Vitamin D and Fish Oil Supplements Don’t Prevent Kidney Disease in Type 2 Diabetics

Taking vitamin D and fish oil supplements won’t prevent kidney disease in people with type 2 diabetes, a new study finds.

Many diabetics use the supplements, hoping they will have a positive effect on their kidneys and heart, the researchers said.

“We wanted this study to clarify whether these supplements have any real kidney benefit in adults with diabetes. Even if it’s not the result we hoped for, closing a chapter is useful for patients and clinicians and researchers alike,” said lead author Dr. Ian de Boer. He is a professor of medicine at the University of Washington School of Medicine, in Seattle.

The researchers hoped the supplements would be beneficial because animal studies and lab experiments had suggested that anti-inflammatory and other properties in these supplements might prevent or slow progression of kidney disease in people with type 2 diabetes.

And in humans, other research has found a link between kidney problems and low levels of vitamin D and diets lacking fish.

For the study, which was part of the nationwide Vitamin D and Omega-3 Trial (VITAL), the researchers looked at kidney function in more than 1,300 people with type 2 diabetes.

Study participants were randomly assigned to get vitamin D and fish oil supplements; vitamin D and a fish oil placebo; fish oil and a vitamin D placebo; or two placebos.

Over five years, kidney function declined an average of 15%. The decline occurred whether participants took supplements or not, the investigators found.

“We were hopeful for both of these interventions, vitamin D and fish oil, but they don’t appear to be particularly effective for this purpose,” de Boer said in a university news release.

About 40% of the 28 million Americans living with type 2 diabetes will develop chronic kidney disease, he noted.

The study was published in the Journal of the American Medical Association. It was presented concurrently at a meeting of the American Society of Nephrology, in Washington, D.C.

Source: HealthDay


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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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Drinking More Sugary Beverages of Any Type May Increase Type 2 Diabetes Risk

People who increase their consumption of sugary beverages—whether they contain added or naturally occurring sugar—may face moderately higher risk of type 2 diabetes, according to a new study from Harvard T.H. Chan School of Public Health. Drinking more sugar-sweetened beverages (SSBs), like soft drinks, as well as 100% fruit juices, was associated with higher type 2 diabetes risk.

The study also found that drinking more artificially sweetened beverages (ASBs) in place of sugary beverages did not appear to lessen diabetes risk. However, diabetes risk decreased when one daily serving of any type of sugary beverage was replaced with water, coffee, or tea. It is the first study to look at whether long-term changes in SSB and ASB consumption are linked with type 2 diabetes risk.

The study was published online October 3, 2019 in the journal Diabetes Care.

“The study provides further evidence demonstrating the health benefits associated with decreasing sugary beverage consumption and replacing these drinks with healthier alternatives like water, coffee, or tea,” said lead author Jean-Philippe Drouin-Chartier, postdoctoral fellow in the Department of Nutrition.

The study looked at 22–26 years’ worth of data from more than 192,000 men and women participating in three long-term studies—the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals’ Follow-up Study. Researchers calculated changes in participants’ sugary beverage consumption over time from their responses to food frequency questionnaires administered every four years.

After adjusting for variables such as body mass index, other dietary changes, and lifestyle habits, the researchers found that increasing total sugary beverage intake—including both SSBs and 100% fruit juice—by more than 4 ounces per day over a four-year period was associated with 16% higher diabetes risk in the following four years. Increasing consumption of ASBs by more than 4 ounces per day over four years was linked with 18% higher diabetes risk, but the authors said the findings regarding ASBs should be interpreted with caution due to the possibility of reverse causation (individuals already at high risk for diabetes may switch from sugary beverages to diet drinks) and surveillance bias (high-risk individuals are more likely to be screened for diabetes and thus diagnosed more rapidly).

The study also found that replacing one daily serving of a sugary beverage with water, coffee, or tea—but not with an ASB—was linked with a 2–10% lower risk of diabetes.

“The study results are in line with current recommendations to replace sugary beverages with noncaloric beverages free of artificial sweeteners. Although fruit juices contain some nutrients, their consumption should be moderated,” said Frank Hu, Fredrick J. Stare professor of nutrition and epidemiology and senior author of the study.

Source: Harvard T.H. Chan School of Public Health


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Maintaining Weight Loss Beneficial for People with Type 2 Diabetes

People with Type 2 diabetes who regained weight forfeited the initial benefits of reduced risk of heart disease or stroke compared to those who maintained their weight loss, according to new research published in the Journal of the American Heart Association, the open access journal of the American Heart Association.

Regaining weight previously lost is common and can deteriorate the initial benefits of lowered heart disease or stroke risks. Few studies have directly compared cardiometabolic risk between people who successfully lost weight and maintained the weight loss to those who regained weight, particularly among people with Type 2 diabetes.

Researchers analyzed data from nearly 1,600 participants with Type 2 diabetes in an intensive weight loss study who lost at least 3% of their initial body weight. They found that among those who lost 10% or more of their body weight and then maintained 75% or more of their weight loss four years later saw a significant improvement in risk factors, such as improved levels of HDL (good) cholesterol, triglycerides, glucose, blood pressure, waist circumference and diabetes control. However, those benefits deteriorated among those who regained weight.

“Our findings suggest that in addition to focusing on weight loss, an increased emphasis should be placed on the importance of maintaining the weight loss over the long-term,” said Alice H. Lichtenstein, D.Sc., senior study author and director of the Cardiovascular Nutrition Laboratory at the Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts. “The bottom line is that maintaining the majority of the weight loss is essential to reducing cardiovascular risk.” Lichtenstein is a member of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health – Lifestyle Nutrition Committee.

The researchers used data from the Look AHEAD study, which assessed a year-long intensive lifestyle intervention program to promote weight loss, compared to standard care for heart disease and stroke risk, among people diagnosed with Type 2 diabetes and who were overweight. The intensive lifestyle intervention program focused on achieving weight loss through healthy eating and increased physical activity, while standard care consisted of diabetes support and education. A three-year maintenance phase included monthly group meetings and recommendations to replace one meal per day with something similar to a replacement shake or bar, and to continue engaging in regular physical activity.

Source: American Heart Association


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Just a Little Weight Loss Can Put Diabetes Into Remission

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

British researchers have good news for people with type 2 diabetes — you don’t need to lose a ton of weight to make a difference in your health.

In fact, they found that losing just 10% of your body weight during the first five years you have the disease can lead to remission of type 2 diabetes. That weight loss would be 18 pounds for someone who weighs 180 pounds.

It doesn’t matter what diet helps you lose the weight. And it doesn’t matter how slow or how quickly those pounds come off, the investigators found.

“Even small amounts of weight loss can help you achieve remission. Extreme dieting and exercising are not necessary,” said study author Dr. Hajira Dambha-Miller, a general practice physician and clinical lecturer at the University of Cambridge School of Clinical Medicine, in the United Kingdom.

“Type 2 diabetes should no longer be seen as a lifelong disease,” she added. The disease can essentially be cured if you lose weight and keep it off, according to Dambha-Miller.

The researchers said that type 2 diabetes affects 400 million people around the world. It’s typically considered a chronic, progressive disease. But significant weight loss through extreme dieting (less than 700 calories a day) can bring about remission in almost 90% of people with type 2 diabetes, the study authors noted. Weight-loss surgery also tends to bring on remission.

Intensive exercise coupled with a modest weight loss of 7% or less of body weight brought on remission in almost 12% of people in one study, according to the new report.

But maybe bringing on remission didn’t need to be so hard, the researchers surmised.

“The existing evidence for achieving remission suggests extreme levels of exercise and rather restrictive diets. This is simply not realistic or achievable for my patients, especially in the longer term,” Dambha-Miller said.

“It is also demotivating for my patients when they are unable to achieve large amounts of weight loss. Accordingly, we decided to look at modest weight loss over a longer period in a real-world population without any crazy diet or exercise requirements,” she explained.

For the new study, the researchers followed the health of almost 900 people newly diagnosed with type 2 diabetes for five years. The study participants, aged 40 to 69, provided information on weight, activity levels, diet and alcohol consumption.

Thirty percent of the group had achieved type 2 diabetes remission at the five-year follow-up. Those who had achieved a 10% weight loss were 77% more likely to be in remission after five years, the findings showed.

There was no specific intervention in the study. “This means there were no mandatory exercise or dietary requirements. All our participants did different things and still managed to lose weight and beat diabetes into remission,” Dambha-Miller said.

She said that experts don’t know exactly how losing weight helps, but they hypothesize that as people lose weight, the beta cells in the pancreas that produce insulin start to work again. That means the body can properly use sugar from foods instead of letting it build up in the blood.

Dr. Berhane Seyoum, chief of endocrinology at Detroit Medical Center and Wayne State University in Michigan, wasn’t involved in the current research, but said the findings are encouraging.

“People with type 2 diabetes can be encouraged to lose weight, and it doesn’t matter how. They can do whatever is convenient for them. Controlling diabetes keeps you healthy, gives you more energy and makes you feel better,” he said.

Seyoum also noted that any amount of weight loss can help the body use insulin better and will help with diabetes management.

The study was published online recently in the journal Diabetic Medicine.

Source: HealthDay