Next-Gen Artificial Pancreas Boosts Blood Sugar Control

Serena Gordon wrote . . . . . . . . .

The latest version of the so-called artificial pancreas system helped people with type 1 diabetes gain even better control of their blood sugar levels than current technology does, a new study reports.

The device combines an insulin pump, a continuous glucose monitor and a computer algorithm. The system measures blood sugar levels and delivers insulin automatically when levels rise. Insulin delivery is temporarily stopped if blood sugar levels drop too low.

People using the artificial pancreas were able to have good blood sugar control for almost an extra three hours each day compared to using just an insulin pump and a continuous glucose monitor.

“People with type 1 diabetes have to think every day about their blood sugar and how they need to manage it. Automated delivery systems can make a big difference and help ease the daily burden of managing blood sugar,” said study lead author Dr. Sue Brown, an endocrinologist and associate professor at the University of Virginia.

Type 1 diabetes develops when the body’s immune system — which normally protects you from disease — mistakenly turns against the healthy cells that produce insulin. Insulin is a hormone needed to control blood sugar levels.

People with type 1 diabetes have to replace that lost insulin — either with shots or through an insulin pump. But getting the right amount can be tricky. Too much insulin can send blood sugar dangerously low, while too little can set people up for serious diabetes complications.

That means people with type 1 diabetes spend a lot of time testing and adjusting their insulin levels throughout the day. That’s where the artificial pancreas can help, by taking over some of this work.

These systems aren’t yet completely automated, though. Diabetics still need to count the carbohydrates in their food and enter that information into their insulin pump.

But it will control blood sugar levels, giving more insulin when needed and pulling back when there’s enough.

“This system can give a more normal way of life,” said study co-author Boris Kovatchev, director of the University of Virginia Center for Diabetes Technology. Kovatchev led the team that developed the system.

Only one artificial pancreas system is approved by the U.S. Food and Drug Administration — the Medtronic 670G. This study didn’t compare the two systems, but the authors said there are important differences in the algorithms controlling each device.

The latest study used Control-IQ artificial pancreas system. It uses an insulin pump made by Tandem Diabetes and a continuous glucose monitor (CGM) from Dexcom.

For the study, 168 people with type 1 diabetes were randomly chosen to wear either the new artificial pancreas system or an insulin pump and glucose monitor alone. The patients were between the ages of 14 and 71.

The study lasted six months. Both Brown and Kovatchev said they didn’t ask participants to change their diet or other lifestyle factors.

The average daily time in-range (a blood sugar between 70 and 180 milligrams per deciliter) averaged 61% at the start of the study for those using the Control-IQ. During the trial, that rose to 71%. That meant participants had good blood sugar control for an additional 2.6 hours a day.

The group who just used an insulin pump and CGM had no change in their in-range time.

There were no severe low blood sugar events. One person in the Control-IQ group had a complication called diabetic ketoacidosis (DKA), because the site where the insulin pump tubing goes into the skin was blocked and insulin couldn’t get through, Brown explained.

Dr. Mary Pat Gallagher is director of the Pediatric Diabetes Center at Hassenfeld Children’s Hospital at NYU Langone in New York City. She said the newest device is more user-friendly than the 670G and the algorithms are significantly different.

“Each design that is approved by the FDA will be slightly better than the one before,” Gallagher said. “They’re building on the successes that came earlier.”

Daniel Finan, a research director with JDRF (formerly the Juvenile Diabetes Research Foundation), said that what’s most important for people with type 1 diabetes is choice. “This study is a meaningful step forward, and there are more good innovations on the horizon,” he said.

Finan noted it was significant that no one dropped out of the study. “This system was designed with usability in mind,” he said. “You can’t reap the benefits if you don’t want to wear the device.”

Tandem Diabetes has filed paperwork with the FDA for approval of the Control-IQ device.

The study was published online in the New England Journal of Medicine.

Source: HealthDay


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Reduction of Carbohydrate Intake Improves Type 2 Diabetics’ Ability to Regulate Blood Sugar

The Danish National Institute of Public Health estimates that the number of Danes diagnosed with type 2 diabetes will have doubled to no less than 430,000 in 2030. Nutritional therapy is important to treat the disease optimally, but the recommendations are unclear. According to the Danish Health Authority, up to 85% of newly diagnosed patients with type 2 diabetes are overweight, and they are typically advised to follow a diet focused on weight loss: containing less calories than they burn, low fat content and a high content of carbohydrates with a low ‘glycaemic index’ (which indicates how quickly a food affects blood sugar levels).

Reduced carbohydrate content – increase in protein and fat

A central aspect in the treatment of type 2 diabetes is the patient’s ability to regulate their blood sugar levels, and new research now indicates that a diet with a reduced carbohydrate content and an increased share of protein and fat improves the patient’s ability to regulate his or her blood sugar levels compared with the conventional dietary recommendations. In addition, it reduces liver fat content and also has a beneficial effect on fat metabolism in type 2 diabetics.

“The purpose of our study was to investigate the effects of the diet without ‘interference’ from a weight loss. For that reason, the patients were asked to maintain their weight. Our study confirms the assumption that a diet with a reduced carbohydrate content can improve patients’ ability to regulate their blood sugar levels – without the patients concurrently losing weight,” explains Senior Consultant, DMSc Thure Krarup, MD, from the Department of Endocrinology at Bispebjerg Hospital. He continues: “Our findings are important, because we’ve removed weight loss from the equation. Previous studies have provided contradictory conclusions, and weight loss has complicated interpretations in a number of these studies.”

New dietary recommendations for type 2 diabetics in future

Based on the growing body of evidence, we might rethink the dietary recommendations for patients with type 2 diabetes, stresses Thure Krarup:

“The study shows that by reducing the share of carbohydrates in the diet and increasing the share of protein and fat, you can both treat high blood sugar and reduce liver fat content. Further intensive research is needed in order to optimise our dietary recommendations for patients with type 2 diabetes,” says Thure Krarup, stressing that the findings should be confirmed in large-scale, long-term controlled trials.

The findings of the study have been published in the article “A carbohydrate-reduced high-protein diet improves HbA1c and liver fat content in weight stable subjects with type 2 diabetes: a randomized controlled trial” in the renowned scientific journal ‘Diabetologia’.

Summary: What did the study show?

  • A diet with a reduced carbohydrate content, high protein content and moderately increased fat content improves glycaemic control (the ability to regulate blood sugar) by reducing blood sugar after meals and ‘long-term blood sugar’ (measured by ‘HbA1c’, which is a blood test used to measure the average blood sugar level over approximately the past two months).
  • A diet with a reduced carbohydrate content, a high protein content and a moderately increased fat content reduces liver fat content.
  • A diet with a reduced carbohydrate content may be beneficial to patients with type 2 diabetes – even if it does not lead to weight loss.

Source: University of Copenhagen


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Study: Red Raspberries May Help with Glucose Control in People with Pre-diabetes

A study released today from the Illinois Institute of Technology shows the benefits of including red raspberries in the diet of individuals with pre-diabetes and insulin resistance.

According to the Centers for Disease Control and Prevention (CDC), an estimated 34 percent of American adults, around 84.1 million in all, had prediabetes in 2015. Patients with prediabetes are at higher risk for a number of conditions – including developing type 2 diabetes, cardiovascular disease and Alzheimer’s disease.

The study, published in Obesity, investigated the effects of red raspberries in a group of people at-risk for diabetes who were overweight or obese and presented with prediabetes and insulin resistance. A metabolically healthy control group was also included in the study for reference.

Using a randomized, controlled, acute study design, 32 adults between the ages of 20-60 years had their blood tested over a 24-hour period after eating breakfast on three separate days. The three breakfast meals were similar in calories and macronutrients, but differed in the amount of frozen red raspberries – one meal contained no raspberries, one contained one cup of raspberries and one contained two cups of raspberries.

The results showed that as the amount of raspberry intake increased, individuals at risk for diabetes needed less insulin to manage their blood glucose. When two cups of red raspberries were included in the meal, glucose concentrations were lower compared to the meal with no red raspberries. The data suggests that simple inclusion of certain fruits, such as red raspberries with meals, can have glucose lowering benefits with indications of improvements in insulin responses. These effects are particularly important for people who are overweight or obese with pre-diabetes.

“People at risk for diabetes are often told to not eat fruit because of their sugar content. However, certain fruits – such as red raspberries – not only provide essential micronutrients, but also components such as anthocyanins, which give them their red color, ellagitannins and fibers that have anti-diabetic actions,” said Britt Burton-Freeman, Ph.D., director, Center for Nutrition Research at Illinois Tech. “For people who are at risk for diabetes, cardiovascular disease and other health risks, knowing what foods have protective benefits and working them into your diet now can be an important strategy for slowing or reversing progression to disease.”

Source: EurekAlert!


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Blood Sugar Spikes Seen in Seemingly Healthy People

Serena Gordon wrote . . . . . . . .

You’d expect big blood sugar fluctuations in people with diabetes. But for those without the disorder, blood sugar levels should remain fairly stable, right?

Maybe not, says a new study. Researchers found some people who don’t have diabetes still have wild swings in their blood sugar levels after they eat.

Among nearly 60 participants, the study authors identified three “glucotypes” based on how much blood sugar spiked after eating — low, moderate and severe.

The study also found that certain foods were more likely to prompt an extreme change in blood sugar (glucose) than others.

“Even if you don’t have diabetes, you may not have normal glucose. There are a lot of people with glucose dysfunction out there who don’t know it,” said the study’s lead author, Michael Snyder. He’s director of genomics and personalized medicine at Stanford University School of Medicine, in California.

Snyder said this finding is potentially concerning because spikes in blood sugar levels have been associated with risk of heart attack and stroke. And it’s possible — though it hasn’t been proven in this study — that people who have big rises in their blood sugar after eating may have a higher risk of diabetes.

Type 2 diabetes is a major health problem, affecting more than 30 million U.S. adults and 422 million worldwide, the authors noted.

But not every medical expert is convinced that these changes in blood sugar in healthy people are something to be concerned about.

Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, pointed out that the study population was small. That makes it difficult to draw conclusions about blood sugar pattern “types,” he said. Zonszein was not involved with the research.

The study volunteers “were separated into low, moderate and severe spikes. But there may be many other patterns,” he said. “Absorption, storage and utilization of [sugars] is highly regulated and difficult to characterize by only three different patterns.”

Zonszein added that blood sugar metabolism is complex and affected by many different variables.

To determine the three glucotypes, the Stanford researchers recruited 57 people without diabetes to wear a device called a continuous glucose monitor for a few weeks.

These devices measure approximate blood sugar levels every five minutes using a sensor that’s inserted underneath the skin, Zonszein said.

People with diabetes use these devices to monitor trends in their blood sugar and to see if treatment changes are needed. The monitors provide more information about blood sugar patterns than standard tests that generally only capture a short period of time.

In addition to discovering the three different glucose spiking patterns, the researchers conducted a sub-study with 30 volunteers who wore a continuous glucose monitor while they ate standardized meals. One meal was cornflakes with milk, another was a protein bar and the third was a peanut butter sandwich.

“Certain foods tend to spike nearly everybody,” Snyder said, adding that the cereal was one such food. About 4 out of 5 people saw their blood sugar jump after consuming cereal and milk, the researchers said.

Some of the spikes observed in the study reached prediabetic and diabetic levels, the study authors noted.

Zonszein said that while continuous glucose monitors are great tools for people with diabetes, they don’t necessarily capture someone’s “glucose metabolism.”

And he doesn’t see the devices being used to replace current screening tests for diabetes until much more research is done comparing this technology to current tests.

The study was published in the journal PLOS Biology.

Source: HealthDay


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A Big Breakfast Could Aid Weight Loss, Glucose Control

Honor Whiteman wrote . . . . . . .

You may have heard that breakfast is “the most important meal of the day,” and a new study helps to support this. It found that eating a big breakfast and reducing lunch and dinner size may be key for people looking to lose weight and improve their blood glucose levels.

Led by researchers from Tel Aviv University in Israel, the study found that adults who were obese and had type 2 diabetes lost more weight and had better blood glucose levels after 3 months when they had a high-energy breakfast every day.

Lead study author Dr. Daniela Jakubowicz, who is a professor of medicine at Tel Aviv University, and colleagues recently presented their results at ENDO 2018, the annual meeting of the Endocrine Society, held in Chicago, IL.

Obesity is a leading risk factor for type 2 diabetes; excess weight makes it more difficult for the body to use insulin — the hormone that regulates blood glucose levels — effectively.

According to the Obesity Society, it is estimated that around 90 percent of adults who have type 2 diabetes are overweight or obese.

In terms of treating obesity and type 2 diabetes, switching to a more healthful diet is often the first port of call. But, as Dr. Jakubowicz notes, it’s not always what and how much we eat that might cause problems; it’s also the time of day at which we eat.

“Our body metabolism changes throughout the day,” as Dr. Jakubowicz explains. “A slice of bread consumed at breakfast leads to a lower glucose response and is less fattening than an identical slice of bread consumed in the evening.”

With this in mind, Dr. Jakubowicz and colleagues sought to find out more about how the timing of food intake influences weight loss and blood glucose levels.

Source: Medical News Today


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