Category Archives: Diabetes

Metformin in breast cancer Nature.com A new study published in the Journal of Clinical Oncology reports that metformin improves the prognosis of patients with HER2-positive, hormone receptor (HR)-positive breast cancer and diabetes mellitus. The phase III randomized ALTTO trial included ...

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Metformin in breast cancer - Nature.com

When a 92-year-old woman with dementia in my companys managed long term care (MLTC) plan had to switch from oral diabetes medication to insulin recently, Yael Reich, a nurse diabetes specialist with the Visiting Nurse Service of New York (VNSNY), was the person who arranged for a friend to administer the shots. In her dual role as diabetes educator and complex case manager, Yael advises VNSNY nurses across New York City, Westchester and Nassau on how to help our patients and health plan members with diabetes manage their glucose levels. Approximately one-third of our patients have diabetes in addition to their primary diagnosis, says Yael, whos worked with VNSNY for 23 years and has been a diabetes specialist and educator since 2004. This means our nurses are treating thousands of patients with diabetes on any given day.

Type 2 diabetes, in which a persons blood glucose levels become chronically elevated, can lead to kidney and eye damage, cardiovascular disease and other health problems. In addition to reviewing with our nurses and their patients the proper way to administer diabetes medications that keep blood glucose levels under control, Yael will also explain to them how weight loss, a healthy diet, exercise, and other lifestyle changes can help prevent diabetes in those who are at risk of developing it, and minimize the need for medication in those who already have diabetes.

According to the CDC, more than 29 million Americans are living with diabetes, and 86 million are living with prediabetes, a serious health condition that increases a persons risk of type 2 diabetes and other chronic diseases. With type 2 diabetes rates in the U.S. continuing to riseone in eleven Americans now has the disease, according to the most recent estimates, including one out of four people aged 65 or olderunderstanding how to prevent and control the condition through lifestyle changes and proper medical care is more important than ever. And since people who have diabetes or are at high risk of developing the condition make up a disproportionate share of home care patients and clients, the visiting nurses and nurse educators employed by home care agencies like VNSNY play a lead role in helping to keep this dangerous condition in check.

Bridging the Gap Between Medical Advice and How People Really Live

One important way that frontline home care clinicians make a difference is by helping their patients bridge the gap between advice they receive from medical professionals and taking steps to follow this advice on a daily basis in the real world. For example, when registered nurse Sheniqua Johnson was providing care recently for a patient with elevated blood glucose levels, her patient agreed readily with her advice to avoid foods high in sugar and processed carbohydratesbut then consistently refused to act on her recommendations. He didnt want someone coming in from the outside telling him what to do, Sheniqua says. On speaking with him further during her home visits, she learned that he was originally from West Africa, and with that information in hand, she was able to engage him around healthy foods hed grown up with and steer him toward a healthier diet.

By visiting with people in their homes, our nurses and nurse educators also come to understand real-life barriers that may not be as obvious to other medical professionals. Fresh vegetables and fruit are often difficult to access in lower income neighborhoods, and can be costly when they are available. As a result, people frequently turn to more convenient and affordablebut less healthyalternatives. Nurse Johnson recalls caring for a woman who was struggling with diabetes, and noticing that her kitchen shelves were crowded with boxes of sugar-sweetened cereal. To save money, thats what I eat for dinner, the woman told her, explaining that she thought she was following her doctors instructions. Johnson was able to help her patient identify easy-to-prepare alternative foods, such as frozen vegetables and lentils, in her local grocery store, that she could buy for the same price to provide better nutrition and help keep blood glucose levels in check.

Our frontline clinicians can also help people who havent developed diabetes identify and correct their risk factors, by walking them through diabetes risk assessments such as the one the American Diabetes Association (ADA) offers onlinea test which you can take yourself by accessing it here. When an assessment indicates that someones risk of developing type 2 diabetes is high, our clinicians will then arrange for them to have their blood glucose levels tested to determine whether they have diabetes or prediabetes (an early warning sign that blood glucose levels arent being adequately controlled).

Encouraging Daily Diabetes-Fighting Behavior

Whether someone has diabetes, prediabetes, or is simply at risk of getting the disease, our nurses and diabetes educators regularly encourage them to take evidence-based steps to prevent diabetes from developing, or manage their condition more effectivelyincluding losing weight, engaging in physical activity each day, and eating healthier foods. Many of our home health aides are now also trained as Health Coaches, and are using proven techniques such as motivational interviewing to help patients make and maintain important lifestyle changes that help them better manage their diabetes and other chronic medical conditions.

In addition to frontline nurses, diabetes educators and home health aides at home care agencies, community-based clinicians also play a significant role in combating the diabetes epidemic. Primary care physicians now routinely refer patients to diabetes educators for practical advice on how to make changes in their daily diets and safely increase physical activity. This is one more confirmation that when it comes to defeating type 2 diabetes, the solution begins at home.

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Frontline Homecare Professionals Make a Difference in Keeping Diabetes In Check - Huffington Post

Diabetes medications were the most expensive traditional therapy drugs in 2016, with an overall trend of 19.4%, according to the latest Express Scripts drug trend report. This positive trend is reflective of increases in both utilization and cost.

Heres how pipeline developments could change the landscape.

Pipeline treatments

Peterson

While I do not see any game-changing medications within the diabetes class that will reach the market within the next several years, there are a few updates that we are watching, says Chris Peterson, director in the emerging therapeutics department at Express Scripts.

He points to the continued growth of the sodium-dependent glucose cotransporter-2 (SGLT-2) inhibitor classsparked by the positive cardiovascular outcomes from empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly), a previously approved SGLT2 inhibitor. Pipeline SGLT-2 inhibitors include investigational ertugliflozin (Merck and Pfizer) and bexagliflozin (Chugai Pharma), both in phase 3 development at press time. Sotagliflozin (Lexicon Pharmaceuticals),a first-in-class oral dual SGLT-1 and SGLT-2 inhibitor for type 1 and type 2 diabetes, also in phase 3. If approved, it will be the first oral drug approved for type 1 diabetes, a disease that typically has been managed by lifestyle modifications and insulins, says Farrah Wong, PharmD, director, pipeline and drug surveillance at OptumRx.

Wong

The glucagon-like peptide-1 (GLP-1) analog class is also expected to grow, says Peterson. This is driven by cardiovascular outcomes data with liraglutide (Victoza, Novo Nordisk) and the introduction of the fixed-dose combination GLP-1 agonist/long-acting insulin products, insulin glargine and lixisenatide injection (Soliqua 100/3, Sanofi) and insulin degludec/liraglutide (Xultophy, Novo Nordisk).

Semaglutide is a GLP-1 agonist in development for glycemic control in patients with type 2 diabetes. It is being developed as both subcutaneous formulation from Novo Nordisk and oral form from Novartis. If approved, it will be the first oral GLP-1 agonist on the market.

As oral drugs are easier to administer and less invasive than injectable drugs, oral semaglutide may offer these advantages over other GLP-1 agonists, says Wong. Furthermore, type 2 diabetics will have another oral therapeutic option in a class of drugs that thus far were only injectable drugs.

Exenatide osmotic mini-pump (ITCA 650, Intarcia Therapeutics, Inc.) is a subcutaneous implant that continuously delivers the GLP-1 agonist, exenatide, for three months (introductory dose) or six months (maintenance dose) to treat type 2 diabetes. Approval is expected in November 2017, says Peterson.

New insulin products are also expected to receive approval soon, including insulin tregopil (Biocon Ltd.), an oral insulin in phase 2 development for type 1 and type 2 diabetes.

Currently, insulins are either injected or inhaled, says Wong. If an oral insulin product is available, the ease of administration may drive some of the market share to shift from injectable/inhaled insulins to the oral product.

Insulin glargine injection (Basaglar, Eli Lilly/Boehringer Ingelheim) approved last year, was the first follow-on insulin glargine product to treat diabetes. Another follow-on insulin glargine product, known as MK-1293 (Merck/Samsung Bioepis), will be competing as a brand product within the market and is expected to be approved in the second quarter of 2017. Basalog is yet another insulin glargine product currently in phase 3 development; however, it is not yet clear whether the manufacturer, Mylan, will seek approval as a competing brand or as a generic to Lantus (Sanofi). Finally, Sanofi is developing SAR342434, a follow-on protein to Lilly's Humalog (insulin lispro), for the treatment of diabetes mellitus. If approved, it will compete as a brand with the other rapid-acting insulins.

Link:
New therapies show promise in treating diabetes - ModernMedicine

Staying healthy can be a challenge for everyone, especially as we age, but for those managing diabetes, keeping aware of changes in your health is critical. According to the CDC, diabetes is the seventh leading cause of death and can lead to permanent disability and serious health issues.

As a registered nurse and the leader of Partners in Care, a licensed home care agency serving the nations largest city, I know that our skilled nurses and licensed home health aides are trained to meet the specialized care needs of our clients diagnosed with diabetes. But even when a patient is doing everything rightmanaging blood sugar levels, exercising, eating healthya host of complications can surface, such as heart problems, nerve damage or blindness. It is important to stay in the know on these common diabetes-related complications and know what to watch out for.

Here are five common complications from diabetes:

Heart DiseaseAccording to the ADA, approximately two out of three people living with diabetes die of heart disease. Diabetes affects cholesterol levels and raises the bad cholesterol while lowering the good cholesterol. When this coadition happens, arteries are narrowed by a buildup of fatty materials, and the chances of having a heart attack or stroke double. If you have chest pain, shortness of breath, sweating, pain or discomfort in the arms, back, jaw or neck, or have nausea with exertion, call your doctor or 911.

NeuropathyIt is likely that almost half of people with diabetes have nerve damage, according to the ADA. This condition causes loss of sensation, and it makes it easier to injure yourself without noticing. Additionally, poor circulation and neuropathy leads to a compromised immune systemyour body cant fight off infection or heal from wounds quickly. Although not everyone will suffer from neuropathy, be sure to control your blood glucose levels and report symptoms to your doctor.

Foot ProblemsPoor circulation and nerve damage can lead to infections of the footsometimes serious ones that spread to the bone, leading to amputation. When you notice a cut or other injury on your foot, keep it clean and notify your doctor immediately. You can also avoid infections by keeping toenails short, wearing comfortable shoes and scheduling regular checkups with a podiatrist.

RetinopathyEye trouble is common among people living with diabetes. Some symptoms to watch out for include black smudges on the eye, blurred vision, sudden loss of vision in one eye, seeing rings around lights, dark spots and flashing lights. Again, by managing blood glucose levels you can avoid damage to your eyes, and you should also consider annual eye exams by a retina specialist.

Kidney FailureAccording to the National Institutes of Health, diabetes is the most common cause of kidney failure. Although it takes approximately 15 years to develop, it is a slow-growing problem that those living with diabetes should monitor. Pay attention to fatigue, an increase in urination frequency, lack of concentration, sleep trouble, muscle cramping at night, lack of appetite, eye puffiness and swollen feet/ankles. You can also get routine tests to monitor kidney function.

Today, 26 million Americans are living with the disease, but by 2050, as many as one in three adults could be living with the diseasekeep yourself protected and informed. For more information on diabetes care, please visit http://www.partnersincareny.org or call 1-888-735-8913.

Jennifer Rajewski, RN, is a senior vice president at Partners in Care, an affiliate of the Visiting Nurse Service of New York.

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Diabetes alert: Will you pass the test? - Amsterdam News

By Al Pikeapike@fosters.com

DURHAM Nick Ritzo had to grow up fast. Diagnosed with Type 1 diabetes at 18 months, he didnt have a choice.

Despite the early responsibility of learning how to take care of his body, the Rye resident and Portsmouth High School graduate developed into an elite athlete along the way.

He won a state title in the shot put less than two years after taking it up and is currently one of the top throwers on the University of New Hampshire mens track and field team, which is getting ready for its outdoor season.

At this point Im pretty mature about it, Ritzo said of living with diabetes. I know how to do everything for myself but I definitely went through a phase where it was very difficult growing up when I didnt know how to do everything and I was very reliant on my parents and grandparents to really look after me.

Then again if someone develops it now its definitely a huge lifestyle change, he continued. Its never easy, but its also one of those illnesses thats not the end of the world. You can adapt. I think in the end its probably made me better for it. Im more mature and Im definitely healthier.

There were times, however, when he felt isolated. Although he had a strong support system at home, he had to become self-disciplined.

It was difficult, said the affable Ritzo. I remember as a kid having a little bit of a sweet tooth. It was always difficult controlling that, and going to friends houses and having to be very careful and being responsible for yourself for a few hours was always difficult. Theres times when you think about it and it seems like the most difficult thing in the world because its just happening to you.

Type 1 diabetes is an auto-immune disease that attacks the pancreas and its ability to produce insulin. It is not yet curable or preventable. Among the early symptoms are fatigue, excessive thirst and frequent urination.

There was never a time when I didnt have it, Ritzo said. Ive always been a pretty inquisitive guy. Its just another way to live your life. Its not really the end of the world. It can be difficult, but its manageable.

Ritzo, who wears an insulin pump and has to constantly monitor his blood sugar level and diet, is also an outstanding student. The junior carries a 3.94 grade-point average in genetics and might apply to medical school after he gets his undergraduate degree.

I knew that I wanted to do something science related, Ritzo said. I thought (genetics) was interesting stuff. I liked how it was new to the field of science where many discoveries were still occurring in the field. Its something that I really enjoy. Its definitely time-consuming and its difficult, but its something that really interests me so I dont mind putting in the time towards it. Its the same with track.

Hes also interested in endocrinology and has considered a career in pediatrics. Ritzo started taking courses in genetics when he was a sophomore at UNH.

Im a Type 1 diabetic so Ive always wanted to get into the field of endocrinology, Ritzo said. Its a big role and also just my interest in science and the fact that Ive been given a lot of opportunities that other people havent been given to go towards this field. Ive always felt like I shouldnt waste those opportunities to go help other people.

Balancing academics with athletics has been challenging but rewarding.

I wasnt too set on doing track here when I first came in, Ritzo said. Im a genetics major and thinking about pre-med. When I first came into school I was really focused on that. I wasnt positive I wanted to do track coming in. Its been a really good decision to do it. With having difficult classes it does give you that structure. Its really helpful especially for me because I get to go outside and throw heavy things around. Thats the oldest stress reliever there is.

Speaking of throwing heavy objects around, Ritzo is coming off a strong indoor season in which he finished fourth in the shot at the America East championship meet and eighth in the 35-pound weight, setting personal records in both events while scoring points for the team.

Hes a tremendous teammate for the other kids, said coach Jim Boulanger. Everybody likes him.

A shot-putter by trade, the 6-foot-5 Ritzo will also compete in the discus and javelin during the outdoor season. His height and arm length coupled with improved technique and athleticism enables him to get more distance on his throws.

A basketball player most of his life, Ritzo was recruited coach Mike Lyford to join the track and field team at Portsmouth High. Ritzo competed for the Clippers outdoors his junior year, and indoors and outdoors as a senior.

(Lyford) was really on my back about it because he thought I could be really good at it, Ritzo said. I guess he was right.

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College track: UNH's Ritzo manages academics, sports and diabetes - Seacoastonline.com

(CNN) Weight loss can be very difficult, especially if you have a lot of pounds to lose. However, the payoff is worth it and the young man youre about to meet is proof.

This is Justin Green and in 2016 he was diagnosed with type two diabetes. At the time, he weighed nearly 400 pounds. Ive lost 120 pounds so far. He recommended being more active and changing my diet.

Justins lifestyle changes didnt come easily. I probably eat less than a quarter of what I used to. Nothing fried, raw vegetables.

Dr. Omotayo Akinmade, a Primary Care Physician at Piedmont Henry Hospital said, We always encourage diabetics to reduce your calories and reduce your carb intake but also only eat when they have to when theyre hungry. Its overeating that leads to an uncontrolled blood sugar.

Justin says his weight loss has improved his overall health and he no longer has to take medication or check his blood sugar. The diagnosis was technically reversed but I consider myself a non-practicing diabetic.

Dr. Akinmade said, Its not uncommon for patients who are very well motivated who have lost significant weight and have change their lifestyle to have a reversal in their blood sugar.

Justins advice for anyone trying to manage their diabetes is to never give up. Feel better in the process and maybe you can bring somebody else along with you.

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One man's journey from diabetes to a lifestyle change - wwlp.com

PARKERSBURG, W.Va. (WTAP) -- Diabetes causes more deaths every year than breast cancer and AIDS combined.

And health officials want you to see if you're at risk for the disease. Tuesday, March 28, was American Diabetes Association Alert Day.

Having diabetes nearly doubles your chance of having a heart attack. Some risk factors for the disease include a family history of diabetes, being over the age of 45, being overweight, a poor diet and not being physically active.

But, health officials say having good diabetes control can reduce your risk for diabetes complications.

"Maintaining a good nutritious diet, maintaining an active lifestyle are key. We can prevent diabetes by doing that," said Dr. Frank Schwartz, a physician in Parkersburg, West Virginia. "And it's going to take a paradigm shift in our country in terms of the food we eat. You know, my grandmother used to say you are what you eat, and it's important to eat fresh vegetables and fresh fruits and avoid packaged foods."

According to the American Diabetes Association, 9 out of 10 Americans most at risk for type 2 diabetes don't even know it.

It takes just one minute to know if you're at risk, by taking the American Diabetes Association's Type 2 Diabetes Test, at the link under the "Related Links" section of this article.

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Doctors encourage everyone to get diabetes testing - KALB News (press release)

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Physical activity, in whatever form you enjoy, is one of the most important aspects of a healthy lifestyle and can have long-term benefits, especially for individuals with either type of diabetes. Regular exercise can not only set you on the path to improve your blood pressure and cholesterol, but it has also been proven to help lower blood sugar levels by improving insulin sensitivity. Exercise can also help you sleep better, improve your mood and reduce stress.

Aerobic exercises, such as walking, swimming, biking and jogging, have been proven to improve glucose control, cardiovascular risk factors and help lower blood sugar levels. It is recommended that individuals participate in at least 150 minutes of moderate exercise, or 90 minutes of vigorous exercise each week. Find an activity that you enjoy and do it! Practicing a form of exercise you like will help you stay motivated and will improve your mood better than an exercise you dislike.

Resistance, or strength training, is also a great way to help improve insulin sensitivity and boost your metabolism. Strength training is also a good option for individuals with other health concerns that make it unsafe to participate in aerobic exercises. It helps increase lean muscle mass, which burns more calories while the body is at rest, and improves bone mineral density that helps fight osteoporosis. It is recommended that an individual practices resistance training two to three times a week, incorporating eight to ten exercises of ten to fifteen repetitions each.

Before beginning any exercise routine, it is always important to consult with a healthcare professional to approach fitness in the safest, most beneficial way. The team of registered dieticians and diabetes educators at the Cone Health Nutrition and Diabetes Management Center is dedicated to educating diabetic patients throughout the community on how to manage their disease through proper nutrition and exercise.

Spokesperson Background:

Laura Watson is a registered dietitian specializing in pediatric nutrition at the Cone Health Nutrition and Diabetes Management Center. Laura received a Bachelor of Science in public health from the University of North Carolina at Chapel Hill in 2007 and earned a Master of Science in nutrition from the University of North Carolina at Greensboro in 2009.

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Diabetes: The Importance of Exercise - myfox8.com

Have you been diagnosed with prediabetes? Do you have a family history of diabetes that you fear may impact you in the future?

Often times, doctors like to "watch" patients who have risk factors for diabetes, including being overweight and having slightly elevated blood sugars, because there hasn't been a place for these patients to learn more on how to stay well until now.

The Wellness Neighborhood of Tahoe Forest Health System is proud to offer Prevent T2, part of the CDC-recognized National Diabetes Prevention Program that has been shown to help at-risk adults cut their risk for developing type 2 diabetes by 58%.

Beginning in April, a Registered Dietitian Nutritionist will be leading the Prevent T2 lifestyle change program at Tahoe-Truckee at low cost for participants. A payment plan will also be available.

This program is unique in that it targets people who do not have diabetes, and who even may not have been told by a doctor that they have prediabetes.

Did you know that roughly one in three American adults has prediabetes, and many don't know it? People with higher-than-normal blood glucose (sugar) levels are 5-15 times more likely to develop type 2 diabetes than those with normal blood glucose levels.

In fact, many people with prediabetes can be diagnosed with type 2 diabetes within 5 years.

The Prevent T2 program offers a proven approach to preventing or delaying the onset of type 2 diabetes through modest lifestyle changes made with the support of a coach and one's peers.

Participants will learn how to eat healthy, add physical activity to their routine, manage stress, stay motivated, and solve problems that can get in the way of healthy changes. The group will meet for a year weekly for the first 6 months, then once or twice a month for the second 6 months to maintain healthy lifestyle changes.

The program's group setting provides a supportive environment with people who are facing similar challenges and trying to make the same changes. Together participants celebrate their successes and find ways to overcome obstacles.

To find out if you are at risk for, or may have, prediabetes, take the risk test (available in English and Spanish) at doihaveprediabetes.org or visit your primary care physician to get the appropriate screening blood tests.

You do not need a referral from you medical provider to participate in the Prevent T2 program, but you do need to qualify based on eligibility criteria (overweight and elevated blood sugars or a previous diagnosis of gestational diabetes) or a score of 5 or higher on the risk test noted above.

To learn more about the Tahoe Forest Prevent T2 program, contact the Center for Health and Sports Performance at 530-587-3769.

Dana Dose, RDN, LD, CDE. Dana is part of the Rethink Healthy team and provides nutrition counseling as well as clinical dietitian services for the Tahoe Forest Health System. Dana will be the trained lifestyle coach for the upcoming Prevent T2 Diabetes Prevention Program.

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Low-cost diabetes prevention program coming to Tahoe Forest Health System - Sierra Sun

COLUMBUS, Ga Columbus is one of eight sites in the world participating in a groundbreaking study in the war against Type 1 Diabetes.

If you look at it from the perspective our community, I dont believe theres ever been a study of this magnitude at this stage of development that is this profound awarded to Columbus, Georgia, says Dr. Steven Leichter, Senior Physician at Endocrine Consultants.

The study focuses on restorative therapy to keep insulin levels maintained or restored using a certain drug that would trick the body into a permanent honeymoon period. During the honeymoon period, the amount of insulin needed to treat diabetes sufferers is low.

If the results of the study prove successful, it could lead to a revolution in the treatment for Type 1 Diabetes.

If we get kids early enough in Type I Diabetes, while they still have some beta cells left, and we give them this drug. It will block the anti-bodies from killing the remaining beta cells, and theyll remain in honeymoon ongoing which will make them very easy to treat, says Dr. Leichter.

Columbus was selected in large part due to the research and growth of Endocrine Consultants. Over the past 21 years, the practice has grown to be one of largest endocrine diabetes centers in Georgia, and the largest in western Georgia.

However, Endocrine Consultants is quick to credit the collaborative nature of the medical community in Columbus for making groundbreaking research such as this possible in our area.

This initial study should take about two years. Two of the participants are local patients.

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Columbus among 8 world sites chosen for groundbreaking pediatric diabetes research - WRBL