Monthly Archives: April 2022

New technologies can improve diabetes outcomes. Learn how health care professionals can help patients access and use these tools.

Diabetes technologies arent reaching everyone who could potentially benefit. Dr. Tamara K. Oser, a primary care doctor and diabetes researcher, discusses how health care professionals can put diabetes technologies into practice.

Q: What technology tools are available for people with diabetes?

A: Weve seen an expansion in the world of diabetes technologies that, if used the right way, can improve diabetes care. We now have continuous glucose monitors (CGMs), insulin pumps that are increasingly automated, connected insulin pens, and apps. Health care professionals and people with diabetes can use technology in many ways to foster diabetes self-management education and support.

Q: How can new technologies benefit people who have diabetes?

A: More evidence is emerging about the benefits of diabetes technologies. For instance, continuous glucose monitoring is associated with improved clinical, psychosocial, and behavioral outcomes, especially for people who have type 1 diabetes or type 2 diabetes that requires intensive insulin therapy. Evidence is also emerging about the benefits of continuous glucose monitoring for people with type 2 diabetes on basal insulin, and even for people with type 2 diabetes who are not on insulin.

However, just having a technology tool doesnt necessarily improve outcomes. Health care professionals and patients with diabetes also need education about how to use the device, how to engage with the data, and how to communicate with each other about the data. For example, when patients start to use CGMs, health care professionals should ask them how often they want to receive CGM alarms. If you dont have this conversation, patients may get too many alarms and develop alarm fatiguemeaning they no longer respond appropriately to alarmsand stop using the device.

There are also exciting advances in insulin pump therapy, including automated insulin delivery systems and work being done to expand access to these technologies as well.

Q: Are diabetes technologies made available to everyone who could benefit from them?

A: No. One study found that continuous glucose monitoring reached about 30% of people with type 1 diabetes in the T1D Exchange Registry, who mostly received care from endocrinologists at academic medical centers. However, we can assume that continuous glucose monitoring is less common among people who receive care from community medical practices, which is where most Americans receive care. We know that about 50% of adults with type 1 diabetes and 90% of adults with type 2 diabetes receive diabetes care from primary care providers, but most of the studies on diabetes technologies are conducted through endocrinology practices at academic medical centers.

So, there may be a geographic disparity in access to diabetes technologies. Our research team is working on many projects to address that geographic disparity and help implement diabetes technologies in primary care.

Q: Are there other disparities in the use of diabetes technologies? How do social determinants of health affect how people with diabetes access and use technology tools?

A: There are also socioeconomic, racial, and ethnic disparities in the use of diabetes technologies. Compared with the white population, racial and ethnic minority groups have higher rates of diabetes and often have worse diabetes outcomes. Patients from racial and ethnic minority groups and patients of lower socioeconomic status are less likely to be offered diabetes technologies.

However, studies have shown that when these patients are given access to diabetes technologies, they have outcomes that are similar to those of white patients or patients with higher socioeconomic status. At the Federally Qualified Health Center where I care for a large immigrant and refugee population, Ive used CGMs with my patients, and theyve done brilliantly.

One reason for disparities in access to diabetes technologies may be implicit bias that affects which patients are offered diabetes technologies. As health care professionals, we need to address our unconscious biases about which patients may or may not benefit from technologies. Other reasons for disparities include physician shortages and restrictive insurance eligibility criteria.

We have a lot of work to do to address disparities. This is a topic Im very passionate aboutmaking sure certain populations arent left behind as diabetes technologies advance.

Q: What are the barriers to using diabetes technologiesboth for health care professionals and for people with diabetes?

A: Compared with endocrinology practices in academic medical centers, primary care practices and community endocrinology practices have different resources and workflows, and how we implement diabetes technology in each setting will be different.

One way that primary care practices can address limitations, in terms of time and workflow, is to engage the entire health care teamincluding diabetes care and education specialists, clinical pharmacists, health coaches, and patient navigatorsin implementing diabetes technologies. A recent Association of Diabetes Care and Education Specialists technology summit brought together a multidisciplinary group of health care professionals to discuss broadening access to diabetes technologies. I also worked with the American Academy of Family Physicians on a Transformation in Practice Series course that provides a comprehensive approach to implementing continuous glucose monitoring in primary care.

For patients with diabetes, one barrier is lack of access, either because they arent offered diabetes technologies or because they lack insurance coverage for technologies. However, even if patients have access, lack of education and support can be a barrier to using diabetes technologies effectively.

Q: What role can a diabetes care and education specialist (DCES) play in helping people with diabetes overcome barriers to using new technologies?

A: A DCES can serve as a technology champion. Any practice that has a DCES is set up for a much greater likelihood of success. The DCES can partner with the patient and the rest of the health care team to address issues related to diabetes technologies, including

However, our team, in partnership with the American Academy of Family Physicians National Research Network and other practice-based research networks, conducted a national survey of 656 primary care providers, and only 36% had a DCES in their practice, even part time. Because the majority of primary care practices dont have access to that valuable resource, we need to consider how a DCES may be able to support multiple practices through telehealth or other novel ways of providing care.

Q: How can other health care professionals integrate technology into diabetes care?

A: Practices that dont have a DCES might have a pharmacist, a health coach, or a case manager who can serve as a technology champion or work as part of a multidisciplinary team to help integrate technology into diabetes care.

Health care professionals can also tailor their approach. If your primary care practice isnt currently using diabetes technology, you might start by choosing a technology that will be most relevant to your patient population. You can then identify members of your health care team who can help implement diabetes technology with patients.

Also, patients may benefit from a diabetes technology even if they arent able or dont want to use every aspect of the technology. I have patients who don't have a smartphone or dont want to use an app, and they just use a reader for continuous glucose monitoring. The reader captures important metrics that we go over together, and Ive seen huge improvements in diabetes management.

Q: What research is being conducted on the use of diabetes technologies?

A: This is an exciting field, and lots of research is going on right now. My research group is studying ways to implement CGM and automated insulin delivery systems in primary care. Other research groups are conducting a study to compare fingerstick blood glucose monitoring to CGMs in primary care practices. Other studies are looking at insulin dosing algorithms in patients using CGMs or fingerstick blood glucose monitoring in a wide range of practice settings.

Many studies are looking at how to use diabetes technology to help patients with self-management and education. The COVID-19 pandemic has demonstrated the benefits of remote monitoring and alternative care models outside the clinic walls.

How do you help patients with diabetes learn about and use diabetes technologies? Tell us below in the comments.

View post:
How Can You Help Patients Use New Diabetes Technologies? | NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Diabetes is a chronic condition that affects a persons blood glucose levels. While the exact cause is still unclear, people living with diabetes may be at a higher risk of hearing loss. This might be due to high sugar levels potentially causing nerve damage to the inner ear.

Diabetes is a condition that affects blood sugar regulation in the body. This can cause fluctuations in blood glucose, known as hypo- and hyperglycemic episodes.

If a person is unable to maintain their blood sugar levels within a healthy range, this may increase their risk of complications, which could include hearing loss.

The exact relationship between diabetes and hearing loss still remains unclear. However, health experts believe that chronic hyperglycemia, which can raise blood pressure and cause damage to several parts of the body, may damage the blood vessels and inner ear structures, which could lead to hearing loss.

In this article, we look at the link between diabetes and hearing loss and suggest steps people with diabetes can take to protect their hearing.

Evidence suggests that individuals with diabetes are twice as likely to have hearing loss as those without diabetes. According to the Centers for Disease Control and Prevention (CDC), uncontrolled high blood sugar levels may lead to hearing loss.

This is because chronic high blood sugar levels may damage the nerves and small blood vessels in the inner ear. Over time, low blood sugar levels may also affect how nerve signals travel from the inner ear to the brain.

The CDC also states that prediabetes can be a risk for hearing loss. People whose blood sugar levels are elevated may be at a 30% higher risk of hearing loss than those with healthy blood sugar levels.

Health experts do not know the exact cause of hearing loss in individuals with diabetes. However, research suggests that sustained high blood sugar levels could lead to damage in the inner ear.

High blood sugar levels may affect blood supply to the small blood vessels and nerves in the inner ear, resulting in damage and affecting hearing. Nerve damage can occur in both type 1 and type 2 diabetes.

Blood sugar levels outside a healthy range may also affect how nerve signals travel to the brain from the inner ear. This damage can also lead to hearing loss.

Other risk factors for hearing loss may include:

To diagnose hearing loss, a doctor, such as an audiologist, may take a persons medical history and assess any symptoms.

Possible symptoms of hearing loss can include:

A doctor may then carry out a hearing exam. This may include a number of different hearing tests, such as:

A doctor may also test blood glucose levels. An A1C test is a useful tool to help monitor diabetes, as it measures the bodys average blood sugar levels over the past 3 months.

The aim of treatment is to improve peoples hearing and their ability to communicate with others.

The type of hearing loss usually associated with diabetes is sensorineural hearing loss (SNHL). This is a type of hearing loss that occurs due to damage to the inner ear or the nerves between the inner ear and the brain.

Treatment for SNHL may include:

If hearing loss is due to nerve damage from diabetes, treatment will also involve close monitoring of blood sugar levels. This may also include lifestyle changes, such as following a balanced diet and getting regular exercise.

While managing blood sugar may help stop progression, it will not reverse existing damage to hearing.

Keeping blood sugar levels within healthy ranges may help protect hearing and prevent damage to the inner ear and hearing nerves.

The National Institute of Diabetes and Digestive and Kidney Diseases offers the following suggestions to help people with diabetes control their blood sugar levels:

Learn more about managing diabetes here.

It is also important that individuals with diabetes attend a hearing test when they first receive a diabetes diagnosis. It is then advisable that they regularly test their hearing every year.

People can also take other steps to protect their hearing, such as using earplugs or ear defenders around loud noise.

Health experts do not know the exact cause, but evidence points to a relationship between diabetes and hearing loss.

Researchers suggest that blood sugar levels outside of healthy ranges may damage nerves and small blood vessels in the inner ear. Over time, this damage may affect hearing and result in hearing loss.

If people have diabetes or prediabetes, they need to attend regular hearing tests and manage their blood sugar levels. If a person has any symptoms of hearing loss, they should contact a doctor as soon as possible to find out the cause and start any treatment.

Individuals can also attempt to prevent hearing loss by using earplugs around loud noise.

See the rest here:
Diabetes and hearing loss: Link, treatment, and more - Medical News Today

In Diabetes and Me, RNZ's Megan Whelan shares her journey of learning to live with type 2 diabetes.

It's not a particularly productive question, but it's the one that plagues me: How much is this my own fault?

Photo: 123rf

If I hadn't eaten those cheeseburgers, would I be here? If the sport that spoke to me was marathon running and not yoga, might my pancreas have been in better shape?

I try to resist being that person who talks about my diet all the time because, my God, those people are boring, but I also can't help it. How to best eat for this condition, and the many hours of exercise I do, and how many grams of protein is in an egg (about six) occupies a pretty large part of my brain space.

And so I feel myself turning into a person I would have avoided a few months ago - and asking questions that I know I won't like the answers to.

To get some good answers, I spoke to Dr Jeremy Krebs, an endocrinologist. Endocrinology is the specialty of "glands and hormones" and diabetes is one of the areas endocrinologists study. He did a doctorate at the UK's prestigious Cambridge University investigating obesity, and he's now a consultant in Wellington, and researches nutrition, obesity and diabetes. So, a very good person to talk to, and - I promise, I wasn't trying to get some free medical advice.

Here's our conversation (edited for length and clarity, and to cut a massive discussion about exercise, which is a whole other column).

RNZ Head of Content Megan Whelan. Photo: RNZ / Rebekah Parsons-King

Megan: I think prior to my diagnosis, if someone had said "hormones" to me, I probably would have thought of progesterone and estrogen and maybe cortisol if I was having a good day. But there are so many, and they're so important, right?

Jeremy: The key one here is obviously insulin and that comes from the pancreas. But when you're thinking about type 2 diabetes, there are many, many different organs and hormones that are involved in the process, and there are many many different versions of it. And so not everybody with type 2 diabetes is the same, whereas type 1 diabetes, which is fundamentally about the failure of the beta cells in the pancreas because of an autoimmune process, is a much more homogeneous condition.

And that's partly what makes type 2 diabetes such a harder beast for people to get their head around. And I mean people in the broader sense, both people with diabetes, but also health professionals and people trying to, you know, find solutions and help and support because there's no one size fits all.

Megan: So, then, what is type 2 diabetes?

Jeremy: The simple version is that diabetes, by definition, is an increase in blood glucose, or blood sugar.

Blood sugar is controlled by two key hormones, the most important being insulin and the other being its counterpart or its counter-hormone, glucagon. The balance of glucose in the body is determined by how good your pancreas is at making insulin, and secondly, how good your tissues are (your liver and your muscle and other tissues in your body) - how good they are at responding to insulin and taking up and storing and using glucose.

So there's two main sides to the equation and type 2 diabetes is where you get a problem, usually on both sides of the equation, but one may dominate the other. So what I mean by that is, if your body becomes resistant to the action of insulin, which is something we generally see as people gain weight, then your pancreas can respond to that by simply pumping out more and more insulin. And it does. [It] does that incredibly well.

But there comes a point where the pancreas says 'bugger, this, I've had enough of that I'm going on strike,' and that's when it can't keep up with that demand. And that's when your blood sugar starts going up.

There's a researcher by the name of Defronzo, who coined a phrase called the ominous octet. It incorporates all of these sorts of ideas that we're talking about: the various hormones that are involved, but it also incorporates ideas of physical activity or inactivity, and then the other key thing which we haven't touched on yet, which is genetics and the role of family history and genes in terms of who might develop diabetes.

So we often think about some of these risk factors in terms of what is modifiable and what's not modifiable, and clearly your genes are not modifiable. There are modifiable things which can influence ... your chance of getting diabetes or your journey with diabetes.

Megan: In my journey I've kind of been swinging wildly between 'you're such a piece of shit, this is your own fault. You absolutely should have known that this was going to happen', it's in my family, I had allowed myself to become inactive, and I have a really stressful job and would come home every night and get takeaways because it's easier than cooking. I look back now and think 'how the hell did you let it get like this?'

And I guess one of the reasons I want to do this whole column is so someone like you can say "well, because you're a human being and that's what happens and it's not your own fault," but also it kind of is my own fault and maybe the ominous octet is a really nice way to do it. Maybe there's bits of it that were my own fault and bits of it that aren't my fault?

Endocrinologist, professor Jeremy Krebs. Photo: Otago University Wellington

Jeremy: There is no question that there are things we have conscious control over and that we can influence, but there's a heck of a lot we don't. Appetite is an incredibly subtle thing. How does anyone maintain a vaguely constant weight in the world that we live in? It's a miracle, frankly.

When we're bombarded with readily available - I used to say cheap, but that's changing - calorie dense, cleverly marketed food that appeals to the palate (because people understand what our tastebuds respond to) and a physical environment that has become less and less demanding for us to do things.

Megan: By doing this column, I'm gonna get some emails that are really, really nasty. What's the best response to those people who will say you should regret every cheeseburger you have eaten?

Jeremy: In a clinical environment that's very much where I start to talk about the genetic side of this and the subtleties of the influence of genes on our appetite regulation. Of course, those people will simply say, 'well, everyone says that, everyone hides behind that, but at end of the day, you know it's still [that] you're still sticking it in your mouth'.

And as you said there are bits of truth to some of that. I wish I hadn't had that 4th glass of red wine last night, but I did. And I had to spend an extra half hour on the treadmill this morning because of it.

But people who would hide behind those sorts of emails to you are lying to themselves, frankly, if they don't think they're not human, and aren't fallible to some of those choices.

Everyone makes choices they know retrospectively weren't the best choices. God, we're human.

Megan: I was doing my grocery order last night and a cauliflower was $7.50 and I thought to myself 'that's a happy meal, that's a combo at a fast food restaurant.' I'm incredibly lucky. I earn a decent amount of money. I don't have kids, so I have disposable income. I can spend $7.50 to buy a cauliflower, but lots of people can't, and that has to be really difficult.

Jeremy: There's no question about it. I was reviewing a paper last night from a group in Auckland and one of the key determinants of both developing diabetes, but also outcomes of diabetes, that overrode ethnicity was deprivation (and we know that ethnicities are a really important factor, which is largely driven by genetics).

You can know till the cows come home what you should be buying in the supermarket. But if the prices keep doing what they're doing at the moment, then you know we're all going to be buying white bread.

Megan: I am aware I am going to anger some people when I ask this, but I watched a talk of yours, and you had a graph of the overwhelming correlation between obesity and type 2 diabetes. And I wonder if there's a disconnect between what we want to believe about weight and what's actually true.

Jeremy: You're right, you will anger a lot of people by that. But there are some truths that you just have to accept. And unfortunately excess fat mass is not healthy. In a number of ways, not just metabolically, in terms of joints, in terms of the hormones of fertility, there's a whole range of stuff.

But turning that into self-blame and self-loathing is not going to achieve anything or help anybody. So if you have to frame it in a way that a person can still live with themselves and make some change which is taking them in a healthier direction, then I'm totally on board with that.

But where you have to be careful is where someone hides behind that and denies some of the harder effects.

Megan: If I had been honest with myself, I knew I wasn't healthy - that is no fault of the people who talk about this, and the really important activism that's happening in that space. But I think the people who think this is all my own fault might miss a point, which is that every experience I've ever had with a GP was negative because of my size. And so of course, I didn't look after myself [by getting help when I need it] because I would have to go to see my GP, who would weigh me and say something and that [made me] felt like shit.

Jeremy: Yep, it's not in any way supporting you.

Megan: So how do we bridge that gap between wanting to help people and not making them feel awful for needing help.

Jeremy: I think in the last 20-plus years of doing this there will be people that I have met that I've tried to help where I've got it right and it's helped them and there will be people where I've tried to help and for whatever reason for that person, I've got it badly wrong and they've gone away hating me because for whatever reasons we didn't quite manage to get that balance, that connection. It's tricky. It's very emotive.

***

Dr Krebs tells a story that many people will recognise. He was overweight, and a child poked him in the stomach, and said "you're fat". For him, that was the trigger to start running and losing weight.

It feels comforting to me that at least one doctor understands that feeling. I have countless stories like that. Like the time a woman walked past me in the supermarket carpark and said "see, that's why we don't buy chocolate biscuits. You don't want to end up like that." As I type this, I can feel the shame that pricked my cheeks, the tears I fought back that someone could be so casually cruel. But it certainly didn't make me want to don my leggings and hit the treadmill.

The question I want to ask isn't "is it my fault?" It isn't the "is being fat unhealthy" that I asked Dr Krebs, because I couldn't, in the moment, articulate what I meant. It's, did I get diabetes because I am fat, or because my fatness meant I couldn't access the care I needed that would have helped me avoid getting it?

That's a question that's much bigger than me, but it's one worth asking - and I am going to keep asking it in this column.

Diabetes and me will be a weekly column on Wednesday mornings.

Originally posted here:
Diabetes and me: Wrestling with the causes of diabetes - RNZ

State drug controllers told to include warning for patients using SGLT2 inhibitors

State drug controllers told to include warning for patients using SGLT2 inhibitors

After the U.S. and Canada, India too has admitted incidence of a rare but serious infection of the genitals and area around the genitals among Type-2 diabetes patients using sodium-glucose cotransporter-2 (SGLT2) inhibitors .

This serious rare infection, called necrotizing fasciitis of the perineum, is also referred to as Fourniers gangrene.

As a precautionary measure the Central Drugs Standard Control Organization (CDSCO) has requested all State Drug Controllers to direct the manufacturers of SGLT2 inhibitor class drugs named Canagliflozin, Dapagliflozin, Empagliflozin, under their jurisdiction to include warnings in the package insert and promotional literature of these drugs.

The Health Ministry, responding to a question on the adverse reaction to the anti-diabetes medicine by MP P. Velusamy, submitted the information recently.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase IV (DPP-IV) inhibitors are recommended as preferred add-on oral anti-diabetic drugs (OADs) after metformin among type-2 diabetes mellitus (T2DM) patients with atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). They are generally many times costlier than other OADs, note experts.

The Ministry submitted in Parliament that CDSCO was notified about a Health Canada communication to all those authorised to market sodium-glucose co-transporter-2 (SGLT2) inhibitors regarding a summary safety review (SSR) on the potential risk of pancreas inflammation (acute and chronic).

United States Food and Drug Administration (USFDA) in its drug safety communications (DSC) has cautioned about cases of rare but serious infection of the genitals and area around the genitals bring reported with use of SGLT2 inhibitors.

This serious rare infection, called necrotizing fasciitis of the perineum, is also referred to as Fourniers gangrene. USFDA has revised the labels of SGLT 2 inhibitors to include new warnings about the risk to patients, noted the Ministry.

It added that the issue was examined in consultation with Subject Expert Committee (SEC) of CDSCO and information available under the Pharmacovigilance Programme of India (PvPI) has also been obtained.

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type-2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesnt make enough insulin. In the past three decades the prevalence of type-2 diabetes has risen dramatically in countries of all income levels, according to the World Health Organisation.

Union Health Minister Dr. Mansukh Mandaviya had stated in Parliament that while the exact number of patients suffering from diabetes in India is not known, however, as per 10th edition of Diabetes Atlas 2021 of International Diabetes Federation (IDF), the estimated number of patients with diabetes between the age group of 20-79 years is 74.2 millions in year 2021 and it is estimated to be increased to 124.8 millions in year 2045.

Continued here:
First case of infection from diabetes medication in India - The Hindu

The diabetes social media sphere has been active as ever this past month, from recognizing international conflict to learning to fine-tune our insulin doses.

Heres our monthly roundup of posts that caught our eye throughout March 2022, in no particular order.

March marked Womens History Month, and we were honored to share this tribute to a host of women whove made an incredible impact on the Diabetes Community through the years.

With the continuing attack on Ukraine, our Diabetes Online Community (DOC) has extended the grassroots #SpareARose campaign through March to raise an impressive amount of money to help those with diabetes in that part of the world. The nonprofit org Beyond Type 1 also has this great resource listing ways to help.

People with diabetes often feel like were under pressure with the demands of daily life alongside handling this condition. This fun Instagram post touches on that topic, as advocate Kylie talks about her life with a lesser-known type of diabetes and how demanding it can be for her. Sure, were told to not strive for perfection, but its easier said than done right?!

We couldnt help but smile at our friend Mila Clarke, who shared on Instagram a recent win of nailing her insulin pre-bolus before a meal. For those on multiple daily injections (MDI) or even using an insulin pump, this is a challenge that so often leaves us missing the mark. Way to go, Mila! (btw: Make sure to turn your volume on, to hear the perfectly-fitting sound choice Mila used to mark the moment).

Tom Karlya over at Diabetes Dad had a great post marking the history of diabetes treatments and advocacy, honoring those whove paved the way and helped shape the community and world of diabetes through the years.

Actor Noah AK, who starred in Star Trek: Discovery with his wife Mary Wiseman, launched a successful crowdfunding campaign during the month, raising money for a new type 1 diabetes-themed movie that envisions the apocalypse, while addressing the important issue of insulin affordability. Many people donating were from the Star Trek community, as well as the #insulin4all movement online. You can read more about his plans on the Kickstarter campaign page.

It wouldnt be March without the madness of college basketball, and keeping with that theme are our friends at Integrated Diabetes Services whove created their own brackets with a diabetes spin. Who do you think will make it to the Sweet Sixteen, Elite Eight, Final Four, and get to the top spot in our D-Community?

The Juicebox Podcast featured an eye-opening episodein which host D-Dad Scott Benner delves into a controversial topic: being a stripper or sex worker who also happens to have type 1 diabetes. This may not be for everyone, but its a worthwhile listen.

Life with diabetes can be everything from frustrating, challenging, adventure-like, or easy-to-handle no big deal all in the same day. We loved this latest post from Molly Johannes at Hugging the Cactus, about a recent rookie mistake that she made in managing her own long-term diabetes. No matter how many years one lives with the big D, it seems were always facing new issues that can make it a bumpy ride.

*We share our favorites each month, and DiabetesMine would love to hear from you via email or on Facebook, Instagram or Twitter.*

Originally posted here:
Around the Diabetes Online Community in March 2022 - Healthline