Worse glycemic control correlated with slower wound healing in patients with diabetes. Every 1% increase in HbA1c was associated with -0.028 cm2decrement in the daily change in wound area....
Every 1% increase in hemoglobin A1c was associated with almost a 0.03 cm2reduction in daily rate of wound resolution. Diabetic patients with peripheral neuropathy or peripheral arterial disease (PAD) were especially susceptible to the impact of glycemic control on wound healing.
In a multivariate analysis, hemoglobin A1c, used as a surrogate for glycemic control, was the only independent predictor of change in wound area, according to a report.
Anna L. Christman, BA, of Johns Hopkins University in Baltimore, stated that, "Our results suggest that better glycemic control could help wound healing in diabetic patients, but that would have to be confirmed in a prospective clinical study."
"It would seem logical that glycemic control would affect wound healing, but to our knowledge, this is the first time the association has been clearly demonstrated," she added.
"Previous studies had evaluated the effect of glucose levels on the risk of amputation, and the results were inconsistent. Ours is the first study to use digital imaging of wounds to examine the association."
Diabetes continues to be a major contributor to lower-leg amputations, ranking second only to trauma as a cause. The necessity of amputation in diabetic patients arises from disease-related neuropathy and vasculopathy.
Identification of modifiable factors that influence wound healing could help reduce the need for amputation, Christman and colleagues noted in a poster presentation. To that end, they performed a retrospective cohort study to identify clinical variables associated with wound healing.
Investigators hypothesized that elevated A1c levels would be the strongest predictor of poor wound healing among common laboratory and clinical measures.
The study involved 183 diabetic patients with an average of 310 wounds and a total wound area that averaged 7.2 cm2. Clinical evaluation of the patients included blood pressure, pulse, temperature, and assessment of peripheral neuropathy status. Laboratory values of interest included HbA1c, total cholesterol, LDL, HDL, triglycerides, and white blood-cell count, as well as body mass index (BMI), smoking status, and presence of PAD.
The primary outcome was the change in the size of the wound area as determined by calibrated tracings of digital images. The impact of clinical variables on wound healing was assessed by multiple linear regression and investigators stratified the results by peripheral neuropathy status and PAD status.
The patients had a mean age of 61, with men and whites each accounting for 55% of the study population. The BMI averaged 35. The mean HbA1c was 8.0%, including 71 patients with values more than 7%, 42 patients with levels of 7.0 to 8.0%, and 70 with HbA1c values >8%.
A majority of the study group (60%) had peripheral neuropathy and 29% had PAD. The patients had an average of 2.3 wounds with a total wound area of 7.2 cm2.
In the overall analysis, HbA1c remained the only significant predictor of the change in wound area per day. Every 1% increase in HbA1c was associated with -0.028 cm2 decrement in the daily change in wound area (P=0.03).
The association remained significant in the stratified analyses. Among patients with peripheral neuropathy, each 1.0% increase in HbA1c was associated with a 0.022 cm2 decrease in the daily wound-healing rate (P=0.043).
Patients with PAD had a decrease in healing rate of 0.030 cm2 for every 1% increase in HbA1c (P=0.046).
Practice Pearls
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that a retrospective cohort study found diabetics with higher HbA1c had a significantly slower rate of wound healing than those with lower HbA1c.
Note that wound healing rates were calculated from calibrated tracings of digital wound images
Christman AL, et al "Hemoglobin A1ac predicts healing rate in diabetic wounds" SID 2011; Abstract 204
Thursday, June 16, 2011
Wednesday, June 15, 2011
Diet Soft Drinks Not Linked to Type 2 Diabetes
New research demonstrates that the consumption of diet soft drinks is not associated with an increased risk of type 2 diabetes....
The study adds weight to the significant research using low-calorie sweeteners that has shown intake of these ingredients does not affect the development of type 2 diabetes. The authors concluded, "This supports our hypothesis that participants use artificially sweetened beverages as dieting aids or because of poor health. A lack of adjustment for these [health and lifestyle] factors may therefore have contributed to illusory associations [between diet soda consumption and type 2 diabetes] in other studies." They further noted, "The association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index."
The researchers followed 40,389 adult men enrolled in the Health Professionals Follow-Up study from 1986 until 2006, to examine the associations between the normal consumption of sugar-sweetened beverages and diet soft drinks and the development of type 2 diabetes.
The data from 2,680 reported cases of type 2 diabetes developed over the 20-year study seemed to indicate that both types of beverages were associated with an increased incidence of type 2 diabetes. However, after adjusting for the health and lifestyle factors, including family history of type 2 diabetes, smoking, physical activity, high triglycerides, high blood pressure, diuretic use, body mass index (BMI), and total calorie intake, the Harvard University researchers found no significant association between diet soft drinks and incidence of type 2 diabetes.
Major health organizations including the American Diabetes Association and the American Dietetic Association support the use of low-calorie sweeteners for people with diabetes to control calorie intake. The American Dietetic Association states in its position paper on the use of nutritive and nonnutritive sweeteners, "Nonnutritive sweeteners are appropriate in medical nutrition therapy for people with diabetes and may help control energy intake." The statement further notes, "Nonnutritive sweeteners do not affect glycemic response and can be safely used by those with diabetes." "When used as part of an overall healthy diet, low-calorie sweeteners, diet soft drinks and other light products can be beneficial tools in helping people control caloric intake and weight," adds Beth Hubrich, a registered dietitian with the Calorie Control Council, an international trade association.
American Journal of Clinical Nutrition, May 2011
The study adds weight to the significant research using low-calorie sweeteners that has shown intake of these ingredients does not affect the development of type 2 diabetes. The authors concluded, "This supports our hypothesis that participants use artificially sweetened beverages as dieting aids or because of poor health. A lack of adjustment for these [health and lifestyle] factors may therefore have contributed to illusory associations [between diet soda consumption and type 2 diabetes] in other studies." They further noted, "The association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index."
The researchers followed 40,389 adult men enrolled in the Health Professionals Follow-Up study from 1986 until 2006, to examine the associations between the normal consumption of sugar-sweetened beverages and diet soft drinks and the development of type 2 diabetes.
The data from 2,680 reported cases of type 2 diabetes developed over the 20-year study seemed to indicate that both types of beverages were associated with an increased incidence of type 2 diabetes. However, after adjusting for the health and lifestyle factors, including family history of type 2 diabetes, smoking, physical activity, high triglycerides, high blood pressure, diuretic use, body mass index (BMI), and total calorie intake, the Harvard University researchers found no significant association between diet soft drinks and incidence of type 2 diabetes.
Major health organizations including the American Diabetes Association and the American Dietetic Association support the use of low-calorie sweeteners for people with diabetes to control calorie intake. The American Dietetic Association states in its position paper on the use of nutritive and nonnutritive sweeteners, "Nonnutritive sweeteners are appropriate in medical nutrition therapy for people with diabetes and may help control energy intake." The statement further notes, "Nonnutritive sweeteners do not affect glycemic response and can be safely used by those with diabetes." "When used as part of an overall healthy diet, low-calorie sweeteners, diet soft drinks and other light products can be beneficial tools in helping people control caloric intake and weight," adds Beth Hubrich, a registered dietitian with the Calorie Control Council, an international trade association.
American Journal of Clinical Nutrition, May 2011
Deadly Fungus Strikes Joplin Tornado Survivors, Volunteers
William Browning William Browning – Thu Jun 9, 2:16 pm ET
Contribute content like this. Start here.
The Greene County (Mo.) Health Department has issued a memo to health care workers who are treating injured victims of May's deadly Joplin tornado, warning them that a powerful fungus has infected patients' wounds.
The Springfield News-Leader reports as many as nine cases have been reported in tornado victims across the area in various hospitals. Once the aggressive fungus -- called zygomycosis -- enters the body, it causes the death of infected cells. Three or four patients, who otherwise would have survived their wounds, have died from it.
If the fungus stays in a limb, like an arm or leg, some treatments have necessitated amputation to save the patient. Others with wounds near the head weren't so lucky -- as soon as brain tissue started dying, it was too late to save the patient.
The National Institutes of Health says this rapid form of infection most often occurs in patients with suppressed immune systems. One study in 2009 noted a diabetes patient who died of the fungal infection at age 48. Despite being treated early, the man's health rapidly declined as the fungus spread through his lungs.
Infections spread through the blood and affects blood circulation. It is unknown how many people may be suffering from infections, but the problem doesn't stop with those injured by the tornado.
KYTV in Springfield reports those helping with cleanup efforts may become scratched by nails or splinters and any fungus residue on those objects may infect someone.
Anyone with diabetes should be extremely careful. The National Institutes of Health lists severe symptoms of the infection: fever, headache, sinus pain, and swelling. Complications that can arise from these fungal infections include nerve damage, blindness, blood clots to the brain and lungs, or even death in extreme cases.
Cases of the deadly fungal infection have shown up in massive disasters before such as the 2004 tsunami off the coast of Indonesia. Health officials in Greene County stated in their memo that this particular infection is "invasive" and that aggressive treatment may be needed "within 24 hours" of reoccurring symptoms.
Any patients suspected of having this infection have been told to seek the guidance of a trauma surgeon or the infectious disease doctor on call.
William Browning, a lifelong Missouri resident, writes about local and state issues for the Yahoo! Contributor Network. Born in St. Louis, Browning earned his bachelor's degree in English from the University of Missouri. He currently resides in Branson.
Contribute content like this. Start here.
The Greene County (Mo.) Health Department has issued a memo to health care workers who are treating injured victims of May's deadly Joplin tornado, warning them that a powerful fungus has infected patients' wounds.
The Springfield News-Leader reports as many as nine cases have been reported in tornado victims across the area in various hospitals. Once the aggressive fungus -- called zygomycosis -- enters the body, it causes the death of infected cells. Three or four patients, who otherwise would have survived their wounds, have died from it.
If the fungus stays in a limb, like an arm or leg, some treatments have necessitated amputation to save the patient. Others with wounds near the head weren't so lucky -- as soon as brain tissue started dying, it was too late to save the patient.
The National Institutes of Health says this rapid form of infection most often occurs in patients with suppressed immune systems. One study in 2009 noted a diabetes patient who died of the fungal infection at age 48. Despite being treated early, the man's health rapidly declined as the fungus spread through his lungs.
Infections spread through the blood and affects blood circulation. It is unknown how many people may be suffering from infections, but the problem doesn't stop with those injured by the tornado.
KYTV in Springfield reports those helping with cleanup efforts may become scratched by nails or splinters and any fungus residue on those objects may infect someone.
Anyone with diabetes should be extremely careful. The National Institutes of Health lists severe symptoms of the infection: fever, headache, sinus pain, and swelling. Complications that can arise from these fungal infections include nerve damage, blindness, blood clots to the brain and lungs, or even death in extreme cases.
Cases of the deadly fungal infection have shown up in massive disasters before such as the 2004 tsunami off the coast of Indonesia. Health officials in Greene County stated in their memo that this particular infection is "invasive" and that aggressive treatment may be needed "within 24 hours" of reoccurring symptoms.
Any patients suspected of having this infection have been told to seek the guidance of a trauma surgeon or the infectious disease doctor on call.
William Browning, a lifelong Missouri resident, writes about local and state issues for the Yahoo! Contributor Network. Born in St. Louis, Browning earned his bachelor's degree in English from the University of Missouri. He currently resides in Branson.
Monday, June 13, 2011
Weight Gain between First and Second Pregnancies Increases Woman's Gestational Diabetes Risk
Compared with women whose weight remained stable, body mass index gains between the first and second pregnancy were associated with an increased risk of gestational diabetes mellitus in the second pregnancy....
But losing weight between the first and second pregnancies appeared to reduce GDM risk in a second pregnancy, particularly for women who were overweight or obese to begin.
GDM is associated with an increased risk of adverse perinatal outcomes as well as subsequent diabetes in women and their offspring, researchers say.
The study examined a diverse cohort of 22,351 women over a 10-year period. Women who gained 2.0-2.9 BMI units (approximately 12 to 17 pounds) between the first and second pregnancy were over two times more likely to develop GDM in the second pregnancy, compared with those whose weight remained stable (plus or minus 6 pounds between pregnancies). Women who gained 3.0 or more BMI units (approximately 18 or more pounds) between the first and second pregnancy were over three times more likely to develop GDM during the second pregnancy, compared with those whose weight remained stable.
Conversely, women who lost more than 6 pounds between the first and second pregnancy reduced their risk of developing GDM in the second pregnancy by approximately 50 percent compared with women whose weight remained stable. The association between losing weight and reduced GDM risk was strongest in women who were overweight or obese in their first pregnancy, explained the researchers.
Previous research has shown that excessive postpartum weight retention and lifestyle changes have been associated with a woman being overweight years after pregnancy, which increases the risk of developing non-insulin-dependent diabetes, said study lead investigator Samantha Ehrlich, MPH. Weight gain before pregnancy and gestational weight gain similarly have been shown to increase the risk of GDM. Additional research has shown that a pregnancy complicated by GDM is associated with a high risk of recurrent GDM in a subsequent pregnancy, explained Ehrlich, who is a PhD candidate in epidemiology at the University of California at Berkeley.
This study is the first to examine whether weight loss before a second pregnancy reduces the risk of recurrent GDM.
Women who lose BMI units between pregnancies appear to have a decreased risk of GDM in their second pregnancy, but there was significant variation by maternal overweight or obese status in the first pregnancy. Weight loss was associated with lower risk of GDM, primarily among women who were overweight or obese in their first pregnancy, Ehrlich said.
She explained that being overweight or obese prior to pregnancy is a well-established risk factor for GDM. Women of normal weight who go on to develop GDM are likely to be more genetically susceptible to the disease. Thus, lifestyle changes resulting in weight loss may not be as effective in reducing GDM risk among normal weight women, she added.
"The results also suggest that the effects of body mass gains may be greater among women of normal weight in their first pregnancy, whereas the effects of losses in body mass appear greater among overweight or obese women," Ehrlich said. "Taken together, the results support the avoidance of gestational weight retention and postpartum weight gain to decrease the risk of GDM in a second pregnancy, as well as the promotion of postpartum weight loss in overweight or obese women, particularly those with a history of GDM."
In the study, BMI change was calculated for each woman. The average height of women in the study was 5 feet 4 inches and one BMI unit corresponded to approximately 6 pounds for women of that height.
A study in the American Journal of Epidemiology found that cardio-metabolic risk factors such as high blood sugar and insulin, and low high-density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy.
A study in The American Journal of Obstetrics and Gynecology found there is an increased risk of recurring gestational diabetes in pregnant women who developed gestational diabetes during their first and second pregnancies.
A study in Diabetes Care of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child's risk of becoming obese years later is significantly reduced.
A study in Obstetrics & Gynecology of 1,145 pregnant women found that women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy.
A study in Ethnicity & Disease of 16,000 women in Hawaii found that more than 10 percent of women of Chinese and Korean heritage may be at risk for developing gestational diabetes.
Obstetrics & Gynecology May 2011
But losing weight between the first and second pregnancies appeared to reduce GDM risk in a second pregnancy, particularly for women who were overweight or obese to begin.
GDM is associated with an increased risk of adverse perinatal outcomes as well as subsequent diabetes in women and their offspring, researchers say.
The study examined a diverse cohort of 22,351 women over a 10-year period. Women who gained 2.0-2.9 BMI units (approximately 12 to 17 pounds) between the first and second pregnancy were over two times more likely to develop GDM in the second pregnancy, compared with those whose weight remained stable (plus or minus 6 pounds between pregnancies). Women who gained 3.0 or more BMI units (approximately 18 or more pounds) between the first and second pregnancy were over three times more likely to develop GDM during the second pregnancy, compared with those whose weight remained stable.
Conversely, women who lost more than 6 pounds between the first and second pregnancy reduced their risk of developing GDM in the second pregnancy by approximately 50 percent compared with women whose weight remained stable. The association between losing weight and reduced GDM risk was strongest in women who were overweight or obese in their first pregnancy, explained the researchers.
Previous research has shown that excessive postpartum weight retention and lifestyle changes have been associated with a woman being overweight years after pregnancy, which increases the risk of developing non-insulin-dependent diabetes, said study lead investigator Samantha Ehrlich, MPH. Weight gain before pregnancy and gestational weight gain similarly have been shown to increase the risk of GDM. Additional research has shown that a pregnancy complicated by GDM is associated with a high risk of recurrent GDM in a subsequent pregnancy, explained Ehrlich, who is a PhD candidate in epidemiology at the University of California at Berkeley.
This study is the first to examine whether weight loss before a second pregnancy reduces the risk of recurrent GDM.
Women who lose BMI units between pregnancies appear to have a decreased risk of GDM in their second pregnancy, but there was significant variation by maternal overweight or obese status in the first pregnancy. Weight loss was associated with lower risk of GDM, primarily among women who were overweight or obese in their first pregnancy, Ehrlich said.
She explained that being overweight or obese prior to pregnancy is a well-established risk factor for GDM. Women of normal weight who go on to develop GDM are likely to be more genetically susceptible to the disease. Thus, lifestyle changes resulting in weight loss may not be as effective in reducing GDM risk among normal weight women, she added.
"The results also suggest that the effects of body mass gains may be greater among women of normal weight in their first pregnancy, whereas the effects of losses in body mass appear greater among overweight or obese women," Ehrlich said. "Taken together, the results support the avoidance of gestational weight retention and postpartum weight gain to decrease the risk of GDM in a second pregnancy, as well as the promotion of postpartum weight loss in overweight or obese women, particularly those with a history of GDM."
In the study, BMI change was calculated for each woman. The average height of women in the study was 5 feet 4 inches and one BMI unit corresponded to approximately 6 pounds for women of that height.
A study in the American Journal of Epidemiology found that cardio-metabolic risk factors such as high blood sugar and insulin, and low high-density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy.
A study in The American Journal of Obstetrics and Gynecology found there is an increased risk of recurring gestational diabetes in pregnant women who developed gestational diabetes during their first and second pregnancies.
A study in Diabetes Care of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child's risk of becoming obese years later is significantly reduced.
A study in Obstetrics & Gynecology of 1,145 pregnant women found that women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy.
A study in Ethnicity & Disease of 16,000 women in Hawaii found that more than 10 percent of women of Chinese and Korean heritage may be at risk for developing gestational diabetes.
Obstetrics & Gynecology May 2011
Sunday, June 12, 2011
Broccoli Sprouts Have Benefits for Diabetes Patients
Broccoli sprouts may boost antioxidant defenses in people with diabetes....
According to findings, a daily dose of five or 10 grams of the broccoli sprout powder was associated with an increase in the total antioxidant capacity of the blood, and reductions in malondialdehyde (MDA), a reactive carbonyl compound and a well-established marker of oxidative stress. The study adds to the growing body of science supporting the potential health benefits of broccoli and broccoli sprouts, most often touted for their potential anti-cancer activity.
The tissue of cruciferous vegetables, like broccoli, cauliflower, cabbage and Brussels sprouts, contain high levels of the active plant chemicals glucosinolates. These are metabolized by the body into isothiocyanates, which are known to be antioxidants and powerful anti-carcinogens. The main isothiocyanate from broccoli is sulphoraphane.
The new study employed a broccoli sprout powder that provided a dose of sulphoraphane isothiocyanates of 22.5 micromoles per gram, and looked at the potential antioxidant activity of broccoli sprout powder to counter oxidative stress in diabetics.
Oxygen-breathing organisms naturally produce reactive oxygen species (ROS), which play an important role in a range of functions, including cell signaling. However, over production of these ROS from smoking, pollution, sunlight, high intensity exercise, or simply ageing, may overwhelm the body's antioxidant defenses and lead to oxidative stress.
Oxidative stress has been linked to an increased risk of various diseases including cancer, Alzheimer's, and cardiovascular disease.
Researchers also note that oxidative stress is a key driver in the onset of insulin resistance, which ultimately leads to diabetes. Diabetes itself is associated with increased levels of oxidative stress, and this can promote the development of diabetes-related complications
Researchers from the National Nutrition and Food Technology Research Institute at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, recruited 81 diabetics to participate in their double-blind, placebo-controlled, randomized clinical trial.
Participants were randomly assigned to receive either five or 10 grams per day of the broccoli sprout powder, or placebo, for four weeks.
Results showed that both broccoli groups experienced significant decreases in MDA, a well-established marker of oxidative stress, as well as reductions in levels of oxidized LDL cholesterol, another oxidative stress marker.
The doses used in this study provided 225 micromoles and 112 micromoles sulforaphane isothiocyanates daily per 10 g and 5 g broccoli sprout doses, respectively.
European Journal of Clinical Nutrition; "Broccoli sprouts reduce oxidative stress in type 2 diabetes: a randomized double-blind clinical trial" Z Bahadoran, P Mirmira, et al
According to findings, a daily dose of five or 10 grams of the broccoli sprout powder was associated with an increase in the total antioxidant capacity of the blood, and reductions in malondialdehyde (MDA), a reactive carbonyl compound and a well-established marker of oxidative stress. The study adds to the growing body of science supporting the potential health benefits of broccoli and broccoli sprouts, most often touted for their potential anti-cancer activity.
The tissue of cruciferous vegetables, like broccoli, cauliflower, cabbage and Brussels sprouts, contain high levels of the active plant chemicals glucosinolates. These are metabolized by the body into isothiocyanates, which are known to be antioxidants and powerful anti-carcinogens. The main isothiocyanate from broccoli is sulphoraphane.
The new study employed a broccoli sprout powder that provided a dose of sulphoraphane isothiocyanates of 22.5 micromoles per gram, and looked at the potential antioxidant activity of broccoli sprout powder to counter oxidative stress in diabetics.
Oxygen-breathing organisms naturally produce reactive oxygen species (ROS), which play an important role in a range of functions, including cell signaling. However, over production of these ROS from smoking, pollution, sunlight, high intensity exercise, or simply ageing, may overwhelm the body's antioxidant defenses and lead to oxidative stress.
Oxidative stress has been linked to an increased risk of various diseases including cancer, Alzheimer's, and cardiovascular disease.
Researchers also note that oxidative stress is a key driver in the onset of insulin resistance, which ultimately leads to diabetes. Diabetes itself is associated with increased levels of oxidative stress, and this can promote the development of diabetes-related complications
Researchers from the National Nutrition and Food Technology Research Institute at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, recruited 81 diabetics to participate in their double-blind, placebo-controlled, randomized clinical trial.
Participants were randomly assigned to receive either five or 10 grams per day of the broccoli sprout powder, or placebo, for four weeks.
Results showed that both broccoli groups experienced significant decreases in MDA, a well-established marker of oxidative stress, as well as reductions in levels of oxidized LDL cholesterol, another oxidative stress marker.
The doses used in this study provided 225 micromoles and 112 micromoles sulforaphane isothiocyanates daily per 10 g and 5 g broccoli sprout doses, respectively.
European Journal of Clinical Nutrition; "Broccoli sprouts reduce oxidative stress in type 2 diabetes: a randomized double-blind clinical trial" Z Bahadoran, P Mirmira, et al
Saturday, June 11, 2011
Lowering Fat Intake Might Stave off Diabetes Even without Weight Loss
Small differences in diet -- even without weight loss -- can significantly affect risk for diabetes....
In this study, 69 healthy, overweight people who did not have diabetes -- but were at risk for it -- were placed on diets with modest reductions in either fat or carbohydrate for eight weeks.
Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at University of Alabama at Birmingham and lead author of the study noted that, "At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity." "These improvements indicate a decreased risk for diabetes."
Gower says the unique aspect of this study is that the results were independent of weight loss.
The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.
"People find it hard to lose weight," said Gower. "What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."
The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.
Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate. The lower carb group's diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.
"The diets used in this study were actually fairly moderate," said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. "Individuals at risk for diabetes easily could adopt the lower fat diet we employed. Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease."
A typical dinner meal on the lower fat diet would include sesame chicken with rice, snow peas and carrots, frozen broccoli, fat-free cheese, oranges and a dinner roll.
Gower says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.
Published online May 18, 2011, by the American Journal of Clinical Nutrition
In this study, 69 healthy, overweight people who did not have diabetes -- but were at risk for it -- were placed on diets with modest reductions in either fat or carbohydrate for eight weeks.
Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at University of Alabama at Birmingham and lead author of the study noted that, "At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity." "These improvements indicate a decreased risk for diabetes."
Gower says the unique aspect of this study is that the results were independent of weight loss.
The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.
"People find it hard to lose weight," said Gower. "What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."
The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.
Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate. The lower carb group's diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.
"The diets used in this study were actually fairly moderate," said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. "Individuals at risk for diabetes easily could adopt the lower fat diet we employed. Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease."
A typical dinner meal on the lower fat diet would include sesame chicken with rice, snow peas and carrots, frozen broccoli, fat-free cheese, oranges and a dinner roll.
Gower says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.
Published online May 18, 2011, by the American Journal of Clinical Nutrition
Thursday, June 9, 2011
Patients with Type 2 Diabetes Lack Knowledge about Hypoglycemia
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.
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.
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