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.
Showing posts with label aging with diabetes. Show all posts
Showing posts with label aging with diabetes. Show all posts
Sunday, June 5, 2011
Saturday, March 26, 2011
Why Don't People Take Their Insulin as Prescribed?
Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and….
The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections, according to researcher Mark Peyrot, PhD.
Data were obtained through an internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat Type 1 or Type 2 diabetes. Multiple regression analysis assessed independent associations of various demographic, disease, and injection-specific factors with insulin omission.
Intentional insulin omission was reported by more than half of respondents; regular omission was reported by 20%. Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and age, education, income, pain, and embarrassment more prominent in Type 2 diabetes. It is not surprising that non-compliance in Type 1 diabetes patients was associated with poor eating habits. The researchers found that younger age, lower income, and embarrassment were the most important factors for poor compliance in people with Type 2 diabetes.
Whereas most patients did not report regular intentional omission of insulin injections, a substantial number did. The findings suggest that it is important to identify patients who intentionally omit insulin and be aware of the potential risk factors identified here. For patients who report injection-related problems (interference with daily activities, injection pain, and embarrassment), providers should consider recommending strategies and tools for addressing these problems to increase adherence to prescribed insulin regimens. This could improve clinical outcomes. Although the results address the needed educational intervention, especially when it comes to embarrassment, pain, and interference with activities, it also points to the fact that healthcare teams need to talk with patients before this becomes a common practice, rather than a single occurrence.
Diabetes Care, Feb. 2011
The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections, according to researcher Mark Peyrot, PhD.
Data were obtained through an internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat Type 1 or Type 2 diabetes. Multiple regression analysis assessed independent associations of various demographic, disease, and injection-specific factors with insulin omission.
Intentional insulin omission was reported by more than half of respondents; regular omission was reported by 20%. Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and age, education, income, pain, and embarrassment more prominent in Type 2 diabetes. It is not surprising that non-compliance in Type 1 diabetes patients was associated with poor eating habits. The researchers found that younger age, lower income, and embarrassment were the most important factors for poor compliance in people with Type 2 diabetes.
Whereas most patients did not report regular intentional omission of insulin injections, a substantial number did. The findings suggest that it is important to identify patients who intentionally omit insulin and be aware of the potential risk factors identified here. For patients who report injection-related problems (interference with daily activities, injection pain, and embarrassment), providers should consider recommending strategies and tools for addressing these problems to increase adherence to prescribed insulin regimens. This could improve clinical outcomes. Although the results address the needed educational intervention, especially when it comes to embarrassment, pain, and interference with activities, it also points to the fact that healthcare teams need to talk with patients before this becomes a common practice, rather than a single occurrence.
Diabetes Care, Feb. 2011
Tuesday, March 22, 2011
Diabetes to double or triple in U.S. by 2050: government
WASHINGTON (Reuters Life!) – Up to a third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise, the Centers for Disease Control and Prevention projected on Friday.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless Americans change their behavior, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote in their report.
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said in a statement.
"Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million U.S. adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
"These projected increases are largely attributable to the aging of the U.S. population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless Americans change their behavior, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote in their report.
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said in a statement.
"Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million U.S. adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
"These projected increases are largely attributable to the aging of the U.S. population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote.
Saturday, March 5, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Kansas City
A: It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetes
The length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Kansas City
A: It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetes
The length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Monday, February 28, 2011
Only 7% of the 60 Million with Prediabetes Are Aware
Measuring glycated hemoglobin levels may be an appropriate means of catching patients with prediabetes....
Ronald Ackerman, MD, MPH, of Indiana University, and colleagues reported in Preventive Medicine that, HbA1c testing yielded similar probabilities for developing diabetes and heart disease as those estimated by using the 2003 American Diabetes Association definition for prediabetes. "The A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and cardiovascular disease," they wrote.
Fasting plasma glucose and two-hour plasma glucose, two commonly used tests for assessing diabetes and prediabetes, are limited because they require a patient to return on a separate day after an overnight fast and remain in the office for 2-3 hours which is a potential barrier to test completion, the researchers said.
Measuring HbA1c is easier -- it requires only one blood draw. In June 2009, the International Expert Committee, which represents several major diabetes groups, recommended using HbA1c to diagnose diabetes.
The recommendations of the committee have stirred up some controversy, still, the researchers said, only about 7% of patients with prediabetes -- who are thus at risk for later diabetes and heart disease -- are aware of their status.
To estimate the risks of developing diabetes and cardiovascular disease for adults with different HbA1c levels, Ackerman and colleagues assessed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Among adults who met the 2003 ADA definition for prediabetes, the probabilities for developing Type 2 disease over 7.5 years and cardiovascular disease over 10 years were 33.5% and 10.7%, respectively.
The researchers found that using HbA1c alone -- with a range of 5.5% to 6.5% defining prediabetes -- would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively).
But using a slightly higher cutoff -- beginning at 5.7% -- would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.
These risks are comparable to those seen in patients enrolled in the Diabetes Prevention Program, which had an enrollment criteria of both elevated fasting plasma glucose and impaired glucose tolerance, the researchers said.
Thus, they concluded, using a bottom cutoff of 5.7% for diagnosing prediabetes may be more appropriate.
Either way, they said, HbA1c measurement "should be considered a means of identifying greater numbers of patients at risk for diabetes and heart disease" -- especially because "of its practical nature and wide availability."
The study was limited by its use of cross-sectional data, and it may be lacking in generalizability. For instance, a greater number of African Americans would be identified as having prediabetes than if using fasting plasma glucose or two-hour plasma glucose testing, the researchers noted.
Ronald Ackerman, MD, MPH, of Indiana University, and colleagues reported in Preventive Medicine that, HbA1c testing yielded similar probabilities for developing diabetes and heart disease as those estimated by using the 2003 American Diabetes Association definition for prediabetes. "The A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and cardiovascular disease," they wrote.
Fasting plasma glucose and two-hour plasma glucose, two commonly used tests for assessing diabetes and prediabetes, are limited because they require a patient to return on a separate day after an overnight fast and remain in the office for 2-3 hours which is a potential barrier to test completion, the researchers said.
Measuring HbA1c is easier -- it requires only one blood draw. In June 2009, the International Expert Committee, which represents several major diabetes groups, recommended using HbA1c to diagnose diabetes.
The recommendations of the committee have stirred up some controversy, still, the researchers said, only about 7% of patients with prediabetes -- who are thus at risk for later diabetes and heart disease -- are aware of their status.
To estimate the risks of developing diabetes and cardiovascular disease for adults with different HbA1c levels, Ackerman and colleagues assessed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Among adults who met the 2003 ADA definition for prediabetes, the probabilities for developing Type 2 disease over 7.5 years and cardiovascular disease over 10 years were 33.5% and 10.7%, respectively.
The researchers found that using HbA1c alone -- with a range of 5.5% to 6.5% defining prediabetes -- would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively).
But using a slightly higher cutoff -- beginning at 5.7% -- would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.
These risks are comparable to those seen in patients enrolled in the Diabetes Prevention Program, which had an enrollment criteria of both elevated fasting plasma glucose and impaired glucose tolerance, the researchers said.
Thus, they concluded, using a bottom cutoff of 5.7% for diagnosing prediabetes may be more appropriate.
Either way, they said, HbA1c measurement "should be considered a means of identifying greater numbers of patients at risk for diabetes and heart disease" -- especially because "of its practical nature and wide availability."
The study was limited by its use of cross-sectional data, and it may be lacking in generalizability. For instance, a greater number of African Americans would be identified as having prediabetes than if using fasting plasma glucose or two-hour plasma glucose testing, the researchers noted.
Friday, January 21, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Friday, December 24, 2010
When to Test Children for Diabetes
Q: My husband is a type 1 diabetic, and we didn't know that until he went for a physical and the doctor said his body was in "ketosis" (shutting itself down). We didn't expect that since he looked healthy, and we didn't recognize any symptoms except frequent urination. At what age should we have our three children (ages 13, 15, and 16) checked? Are there more obvious signs in children? Do you recommend any particular diet as a starting point for better eating? Sorry for the many questions, I am just trying to keep my info straight. Thank you very much in advance for your time in answering this. Have a great day.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!
There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.
In light of all these factors, the best way to move forward is to do the following:
Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.
Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!
There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.
In light of all these factors, the best way to move forward is to do the following:
Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.
Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.
1 in 3 Americans will have diabetes by 2050
In the United States, 1 in 3 people will have Type 2 diabetes by 2050 if current trends continue, according to a new report from the Centers for Disease Control and Prevention.
The projections, released today, are alarming to U.S. health officials, who say the numbers highlight the need for interventions to keep the number of new cases from climbing.
Currently, 1 in 10 Americans has Type 2 diabetes. But if new cases develop as projected, its prevalence could double or triple over the next 40 years, said Ann Albright, director of the Division of Diabetes Translation at the CDC.
"We can't have that, it's unsustainable," Albright told MyHealthNewsDaily.
Type 2 diabetes is the most common form of diabetes, and is triggered by a
combination of unchangeable factors, such as family history and race, and controllable factors, such as obesity and inactivity, according to the Mayo Clinic.
It's also the seventh leading cause of death in the United States, according to 2007 data, and is the leading cause of leg and foot amputations, kidney failure and new cases of blindness in adults under age 75, according to the CDC.
The costs of diabetes add up to about $174 billion a year, the CDC said.
Explaining the increase
An aging population and the growth of minority populations are expected to add to the disease's prevalence, Albright said. African-Americans, Latinos, Native Americans and certain Asians and Pacific Islanders are at high risk of developing diabetes.
Advances in medicine, which may help people with the disease live longer, and better detection of diabetes are other reasons why its prevalence could dramatically increase by 2050, she said. Right now, 24 million Americans have Type 2 diabetes, but a quarter of them don't know it, according to the CDC.
And because people are living longer, more cases are likely to come from older people. The percentage of people ages 65 and older with diabetes is expected to increase; it was 12.4 percent in 2000, but will be 19.6 percent in 2030, Albright said.
"We're living longer, but Type 2 diabetes does get more prevalent as you age," she said. "The body's ability to use insulin does gradually decline, but that can be slowed by maintenance, diet and regular physical activity."
Need for interventions
Right now, about 60 million people in the United States have pre-diabetes — a stage of insulin resistance before full-blown diabetes. If these people don't change their exercise and eating habits now, they will develop diabetes in the next three to six years, Albright said.
"They don’t have a big window," she said.
It will take a combination of personal decisions and policy changes to turn the diabetes rate around. Making healthy food more accessible and implementing prevention programs will help, she said.
One such program is the CDC's new National Diabetes Prevention Program, which aims to provide people with information about diabetes, promote lifestyle changes and reduce disparities between different groups.
A clinical trial showed that high-risk people who went through this prevention program reduced their risk of developing diabetes by 58 percent, according to the report.
"It's not enough for research to be done, you need to get the [information] in people's hands," Albright said. The intervention program makes use of the research, but "environmental and lifestyle changes need to complement it to be successful."
MyHealthNewsDaily Copyright © 2010. All rights reserved.
The projections, released today, are alarming to U.S. health officials, who say the numbers highlight the need for interventions to keep the number of new cases from climbing.
Currently, 1 in 10 Americans has Type 2 diabetes. But if new cases develop as projected, its prevalence could double or triple over the next 40 years, said Ann Albright, director of the Division of Diabetes Translation at the CDC.
"We can't have that, it's unsustainable," Albright told MyHealthNewsDaily.
Type 2 diabetes is the most common form of diabetes, and is triggered by a
combination of unchangeable factors, such as family history and race, and controllable factors, such as obesity and inactivity, according to the Mayo Clinic.
It's also the seventh leading cause of death in the United States, according to 2007 data, and is the leading cause of leg and foot amputations, kidney failure and new cases of blindness in adults under age 75, according to the CDC.
The costs of diabetes add up to about $174 billion a year, the CDC said.
Explaining the increase
An aging population and the growth of minority populations are expected to add to the disease's prevalence, Albright said. African-Americans, Latinos, Native Americans and certain Asians and Pacific Islanders are at high risk of developing diabetes.
Advances in medicine, which may help people with the disease live longer, and better detection of diabetes are other reasons why its prevalence could dramatically increase by 2050, she said. Right now, 24 million Americans have Type 2 diabetes, but a quarter of them don't know it, according to the CDC.
And because people are living longer, more cases are likely to come from older people. The percentage of people ages 65 and older with diabetes is expected to increase; it was 12.4 percent in 2000, but will be 19.6 percent in 2030, Albright said.
"We're living longer, but Type 2 diabetes does get more prevalent as you age," she said. "The body's ability to use insulin does gradually decline, but that can be slowed by maintenance, diet and regular physical activity."
Need for interventions
Right now, about 60 million people in the United States have pre-diabetes — a stage of insulin resistance before full-blown diabetes. If these people don't change their exercise and eating habits now, they will develop diabetes in the next three to six years, Albright said.
"They don’t have a big window," she said.
It will take a combination of personal decisions and policy changes to turn the diabetes rate around. Making healthy food more accessible and implementing prevention programs will help, she said.
One such program is the CDC's new National Diabetes Prevention Program, which aims to provide people with information about diabetes, promote lifestyle changes and reduce disparities between different groups.
A clinical trial showed that high-risk people who went through this prevention program reduced their risk of developing diabetes by 58 percent, according to the report.
"It's not enough for research to be done, you need to get the [information] in people's hands," Albright said. The intervention program makes use of the research, but "environmental and lifestyle changes need to complement it to be successful."
MyHealthNewsDaily Copyright © 2010. All rights reserved.
Wednesday, December 22, 2010
What Is Peripheral Artery Disease?
Peripheral artery disease (PAD) can sometimes go undetected, so it's important to know the symptoms. Plus, learn about the possible complications of PAD and how the condition is treated.
Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.
Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.
Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke
"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."
If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.
Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.
It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.
When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.
Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.
Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.
Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.
Here are steps your doctor may recommend to treat and manage PAD:
Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods
In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.
By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH
Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.
Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.
Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke
"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."
If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.
Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.
It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.
When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.
Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.
Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.
Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.
Here are steps your doctor may recommend to treat and manage PAD:
Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods
In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.
By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH
Tuesday, December 7, 2010
Fearful of Complications
Q: I've had type 1 diabetes since I was a kid (I'm now 42). It's well controlled, but lately I'm starting to be really anxious about complications. What can I do to save myself from all the scary things that can happen to me as I get older?
– Brooke
A: Let me start by congratulating you on controlling your blood sugar — it is extremely important to your health. The discipline with which you've controlled your type 1 diabetes thus far, and close collaboration with your doctor, will surely help reduce your risk of worrisome complications.
Over the last several years, a number of studies have shown us that diabetes-related complications are the consequence of both poor glucose control and conditions such as high blood pressure and high cholesterol. The latter are associated with advancing age, genetic risk, and an unhealthy lifestyle. As long as you continue to control your blood sugar, with close follow-up from your doctor, then concentrating on lifestyle factors is the best way to improve your odds of avoiding complications.
As you grow older, regular exercise and ideal body weight maintenance become increasingly important components of diabetes care, blood pressure control, and lipid (cholesterol) management. Having a sustained normal or near-normal glucose level, blood pressure below 120/80, and a low cholesterol level (low-density lipoprotein level below 100 mg/dl) will stave off bad outcomes.
Besides home glucose monitoring, keep track of your glycosylated hemoglobin (hemoglobin A1c) level. Levels below 7 percent are associated with reduced complications — I prefer maintaining this level closer to 6 percent. Other risk factors you can change through exercise and a healthful diet include a high triglyceride level and a reduced level of high-density lipoprotein (HDL-C). A triglyceride level below 150 mg/dl and an HDL-C level above 40 mg/dl are associated with better health outcomes.
As an adult over age 40, you might be able to take daily aspirin, which considerably reduces cardiovascular risk. Do seek the advice of your doctor on this and other specific treatment and monitoring recommendations. Most important, if you use tobacco, stop. Quitting smoking is the single most critical step you will ever take toward preventing many of the diabetes-related complications.
– Brooke
A: Let me start by congratulating you on controlling your blood sugar — it is extremely important to your health. The discipline with which you've controlled your type 1 diabetes thus far, and close collaboration with your doctor, will surely help reduce your risk of worrisome complications.
Over the last several years, a number of studies have shown us that diabetes-related complications are the consequence of both poor glucose control and conditions such as high blood pressure and high cholesterol. The latter are associated with advancing age, genetic risk, and an unhealthy lifestyle. As long as you continue to control your blood sugar, with close follow-up from your doctor, then concentrating on lifestyle factors is the best way to improve your odds of avoiding complications.
As you grow older, regular exercise and ideal body weight maintenance become increasingly important components of diabetes care, blood pressure control, and lipid (cholesterol) management. Having a sustained normal or near-normal glucose level, blood pressure below 120/80, and a low cholesterol level (low-density lipoprotein level below 100 mg/dl) will stave off bad outcomes.
Besides home glucose monitoring, keep track of your glycosylated hemoglobin (hemoglobin A1c) level. Levels below 7 percent are associated with reduced complications — I prefer maintaining this level closer to 6 percent. Other risk factors you can change through exercise and a healthful diet include a high triglyceride level and a reduced level of high-density lipoprotein (HDL-C). A triglyceride level below 150 mg/dl and an HDL-C level above 40 mg/dl are associated with better health outcomes.
As an adult over age 40, you might be able to take daily aspirin, which considerably reduces cardiovascular risk. Do seek the advice of your doctor on this and other specific treatment and monitoring recommendations. Most important, if you use tobacco, stop. Quitting smoking is the single most critical step you will ever take toward preventing many of the diabetes-related complications.
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