and Type 2 diabetes. They said that theseresults suggest that, although A1c could be used as a clinical tool to identify Type 2 diabetes,along with fasting and 2-h glucose, the use of A1c by itself to pinpoint prediabetes and Type 2 diabetes is not recommended.
Researchers also said that their data are in agreement with those who reported using the National Health and Nutrition Examination Survey of 14,611 individuals aged <20 years,clearly showing that an A1c of 6.5% has a lower capacity to detect prediabetes and undiagnosed Type 2 diabetes than the OGTT.
Studies in adults have clearly shown the utility of A1c in predicting Type 2 diabetes (12–14) and cardiovascular disease even in nondiabetic adults. Nevertheless, concerns in the use of A1c for diagnosing Type 2 diabetes have been recently raised in view of the poor relationship with fasting glucose, the overall lower diagnostic performance in some groups such as pregnant women and the elderly, and the risk of over diagnosing patients with anemia and those predisposed to rapid glycosylation. In addition, as previously stated, it should be noted that, despite the numerous advantages, the use of A1c as a diagnostic tool would largely affect national surveillance of prediabetes and Type 2 diabetes.
Different cutoff points have been reported when the ROC curve was used to identify the cutoff point for diagnosing Type 2 diabetes or prediabetes. A review on A1c as a screening tool for diabetes showed that three cutoff points (5.9, 6.1, and 6.3%) of A1c were advised as cutoff points for detecting diabetes in at least two different studies, and most studies identified a cutoff point of >6.1% as optimum for the detection of Type 2 diabetes. In addition, researchersconcluded that at equivalent cutoff points, sensitivity was generally lower in detecting IGT for both A1c and fasting plasma glucose in both community- and hospital-based studies. Thus, the cutoff point identified in this study of 5.8% is somewhat lower than oftentimes reported,which might indicate that the population is of especially high risk. Although only a small percentage of subjects had a repeated A1c and OGTT after a follow-up of 2 years, we believethat the data are important, indicating that the best predictors of future diabetes or prediabetes are A1c and the 2-h glucose from the OGTT. Thus, both the cross-sectional and longitudinal data would argue in favor of the utility of performing both tests in obese youth forpredicting future development of diabetes.
A few limitations are worth noting. There is no lean control group, a clinic based cohort was studied, and the follow-up group is small. Strengths include the large group of obese youngsters without known diabetes and the existence of data derived on the same day for both the OGTT and A1c.
The American Diabetes Association suggested that an A1c of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1c by itself represents a poor diagnostic tool forprediabetes and Type 2 diabetes in obese children and adolescents.
Further investigation on the role of A1c in the diagnosis of prediabetes and diabetes in children and adolescents is needed. Prospective studies are especially important to examine the utility of A1c in pediatric populations in the prediction of diabetes-related comorbidities later in life.
Published online before print April 22, 2011, doi: 10.2337/dc10-1984 Diabetes Care April 22, 2011
Hemoglobin A1c has emerged as a recommended diagnostic tool foridentifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1c with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.
Researchers studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1c measurement. These tests were repeated after a follow-up time of 2 years in 218 subjects.
At baseline, subjects were stratfied according to A1c categories: 77% with normal glucose tolerance (A1c ,5.7%), 21% at risk for diabetes (A1c 5.7–6.4%), and 1% with diabetes (A1c .6.5%). In the at-risk-for-diabetes category, 47% were classfied with pre-diabetes or diabetes, and in the diabetes category, 62% were classified with Type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1c was 0.81 (95% CI 0.70-0.92).
The threshold for identifying Type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1c and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.
In a large clinic based multiethnic cohort of obese children and adolescents, regardless of age and sex, an A1c of 6.5% had relatively low sensitivity and specificity for classifying Type 2diabetes. There was poor agreement between A1c and OGTT criteria in classifying subjects with glucose values suggestive of Type 2 diabetes. The optimal threshold of A1c was 5.8% for identifying Type 2 diabetes, with a specificity of 87.64% and sensitivity of 67.7%, and 5.5% for identifying IGT. The diagnostic utility of A1c was examined according to ADA criteria with OGTT as the reference. Researchers observed that the use of an A1c of 6.5% would largely underestimate the prevalence of pre-diabetes and Type 2 diabetes. They said that theseresults suggest that, although A1c could be used as a clinical tool to identify Type 2 diabetes,along with fasting and 2-h glucose, the use of A1c by itself to pinpoint prediabetes and Type 2 diabetes is not recommended.
Researchers also said that their data are in agreement with those who reported using the National Health and Nutrition Examination Survey of 14,611 individuals aged <20 years,clearly showing that an A1c of 6.5% has a lower capacity to detect prediabetes and undiagnosed Type 2 diabetes than the OGTT.
Studies in adults have clearly shown the utility of A1c in predicting Type 2 diabetes (12–14) and cardiovascular disease even in nondiabetic adults. Nevertheless, concerns in the use of A1c for diagnosing Type 2 diabetes have been recently raised in view of the poor relationship with fasting glucose, the overall lower diagnostic performance in some groups such as pregnant women and the elderly, and the risk of over diagnosing patients with anemia and those predisposed to rapid glycosylation. In addition, as previously stated, it should be noted that, despite the numerous advantages, the use of A1c as a diagnostic tool would largely affect national surveillance of prediabetes and Type 2 diabetes.
Different cutoff points have been reported when the ROC curve was used to identify the cutoff point for diagnosing Type 2 diabetes or prediabetes. A review on A1c as a screening tool for diabetes showed that three cutoff points (5.9, 6.1, and 6.3%) of A1c were advised as cutoff points for detecting diabetes in at least two different studies, and most studies identified a cutoff point of >6.1% as optimum for the detection of Type 2 diabetes. In addition, researchersconcluded that at equivalent cutoff points, sensitivity was generally lower in detecting IGT for both A1c and fasting plasma glucose in both community- and hospital-based studies. Thus, the cutoff point identified in this study of 5.8% is somewhat lower than oftentimes reported,which might indicate that the population is of especially high risk. Although only a small percentage of subjects had a repeated A1c and OGTT after a follow-up of 2 years, we believethat the data are important, indicating that the best predictors of future diabetes or prediabetes are A1c and the 2-h glucose from the OGTT. Thus, both the cross-sectional and longitudinal data would argue in favor of the utility of performing both tests in obese youth forpredicting future development of diabetes.
A few limitations are worth noting. There is no lean control group, a clinic based cohort was studied, and the follow-up group is small. Strengths include the large group of obese youngsters without known diabetes and the existence of data derived on the same day for both the OGTT and A1c.
The American Diabetes Association suggested that an A1c of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1c by itself represents a poor diagnostic tool forprediabetes and Type 2 diabetes in obese children and adolescents.
Further investigation on the role of A1c in the diagnosis of prediabetes and diabetes in children and adolescents is needed. Prospective studies are especially important to examine the utility of A1c in pediatric populations in the prediction of diabetes-related comorbidities later in life.
Published online before print April 22, 2011, doi: 10.2337/dc10-1984 Diabetes Care April 22, 2011
Monday, June 6, 2011
How to Stop Food Cravings
Over time, restricting some foods may tamp down those cravings....
The study centered on 270 men and women who were randomly assigned to a low-carbohydrate diet or a low-fat diet for two years. Those on the low-carb diet were told to limit carbohydrates and eat foods high in fat and protein. Those on the low-fat diet cut back on calories and fat and limited protein to about 15% of calories from protein, 30% from fat and 55% from carbohydrate.
Foods such as jelly that are high in sugar were discouraged on the low-carb diet, and high-carb foods such as bagels were banned on the low-carb diet.
Researchers surveyed participants about how often they craved sweets, high-fat foods, carbohydrates and starches and fast-food fats. Participants also were asked about their preferences for certain foods -- this was used to measure how much they liked the foods that were restricted from their diets.
The researchers found that those in the low-carbohydrate group had much larger drops in cravings for carbs and starches compared to the low-fat group. The low-carb group showed substantially bigger declines in preferences for high-carb and high-sugar foods compared to the low-fat group. The low-carb group also was less bothered by hunger than those in the low-fat group.
The low-fat group, meanwhile, saw bigger decreases in cravings for high-fat foods than did the low-carb group. The low-fat group also had larger reductions in preferences for low-carb/high-protein foods compared to the low-carb group.
The findings "demonstrate that promoting the restriction of specific types of foods while dieting causes decreased cravings and preferences for the foods that are targeted for restriction," the authors wrote.
That's counterintuitive to what most people think they'll experience when they diet and, the authors noted, could put those dieters' concerns to rest.
Obesity, April 2011.
The study centered on 270 men and women who were randomly assigned to a low-carbohydrate diet or a low-fat diet for two years. Those on the low-carb diet were told to limit carbohydrates and eat foods high in fat and protein. Those on the low-fat diet cut back on calories and fat and limited protein to about 15% of calories from protein, 30% from fat and 55% from carbohydrate.
Foods such as jelly that are high in sugar were discouraged on the low-carb diet, and high-carb foods such as bagels were banned on the low-carb diet.
Researchers surveyed participants about how often they craved sweets, high-fat foods, carbohydrates and starches and fast-food fats. Participants also were asked about their preferences for certain foods -- this was used to measure how much they liked the foods that were restricted from their diets.
The researchers found that those in the low-carbohydrate group had much larger drops in cravings for carbs and starches compared to the low-fat group. The low-carb group showed substantially bigger declines in preferences for high-carb and high-sugar foods compared to the low-fat group. The low-carb group also was less bothered by hunger than those in the low-fat group.
The low-fat group, meanwhile, saw bigger decreases in cravings for high-fat foods than did the low-carb group. The low-fat group also had larger reductions in preferences for low-carb/high-protein foods compared to the low-carb group.
The findings "demonstrate that promoting the restriction of specific types of foods while dieting causes decreased cravings and preferences for the foods that are targeted for restriction," the authors wrote.
That's counterintuitive to what most people think they'll experience when they diet and, the authors noted, could put those dieters' concerns to rest.
Obesity, April 2011.
Sunday, June 5, 2011
Antifibrotic May Slow Diabetic Nephropathy
Diabetic nephropathy may not just slow but may actually improve with the novel antifibrotic agent pirfenidone (Esbriet)....
Kidney function continued to drop in diabetic kidney disease patients without treatment, but rose significantly with a low dose of pirfenidone over one year.
Mean estimated glomerular filtration rate (eGFR) rose by an average 3.3 ml/min per 1.73 m2 with 1,200-mg pirfenidone, but fell by 2.2 ml/min per 1.73 m2 with placebo in the study (P=0.026). This kind of improvement hasn't been seen with the current standard of care with renin-angiotensin system (RAS) blockers, the researchers noted, calling the results promising.
"Even when maximized, [RAS blockers] may decrease rate of progression, but they do not arrest or reverse diabetic nephropathy," wrote Dr. Sharma, of the University of California San Diego and VA Medical Center in La Jolla.
When diabetes patients develop even low levels of kidney disease, their risk of cardiovascular and other complications requiring hospitalization goes up, Sharma explained.
Pirfenidone is under development for treatment of idiopathic pulmonary fibrosis. An FDA advisory panel gave the thumbs up to the drug early last year, but the agency ultimately turned it down, citing the need for further efficacy data.
But since fibrosis and inflammation play a role in progression of diabetic kidney damage as well, Sharma's group did an exploratory study in 77 patients with Type 1 or Type 2 diabetes and established nephropathy marked by elevated albuminuria and eGFR of 20 to 75 ml/min per 1.73 m2.
The double-blind, placebo-controlled, dose-ranging protocol randomized patients to placebo or pirfenidone at either 1,200 or 2,400 mg per day on top of their stable regimen; study participants had both their diabetes and their blood pressure under good control.
During the study, no patient in the low-dose pirfenidone group was put on dialysis by their primary provider, whereas four placebo-group patients initiated dialysis, as did one in the 2,400-mg pirfenidone group.
However, a larger study is needed to validate any difference in rates of progression to dialysis, Sharma warned. The paper also noted that a larger study was needed to replicate these results.
Change in urine albumin-to-creatinine ratio did not differ significantly among groups. Nor did the researchers find any biomarkers that could predict benefit from pirfenidone.
Sharma said his group is actively looking for such biomarkers and noted that their exploratory study is just one step on the way to a larger-scale trial to validate the benefits for diabetic nephropathy.
Practice Pearls:
Explain that an exploratory study found that 54 weeks of 1200 mg of the new antifibrotic drug, pirfenidone, improved the mean estimated glomerular filtration rate (eGFR) in patients with existing diabetic nephropathy due to Type 1 or Type 2 diabetes.
Note that the eGFR after one year was not significantly different between those receiving 2400 mg of the drug and placebo and the study had a high drop-out rate.
Journal of the American Society of Nephrology, April 2011.
Kidney function continued to drop in diabetic kidney disease patients without treatment, but rose significantly with a low dose of pirfenidone over one year.
Mean estimated glomerular filtration rate (eGFR) rose by an average 3.3 ml/min per 1.73 m2 with 1,200-mg pirfenidone, but fell by 2.2 ml/min per 1.73 m2 with placebo in the study (P=0.026). This kind of improvement hasn't been seen with the current standard of care with renin-angiotensin system (RAS) blockers, the researchers noted, calling the results promising.
"Even when maximized, [RAS blockers] may decrease rate of progression, but they do not arrest or reverse diabetic nephropathy," wrote Dr. Sharma, of the University of California San Diego and VA Medical Center in La Jolla.
When diabetes patients develop even low levels of kidney disease, their risk of cardiovascular and other complications requiring hospitalization goes up, Sharma explained.
Pirfenidone is under development for treatment of idiopathic pulmonary fibrosis. An FDA advisory panel gave the thumbs up to the drug early last year, but the agency ultimately turned it down, citing the need for further efficacy data.
But since fibrosis and inflammation play a role in progression of diabetic kidney damage as well, Sharma's group did an exploratory study in 77 patients with Type 1 or Type 2 diabetes and established nephropathy marked by elevated albuminuria and eGFR of 20 to 75 ml/min per 1.73 m2.
The double-blind, placebo-controlled, dose-ranging protocol randomized patients to placebo or pirfenidone at either 1,200 or 2,400 mg per day on top of their stable regimen; study participants had both their diabetes and their blood pressure under good control.
During the study, no patient in the low-dose pirfenidone group was put on dialysis by their primary provider, whereas four placebo-group patients initiated dialysis, as did one in the 2,400-mg pirfenidone group.
However, a larger study is needed to validate any difference in rates of progression to dialysis, Sharma warned. The paper also noted that a larger study was needed to replicate these results.
Change in urine albumin-to-creatinine ratio did not differ significantly among groups. Nor did the researchers find any biomarkers that could predict benefit from pirfenidone.
Sharma said his group is actively looking for such biomarkers and noted that their exploratory study is just one step on the way to a larger-scale trial to validate the benefits for diabetic nephropathy.
Practice Pearls:
Explain that an exploratory study found that 54 weeks of 1200 mg of the new antifibrotic drug, pirfenidone, improved the mean estimated glomerular filtration rate (eGFR) in patients with existing diabetic nephropathy due to Type 1 or Type 2 diabetes.
Note that the eGFR after one year was not significantly different between those receiving 2400 mg of the drug and placebo and the study had a high drop-out rate.
Journal of the American Society of Nephrology, April 2011.
Friday, June 3, 2011
Pregnancy Foot Problems
Pregnancy and the Feet
Pregnancy is seen by most as a time of anticipation and joy, but it can take a toll on a woman’s body. Even the feet can be affected. Researchers report more than half of all pregnant women have foot complaints.
According to Adriana Karpati, D.P.M., Podiatrist in Grapevine, TX one of the most commonly encountered foot problems in pregnancy is plantar fasciitis (heel pain). As the woman nears the last trimester, production of a hormone, called relaxin, causes the ligaments to loosen in preparation for movement of the baby through the birth canal. This process also loosens the ligaments in the foot. The extra weight during pregnancy compounds the problem, and may cause the arch to flatten and the foot to roll inward while walking. This puts stress on the fascia, or connective tissue that runs from the front of the foot to the heel. The fascia becomes inflamed, leading to heel pain. The pain is worse when first getting out of bed in the morning or after sitting for long periods of time.
Foot swelling is also very common in pregnancy. It occurs due to extra blood volume to support the fetus and pooling of fluid in the lower body. Swelling can be worse after standing for extended periods or during warmer weather. The increase in foot size also makes wearing some shoes more uncomfortable.
Many pregnant women complain of foot cramps (the cramps can also occur in the legs). These become more common during the second and third trimester. The cramps can be caused by an increase in blood volume, relaxation of the blood vessels (which slows circulation) and compression of the veins in the pelvis from the added weight (affecting circulation in the feet). Foot cramps are common at night, but can also occur during the day.
Karpati says pregnant women may also develop ingrown toenails. This is usually caused when the swollen feet are stuffed inside shoes that are too tight. She says pregnant women are used to getting bigger maternity clothes to match their growing girth. However, many patients don’t think about changing their shoe size. The foot can get flatter and wider, growing in length by an extra half inch.
Treating and Preventing Pregnancy-related Foot Problems
Karpati says it’s important for a pregnant woman to take care of her feet as well as the rest of her body. Many foot problems can be relieved or prevented by wearing properly sized shoes. Since the feet tend to swell and enlarge, a new pair of comfortable shoes may be needed. Make sure to get shoes that have a good arch support. Orthotics can also help support the arch. If shoes in general are uncomfortable, try wearing slippers around the house. Avoid going barefoot, which doesn’t give any support to the feet and can increase risk of foot injury.
To reduce swelling, take frequent breaks from standing. Sit down and prop up the feet for at least 30 minutes a day. Don’t cross the legs (this impedes the ability of blood to flow back up to the heart) and avoid wearing pants with constricting ankle cuffs or tight ankle jewelry. It’s also important to watch salt intake, which can contribute to fluid retention and swelling, get regular exercise and eat a healthy diet.
For both heel pain and leg/foot cramps, Karpati recommends stretching. A splint may be worn at night to keep the ankle and foot at a right angle and reduce risk of cramps while sleeping.
Women with ingrown toenails may get some relief by soaking the foot in warm water for the nail to soften. For very small ingrown nails, it may be possible to cut the nail at an angle and peel off the excess nail on the side. For larger or deeper ingrown nails, or if the nail is very red, sore or has any drainage, see a podiatrist for treatment.
Karpati says many pregnancy-related foot problems resolve after the baby is born and the woman gets back to a normal weight and routine. However, sometimes the feet may still be larger, requiring a larger shoe size than that worn needed before pregnancy.
For information on foot problems:
American College of Foot and Ankle Surgeons
American Orthopaedic Foot and Ankle Society
American Podiatric Medical Association
Copyright 2011 by WSOCTV.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Pregnancy is seen by most as a time of anticipation and joy, but it can take a toll on a woman’s body. Even the feet can be affected. Researchers report more than half of all pregnant women have foot complaints.
According to Adriana Karpati, D.P.M., Podiatrist in Grapevine, TX one of the most commonly encountered foot problems in pregnancy is plantar fasciitis (heel pain). As the woman nears the last trimester, production of a hormone, called relaxin, causes the ligaments to loosen in preparation for movement of the baby through the birth canal. This process also loosens the ligaments in the foot. The extra weight during pregnancy compounds the problem, and may cause the arch to flatten and the foot to roll inward while walking. This puts stress on the fascia, or connective tissue that runs from the front of the foot to the heel. The fascia becomes inflamed, leading to heel pain. The pain is worse when first getting out of bed in the morning or after sitting for long periods of time.
Foot swelling is also very common in pregnancy. It occurs due to extra blood volume to support the fetus and pooling of fluid in the lower body. Swelling can be worse after standing for extended periods or during warmer weather. The increase in foot size also makes wearing some shoes more uncomfortable.
Many pregnant women complain of foot cramps (the cramps can also occur in the legs). These become more common during the second and third trimester. The cramps can be caused by an increase in blood volume, relaxation of the blood vessels (which slows circulation) and compression of the veins in the pelvis from the added weight (affecting circulation in the feet). Foot cramps are common at night, but can also occur during the day.
Karpati says pregnant women may also develop ingrown toenails. This is usually caused when the swollen feet are stuffed inside shoes that are too tight. She says pregnant women are used to getting bigger maternity clothes to match their growing girth. However, many patients don’t think about changing their shoe size. The foot can get flatter and wider, growing in length by an extra half inch.
Treating and Preventing Pregnancy-related Foot Problems
Karpati says it’s important for a pregnant woman to take care of her feet as well as the rest of her body. Many foot problems can be relieved or prevented by wearing properly sized shoes. Since the feet tend to swell and enlarge, a new pair of comfortable shoes may be needed. Make sure to get shoes that have a good arch support. Orthotics can also help support the arch. If shoes in general are uncomfortable, try wearing slippers around the house. Avoid going barefoot, which doesn’t give any support to the feet and can increase risk of foot injury.
To reduce swelling, take frequent breaks from standing. Sit down and prop up the feet for at least 30 minutes a day. Don’t cross the legs (this impedes the ability of blood to flow back up to the heart) and avoid wearing pants with constricting ankle cuffs or tight ankle jewelry. It’s also important to watch salt intake, which can contribute to fluid retention and swelling, get regular exercise and eat a healthy diet.
For both heel pain and leg/foot cramps, Karpati recommends stretching. A splint may be worn at night to keep the ankle and foot at a right angle and reduce risk of cramps while sleeping.
Women with ingrown toenails may get some relief by soaking the foot in warm water for the nail to soften. For very small ingrown nails, it may be possible to cut the nail at an angle and peel off the excess nail on the side. For larger or deeper ingrown nails, or if the nail is very red, sore or has any drainage, see a podiatrist for treatment.
Karpati says many pregnancy-related foot problems resolve after the baby is born and the woman gets back to a normal weight and routine. However, sometimes the feet may still be larger, requiring a larger shoe size than that worn needed before pregnancy.
For information on foot problems:
American College of Foot and Ankle Surgeons
American Orthopaedic Foot and Ankle Society
American Podiatric Medical Association
Copyright 2011 by WSOCTV.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Thursday, June 2, 2011
Limiting Carbs, Not Calories, Reduces Liver Fat Faster
Curbing carbohydrates is more effective than cutting calories for individuals who want to quickly reduce the amount of fat in their liver....
Lead author Dr. Jeffrey Browning, assistant professor of internal medicine at UT Southwestern, stated that, "What this study tells us is that if your doctor says that you need to reduce the amount of fat in your liver, you can do something within a month."
The results could have implications for treating numerous diseases including diabetes, insulin resistance and nonalcoholic fatty liver disease, or NAFLD. The disease, characterized by high levels of triglycerides in the liver, affects as many as one-third of American adults. It can lead to liver inflammation, cirrhosis and liver cancer.
For the study, researchers assigned 18 participants with NAFLD to eat either a low-carbohydrate or a low-calorie diet for 14 days.
The participants assigned to the low-carb diet limited their carbohydrate intake to less than 20 grams a day, the equivalent of a small banana or a half-cup of egg noodles for the first seven days. For the final seven days, they switched to frozen meals prepared by UT Southwestern's Clinical and Translational Research Center (CTRC) kitchen that matched their individual food preferences, carbohydrate intake and energy needs.
Those assigned to the low-calorie diet continued their regular diet and kept a food diary for the four days preceding the study. The CTRC kitchen then used these individual records to prepare all meals during the 14-day study. Researchers limited the total number of calories to roughly 1,200 a day for the female participants and 1,500 a day for the males.
After two weeks, researchers used advanced imaging techniques to analyze the amount of liver fat in each individual. They found that the study participants on the low-carb diet lost more liver fat.
Although the study was not designed to determine which diet was more effective for losing weight, both the low-calorie dieters and the low-carbohydrate dieters lost an average of 10 pounds.
Dr. Browning cautioned that the findings do not explain why participants on the low-carb diet saw a greater reduction in liver fat, and that they should not be extrapolated beyond the two-week period of study. "This is not a long-term study, and I don't think that low-carb diets are fundamentally better than low-fat ones," he said. "Our approach is likely to be only of short-term benefit because at some point the benefits of weight loss alone trounce any benefits derived from manipulating dietary macronutrients such as calories and carbohydrates.
"Weight loss, regardless of the mechanism, is currently the most effective way to reduce liver fat."
American Journal of Clinical Nutrition April, 2011
Lead author Dr. Jeffrey Browning, assistant professor of internal medicine at UT Southwestern, stated that, "What this study tells us is that if your doctor says that you need to reduce the amount of fat in your liver, you can do something within a month."
The results could have implications for treating numerous diseases including diabetes, insulin resistance and nonalcoholic fatty liver disease, or NAFLD. The disease, characterized by high levels of triglycerides in the liver, affects as many as one-third of American adults. It can lead to liver inflammation, cirrhosis and liver cancer.
For the study, researchers assigned 18 participants with NAFLD to eat either a low-carbohydrate or a low-calorie diet for 14 days.
The participants assigned to the low-carb diet limited their carbohydrate intake to less than 20 grams a day, the equivalent of a small banana or a half-cup of egg noodles for the first seven days. For the final seven days, they switched to frozen meals prepared by UT Southwestern's Clinical and Translational Research Center (CTRC) kitchen that matched their individual food preferences, carbohydrate intake and energy needs.
Those assigned to the low-calorie diet continued their regular diet and kept a food diary for the four days preceding the study. The CTRC kitchen then used these individual records to prepare all meals during the 14-day study. Researchers limited the total number of calories to roughly 1,200 a day for the female participants and 1,500 a day for the males.
After two weeks, researchers used advanced imaging techniques to analyze the amount of liver fat in each individual. They found that the study participants on the low-carb diet lost more liver fat.
Although the study was not designed to determine which diet was more effective for losing weight, both the low-calorie dieters and the low-carbohydrate dieters lost an average of 10 pounds.
Dr. Browning cautioned that the findings do not explain why participants on the low-carb diet saw a greater reduction in liver fat, and that they should not be extrapolated beyond the two-week period of study. "This is not a long-term study, and I don't think that low-carb diets are fundamentally better than low-fat ones," he said. "Our approach is likely to be only of short-term benefit because at some point the benefits of weight loss alone trounce any benefits derived from manipulating dietary macronutrients such as calories and carbohydrates.
"Weight loss, regardless of the mechanism, is currently the most effective way to reduce liver fat."
American Journal of Clinical Nutrition April, 2011
Wednesday, June 1, 2011
Preventing Type 2 Diabetes with Early Pharmacological Intervention
According to Ralph DeFronzo, it is never too early to prevent diabetes....
In the U.S., 26 million individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40-50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications.
Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40-50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function -- the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes -- uniformly have been shown to prevent progression of IGT to type 2 diabetes.
The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50-70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70-80% of their β-cell function, and have an ∼ 10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.
Type 2 diabetes can be prevented with early pharmacological intervention; DeFronzo RA, Abdul-Ghani M; Diabetes Care 34 Suppl 2 S202-9 (May 2011)
In the U.S., 26 million individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40-50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications.
Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40-50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function -- the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes -- uniformly have been shown to prevent progression of IGT to type 2 diabetes.
The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50-70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70-80% of their β-cell function, and have an ∼ 10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.
Type 2 diabetes can be prevented with early pharmacological intervention; DeFronzo RA, Abdul-Ghani M; Diabetes Care 34 Suppl 2 S202-9 (May 2011)
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