Monthly Archives: July 2021

July 16, 2021

If you have diabetes, even a minor cut or scrape can turn into a serious problem. Heres how to treat a wound properly to protect your health.

For most people, a nick or a scrape is no big deal. But for someone with diabetes, even a minor cut or scrape can turn into a very serious problem if not treated properly.

Diabetes impacts white blood cell function, which obstructs the bodys ability to fight bacteria and close wounds, says Asaad H. Samra, M.D., director of the Center for Wound Healing at Bayshore Medical Center. In addition, people with uncontrolled diabetes may develop poor circulation, making it difficult for the body to deliver nutrients to injured areas, which hinders the healing process.

Thats why its crucial for people with diabetes to correctly treat any wound, no matter how minor it seems. Heres some advice from Dr. Samra:

Wash the wound thoroughly. Use an antibacterial soap and warm water to clean out the wound. Then pat dry with a clean cloth and apply over-the-counter antibacterial ointment.

Cover the wound. Use a bandage to keep the wound clean, moist and protected. Its now considered old, inaccurate information to let a wound dry out, says Dr Samra.

Redress it daily. Take off the bandage and make sure nothing has significantly changed since the last time you saw the wound. Use soap and water to wash away the old ointment, then pat dry and apply a fresh coat. If, after a few days, you feel the wound is healing well, you can stretch the redressing to every other day.

Inspect it every time you change the bandage. If you dont see improvement over the course of a week, or if any redness or foul smell develops, call your doctor. Also contact your doctor if the wound fails to heal within four to six weeks.

Check your feet daily. Diabetes can lead to neuropathy, which limits sensation in the extremities. So someone with diabetes could have an injury on their foot and not even know it, says Dr. Samra. This, plus poor blood flow, puts you at risk for developing an infection from a foot sore. Be on the lookout for any cuts, sores, blisters, swelling or any changes to the skin or nails. Dont forget to check the bottom of your feet (use a mirror). And never go barefoot, even inside your house.

Next Steps & Resources:

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

View original post here:
How Diabetics Should Treat Cuts and Scrapes - Diabetes, Health Topics - Hackensack Meridian Health

If youre preparing for the United States Medical Licensing Examination (USMLE) Step 3 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check outall posts in this series.

The AMA selected Kaplan as a preferred provider to support you in reaching your goal of passing the USMLE or COMLEX-USA.AMA members can save 30% on access to additional study resources, such as Kaplans Qbank and High-yield courses. Learn more.

This months stumper

A 69-year-old woman with a 15-year history of type 2 diabetes mellitus presents to the emergency department with shortness of breath for two hours. There is no chest pain, diaphoresis, dizziness, or nausea. Past medical history is significant for diabetic foot ulcers. She has been postmenopausal for the past 18 years. Her blood pressure is 125/80 mm Hg, pulse is 70 beats per minute, and respirations are 15 breaths a minute.

On physical examination, there is a third heart sound present, but the rate and rhythm are normal. There are rales at the bilateral lung bases, but there is no wheezing or rhonchi. A chest radiograph reveals a normal mediastinum and a fine interstitial infiltrate with pleural effusions. The next step in evaluating this patient is to:

A. Order a complete blood count.

B. Order an echocardiogram.

C. Order an electrocardiogram.

D. Perform a stress treadmill test.

E. Send her for pulmonary function tests.

The correct answer is C.

Kaplan Medical explains why

Patients with diabetes are prone to silent ischemiathat is myocardial infarction without chest pain due to neuropathy. Furthermore, some postmenopausal women who are not on hormone replacement therapy are at a higher risk of cardiac disease in comparison to women who take hormones.

A 2007 study showed women receiving estrogen alone hormone-replacement therapy resulted in fewer events related to coronary heart disease (CHD) if initiated between the ages of 50 and 59 years or within 10 years after menopause. An electrocardiogram is the most important initial test for myocardial infarction. Cardiac enzymes (creatinine kinase, troponin) must also be obtained serially to rule out myocardial infarction.

Why the other answers are wrong

Choice A: This patient has no evidence of pneumonia on the chest radiograph. The patient's presentation is not consistent with pneumonia. Acute onset of shortness of breath is not consistent with pneumonia. A complete blood count would be routinely ordered in the work up of ischemia, however.

Choice B: An echocardiogram is necessary for the work up of congestive heart failure, but it is of limited use in evaluating cardiac ischemia. This test may be necessary if an acute myocardial infarction is ruled out.

Choice D: A stress or exercise treadmill test may be necessary to work up cardiac ischemia once an acute myocardial infarction is ruled out.

Choice E: A pulmonary function test will probably be necessary in the future if no cardiac ischemia is detected, and interstitial lung disease is suspected. This test may be necessary to work up cardiac ischemia once an acute myocardial infarction is ruled out.

For more prep questions on USMLE Steps 1, 2 and 3, viewother posts in this series.

Continue reading here:
Kaplan USMLE Step 3 prep: Shortness of breath in woman with diabetes - American Medical Association

The FDA has approved finerenone for the treatment of adult patients with chronic kidney disease associated with type 2 diabetes.

The FDA has approved finerenone (Kerendia, Bayer) for the treatment of adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Finerenone is a first-in-class nonsteroidal mineralocorticoid receptor antagonist (MRA) indicated to reduce the risk of sustained estimated glomerular filtration rate decline, kidney failure, cardiovascular death, non-fatal myocardial infarction and hospitalization for heart failure. It is also the first and only nonsteroidal MRA that has been approved for use in this patient population.

The FDA approval was based on the results from the phase 3 FIDELIO-DKD trial, which demonstrated positive kidney and cardiovascular outcomes in patients with CKD associated with T2D. The approval also follows the previously granted priority review designation by the FDA.

The patient population included in the trial that supported the approval of Kerendia were at risk of chronic kidney disease progression despite receiving standard of care treatment to control blood pressure and blood glucose, said lead study investigator George Bakris, MD, University of Chicago, in a press release. In people with chronic kidney disease associated with type 2 diabetes, physicians now have a new treatment to provide kidney protection.

Currently, many patients with CKD associated with T2D are at risk for CKD progression and the occurrence of cardiovascular events. Known to be a leading cause of end-stage kidney disease, T2D can cause patients to need dialysis or a kidney transplant in order to stay alive. Additionally, Black and Hispanic American patients have been found to have increased rates of kidney failure in comparison to white patients.

Chronic kidney disease associated with type 2 diabetes can have such a debilitating impact on patients lives. Unfortunately, this disease is far reaching, as up to 40% of all patients with type 2 diabetes develop chronic kidney disease, said kidney transplant patient Kevin Longino, CEO, National Kidney Foundation, in the press release. It is important for physicians and patients to have new treatment options that can slow chronic kidney disease progression.

Finerenone has been found to be successful in this patient population because of its ability to block the overactivation of the mineralocorticoid receptor, which is thought to contribute to fibrosis and inflammation. If fibrosis and inflammation occurs, these issues can lead to permanent kidney damage.

Kerendia is the first and only nonsteroidal mineralocorticoid receptor antagonist proven to significantly slow chronic kidney disease progression and reduce cardiovascular risk in people with chronic kidney disease associated with type 2 diabetes, said Amit Sharma, MD, vice president of cardiovascular and renal, Bayer US Medical Affairs, in the press release. We are excited to bring this new kidney-focused treatment to people living with this condition.

Currently, finerenone is planned to be available in the United States at the end of July 2021. Additionally, finerenone has been submitted by Bayer for marketing authorization in the European Union.

REFERENCE

Bayers KERENDIA (finerenone) Receives U.S. FDA Approval for Treatment of Patients with Chronic Kidney Disease Associated with Type 2 Diabetes. Whippany, NJ: Bayer; July 10, 2021. https://www.businesswire.com/news/home/20210709005441/en. Accessed July 20, 2021.

The rest is here:
Finerenone Receives FDA Approval for Treatment of Chronic Kidney Disease Associated with Type 2 Diabetes - Pharmacy Times

Guidelines from the CDC, American Diabetes Association, and the American College of Obstetricians and Gynecologists recommend providers offer women with diabetes or hypertension pre-pregnancy health counseling to mitigate the increased maternal and infant risk associated with both conditions. However, not much is known about how many women actually receive this important counseling.

Pre-pregnancy counseling is counseling a woman receives from their health care provider in one or many visitscounseling can cover a variety of topics. For women with diseases like diabetes or hypertension, these counseling sessions can offer the information a woman needs to care for herself and any future children before pregnancy or even before conception.

Through PRAMS, the CDC asks women to provide responses a year after birth to see if they received one or all of four types of pre-pregnancy counseling: counseling on folic acid, too much of which can cause neural defects in infants; a discussion on whether a woman desired to get pregnant; birth control counseling; and how to prepare for a healthy pregnancy. The study revealed that less than half the women reported receiving the recommended pre-pregnancy counseling. This shows a lack of care for women with these conditions and a need for evidence-based and patient-centered models of pre-pregnancy counseling for those with diabetes and hypertension, according to the study.

Previous studies have found that womenregardless of whether they have diabetes or hypertensionare less likely to know about their care and risk before or during pregnancy, regardless of age, race, whether they had been pregnant before. Black and Latina women of reproductive age are particularly impacted by diabetes and hypertension. The studys data found that of the women surveyed, 18.51% non-Hispanic Black women had diabetes alone, 33.7% had hypertension alone, and 12.11% had both hypertension and diabetes. Of those Hispanic women surveyed, 29.23% of women had diabetes alone, 16.16% had hypertension alone, and 13.2% had both hypertension and diabetes.

The model used by physicians for pre-pregnancy counseling depends, according to Marshall, on how physicians are given options for patient-centered care.

Marshall hopes to expand her research to include the development of a decision-support tool that would allow patients to determine what they need from their physician before their visit. She is also looking to expand her study to include women who may have experienced stillbirths or deliveries other than live birth, a cross section of women missing from the dataset used in the paper.

Im an interventionist which means Im always trying to get to a point where we can develop, implement and evaluate methods that can improve healthcare delivery. So given my interest, its helpful to see where things are now, says Marshall.

Study co-authors included Berkeley Public Healths Zille Huma, MPH, MBBS, and Julianna Deardorff, PhD, and Laura E. Britton, PhD, RN, of Columbia University School of Nursing.

View the full study

Go here to see the original:
Women with diabetes and hypertension don't receive recommended pre-pregnancy counseling - UC Berkeley Public Health - UC Berkeley School of Public...

Diabetes is at record levels in the U.S.nearly 34 million Americans, or 10.5% of the population, is affected. The condition occurs when the body is unable to adequately process blood sugar. That can damage blood vessels throughout the body, potentially leading to heart disease, stroke, blindness, and amputation. But diabetes generally doesn't develop overnight. Little things you do regularly, without thinking, may be seriously raising your risk. Here is what doctors who treat diabetes say are the everyday habits that lead to diabetes. Read onand to ensure your health and the health of others, don't miss these Sure Signs You Have "Long" COVID and May Not Even Know It.

"One of the common unhealthy habits is having soda to quench your thirst, when what you need is water," says Thomas Horowitz, DO, a family medicine specialist at CHA Hollywood Presbyterian Medical Center in Los Angeles. "The sugar content of items commonly consumed can be very higha Super Gulp soft drink consists of a handful of sugar; a can of soda or a sweet cereal is far more that your body may be able to handle." Kathleen Wyne, MD, Ph.D., an endocrinologist who treats patients with diabetes at The Ohio State University Wexner Medical Center, agrees: "For many people, stopping sugared soda leads to rapid 20-pound weight loss."

"Diabetes is when your body cannot provide enough insulin to allow glucose (sugar) into the hungry cells of your body," says Horowitz. "The best way to avoid it is to be on a diet that does not task your insulin supply." He recommends choosing foods that break down slowly or have limited sugarfor example, protein, whole grains and vegetables instead of refined grains or sweets."

A sedentary lifestyle is a major risk factor for diabetes. The good news: "Any activity can improve insulin sensitivity and slow the progression to diabetes," says Wyne. Her suggestions to sneak some extra walking into your day: Park at the back of parking lots instead of the front; wake up early to go for a stroll instead of sleeping in; take a walk instead of eating dessert; or get a dog that needs to be walked a few times a day.

Wyne offers these tips to avoid the overeating that can lead to diabetes and other health problems:

Even if you're exercising regularly, long periods of sitting can create metabolic changes which increase blood sugar, weaken muscles and imperil your heart health, says Sarah Rettinger, MD, an endocrinologist at Providence Saint John's Health Center in Santa Monica, California. She recommends setting a timer reminding you to get up and move every hour for at least five to ten minutes. "If you can't take a short walk outside, walk up and down stairs, take a few laps around the house or apartment, do a few jumping jacksanything to get your heart rate up a bit, or to make you a little out of breath," says Rettinger. "Over the course of a day, these mini-breaks really add up."

"Everyone knows he or she has to eat healthfully. I would add that eating mindfully can be helpful," says Rettinger. "If you find yourself standing near the fridge over-eating, take a pause and ask, 'Why am I eating? Am I hungry? Or am I bored, stressed or do I need soothing?' Some patients find it helpful to limit themselves to eating only at mealtimes or before a specific time of night." In Rettinger's home, the kitchen is closed after 8 pm.

RELATED: 7 Signs You've Got a "Deadly" Blood Clot Inside You

"Have 'scaffolding'make sure that everyone in your household is on the same page about your health," says Rettinger. "It's hard enough to eat healthfully sometimes. You don't want a family member bringing in doughnuts or making late-night ice-cream runs. It's easier to stick with healthy habits when others around you are as well." Likewise, if you're confused, struggling or frustrated about how to stick to a healthy lifestyle, ask your healthcare provider for help. And to get through life at your healthiest, don't miss these 13 Everyday Habits That Are Secretly Killing You.

See the original post here:
7 Ways You Can Give Yourself Diabetes, Doctors Say | Eat This Not That - Eat This, Not That

July 20 (UPI) -- Using wearable fitness trackers boosts physical activity levels in adults who are overweight and those with diabetes and heart disease, according to an analysis published Tuesday by JAMA Network Open.

In the review of data from 34 clinical studies that collectively included nearly 3,800 participants, these devices, which include step counters and accelerometers that record movement, boosted physical activity levels by about 70%, the data showed.

With step counters, or pedometers, this translated into an additional 1,900 steps per day over the course of a roughly 15-week period, the researchers said.

Still, even with improvements seen in those using the devices, which were more pronounced with step counters, study subjects' physical activity levels remained lower than recommended.

"In this study, interventions of the use of wearable activity trackers and in particular pedometers were associated with greater physical activity levels per day among people with cardiometabolic conditions," wrote researchers from the University of Manchester in England.

"Nevertheless, the improvements were generally lower than those recommended in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report by the U.S. Department of Health and Human Services and in other recommendations from global governments and agencies," they said.

In most of the studies included in the analysis, wearable fitness trackers were prescribed by healthcare providers as part of a self-management plan for these chronic health conditions.

The U.S. Department of Health and Human Services recommends that adults engage in at least 150 to 300 minutes of moderate-intensity aerobic activity, such as brisk walking or fast dancing, every week.

This type of aerobic exercise is particularly beneficial in people with diabetes and heart disease, as it can help maintain healthy blood sugar, blood pressure and cholesterol levels, according to the American Diabetes Association and American Heart Association.

Wearable activity trackers "may empower people with cardiometabolic conditions to improve their physical activity levels," the authors of this study wrote.

Devices such as pedometers, or portable electrical trackers that count each step a person takes, and accelerometers or fitness trackers, which measure acceleration forces, "are simple, relatively affordable [and] user-friendly," they said.

The 34 studies included in this analysis assessed the role of these devices in improving physical activity in 3,793 people who were overweight and diagnosed with diabetes, heart disease or both. Study participants were between age 30 and 65.

Eight of the included studies focused specifically on wearable fitness trackers, while the remaining 26 evaluated pedometers or step counters.

Collectively, based on cumulative results from all the studies, the devices increased physical activity levels by about 70%, the data showed.

Pedometer users saw, on average, roughly 85% increases in step counts, while accelerometer users experienced 30% gains in "moderate-vigorous physical activity."

Users of these devices also had modest improvements in blood sugar and blood pressure levels as well as body weight, according to the researchers.

The findings "suggest that interventions that combine the use of monitoring devices ... with regular consultations with healthcare professionals" may have the most significant effect on physical activity improvements, the researchers wrote.

"Giving feedback and lifestyle advice to patients regularly may support the effectiveness of these interventions," they said.

See the original post here:
Study: Fitness trackers boost exercise in adults with diabetes, heart disease - UPI News

Chronic kidney disease (CKD) and diabetes are associated with deceased quality-of-life. The combined impact of having both diseases is less well known. Melanie L. R. Wyld, MBBS, MBA, MPH, and colleagues conducted a prospective, longitudinal cohort study to measure quality-of-life in patients with both CKD and diabetes. Results were reported in Nephrology Dialysis Transplantation [2021;36(6):1048-1056].

The study included community-based Australians 25 years of age who participated in the Australian Diabetes, Obesity and Lifestyle study. The physical component summary and mental component summary subscores of the Short Form (36) Health Survey were used to measure quality-of-life.

A total of 11,081 participants had quality-of-life measurements at baseline. Of those, 1112 had CKD, 1001 had diabetes, and 271 had both. Of the patients with CKD, 421 had CKD stage 1, 314 had stage 2, 346 had stage 3, and 31 had stages 4/5. Baseline physical component summary scores were lower for those with both CKD and diabetes than those with either disease alone (P<.001) in adjusted linear mixed effect models. In longitudinal analyses, there was a more rapid decline in physical component summary score in those with both diseases.

In conclusion, the researchers said, The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with one condition.

Go here to see the original:
Diabetes and CKD and Quality-of-Life - DocWire News

Posted: Jul 14, 2021 / 12:28 PM CDT / Updated: Jul 14, 2021 / 12:28 PM CDT

Dr. J Murray Hockings, DO, founder of Help Your Diabetes, spoke with Studio 512 Co-Host Stephanie Gilbert about the connection between type-2 diabetes and COVID-19, how the disease can be reversed with his patented system, and more.

What is the connection between COVID-19 and type-2 diabetes?

The CDC says that 94% of anyone who died from Covid had at least one underlying health condition and type-2 diabetes is one of the most common underlying conditions, so its important to reverse your diabetes so you can help prevent serious complications from COVID-19, Dr. Hockings said.

What are the most common complications of type-2 diabetes?

Blurred vision that can lead to blindness, kidney stress that can lead to dialysis or transplant, heart disease that can lead to heart attack or stroke, neuropathy that can lead to blindness, Alzheimers (type-3 diabetes), erectile dysfunction (ED), and cancer, Dr. Hockings said.

Is type-2 diabetes reversible?

Yes, it is and we have the only patented system in the world that reverses type-2 diabetes, and we guarantee results. After finishing our program as directed, if you are still taking any diabetic medications, you will get a 100% refund plus $500 just for trying it, so you have nothing to lose by trying our program, Dr. Hockings said.

How do people find out more about your program?

We are a comprehensive diabetes reversal consultation, which includes a diabetes reversal video training, a diabetes reversal score, and a diabetes reversal assessment and customized plan. The first 30 people who sign up only have to pay $37 instead of our normal fee of $150. They can go toStopYourDiabetesNow.com, Dr. Hockings said.

This segment is paid for by Help Your Diabetes and is intended as an advertisement. Opinions expressed by the guest(s) on this program are solely those of the guest(s) and are not endorsed by this television station.

Visit link:
What Is The Connection Between Type-2 Diabetes And COVID-19? - KXAN.com

Millions of US adults aged 70 years and over previously advised to take aspirin for primary prevention would not now have it recommended for routine continued use in particular those with diabetes at low risk of cardiovascular disease (CVD) say the authors of a new study investigating trends in use of the medication.

The cross-sectional study looked at aspirin use for both primary and secondary prevention of CVD in older adults ( 60 years), with primary prevention being the key concern in this age group for whom harms, mainly bleeding, might outweigh benefits.

In fact, older people with diabetes were found to be twice as likely to use aspirin for primary prevention as those without diabetes (odds ratio [OR], 1.98).

The authors, led by Elizabeth Liu, Johns Hopkins University School of Medicine, Baltimore, Maryland, suggest "that older adults may have potential overuse of aspirin therapy if it is not actively discontinued, especially among those with diabetes," in their article published online June 21 in JAMA Network Open.

In an accompanying editorial, Wilson D. Pace, MD, chief medical officer, DARTNet Institute, Aurora, Colorado, points out that the study shows "a large percentage of individuals 70 years and older take daily aspirin in the absence of known CVD."

Indeed, "more than 20% of individuals with low cardiovascular risk use daily aspirin," he noted. "And this increased to over 50% in those people over 80 years. This rate of aspirin use is poorly justified by current evidence and would seem likely to be causing more harm than good."

Revised guidelines from the American Diabetes Association (ADA) and American College of Cardiology (ACC) in 2021 recommend consideration of aspirin use for primary prevention in individuals with diabetes who have an increased CVD risk, without increased risk of bleeding, but generally not in those aged 70 years and older.

Studies published in 2018 were a turning point. Evidence from three large trials (ASCEND, ASPREE, and ARRIVE) led to a change in guidelines by the ADA and ACC.

Both organizations discourage the use of aspirin for primary prevention in people over 70 years with or without diabetes.

The findings from the new cross-sectional study show the potential to reduce aspirin use in older adults.The new studyis based on data on preventive aspirin use in 7103 adults over aged 60 from the National Health and Nutrition Examination Survey (NHANES) in 2011-2018,

Overall, aspirin use for primary or secondary prevention in older US adults was 46.7%. For those with diabetes it was 61.7%, compared to 42.2% in those without diabetes.

Among people with diabetes, the likelihood of aspirin use in older vs younger age categories (reference, 60-69 years) did not differ in multivariable logistic models adjusting for race, sex, education, CVD risk category, and body mass index.

"Preventive aspirin use was higher among older adults with diabetes than in those without diabetes," the researchers say.

Extrapolating from their analysis, they suggest that continued aspirin use would now not be recommended in the 9.9 million older US adults who have been taking aspirin for primary prevention, particularly those with diabetes.

Going forward, it will be important to examine if the changes to guidelines made in 2018 will have any effect on such prescribing, they add.

"Ultimately, future studies should examine the influence of updating guidelines on clinician behaviors and the association of changing trends in preventive aspirin use with the development of CVD in older adults," they write.

Senior author RitaKalyani, MD, also of Johns Hopkins, emphasized the importance of initiating a conversation about the benefits and risks of aspirin use in older patients.

"It's important that for patients taking aspirin, as well as clinicians treating those over 70 years, with and without diabetes, to discuss if they're taking aspirin for primary prevention," she told Medscape Medical News.

"If they are, then on an individual basis, they need to together discuss the potential benefits and harms involved in the context of recently updated guidelines and studies," she added.

Pace noted that most individuals older than 70 years are not newly initiating aspirin, but continuing therapy started at a younger age.

"Stopping a therapy on which an individual appears to be doing well can be a much harder decision for both patient and clinician than not starting the treatment in the first place," said Pace.

"Only through careful, ongoing assessments can physicians make sure they are following what many consider to be the most important ethical tenet of clinical care primum non nocere first, do no harm."

JAMA Netw Open.2021;4:e2112210. Full text

The authors, including Liu and Kalyani, as well as Pace, have reported no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

Go here to read the rest:
Is Aspirin Overused in Older Patients With Diabetes? - Medscape