Could Big Lifestyle Changes Be Key to Managing Type 2 Diabetes?

Serena Gordon wrote . . . . . .

When it comes to type 2 diabetes management, a new study finds that more is definitely better for lowering blood sugar levels.

The study showed that adding intensive lifestyle management to standard diabetes care (diabetes medication and usual lifestyle change advice) brought blood sugar into a nondiabetic range.

The intensive intervention worked so well that “half of the intervention group did not need glucose-lowering medications to maintain or even improve [blood sugar] control,” said the study’s senior researcher, Mathias Ried-Larsen.

So, what exactly constitutes an “intensive” intervention?

“Patients were prescribed exercise five to six times per week for 30 to 60 minutes per session. That included both endurance and resistance training,” said Ried-Larsen, of Rigshospitalet in Copenhagen, Denmark.

“In the beginning, the exercise was supervised by a coach, but gradually, they were left on their own. Moreover, they received a dietary program with focus on foods rich in fiber, low in saturated fats, lots of fruit and no processed food. We designed the diet for patients to lose weight,” he said.

The study included nearly 100 people from Denmark. All had had type 2 diabetes for less than 10 years, and none had complications from the disease.

The average age of the participants was 55, and nearly half were women. Average A1C level at the start of the study was 6.7 percent. A1C is a blood test that estimates average blood sugar levels over two to three months. An A1C of 6.5 percent or higher indicates diabetes, according to the American Diabetes Association.

Study participants were randomly placed into the usual care group or the intensive lifestyle management group.

After a year, the intensive group lost 13 pounds compared to 4 pounds in the standard management group, the findings showed. LDL cholesterol (the bad kind) and triglycerides (another type of bad blood fat) were reduced more in the intensive group than in the standard group. HDL cholesterol (the good kind) rose more in the intensive group than in the standard group, according to the report.

Average A1C dropped from 6.65 to 6.34 percent in the intensive intervention group, and from 6.74 percent to 6.66 percent in the standard group, the investigators found.

In addition, three-quarters of those in the intensive group needed less diabetes medication, while only one-quarter of the standard care group lowered their medications, the researchers reported.

Not every expert agrees that lowering or stopping diabetes medications is a good idea, however.

Dr. Joel Zonszein is director of the clinical diabetes center at Montefiore Medical Center in New York City.

Zonszein noted that study participants were taking metformin and GLP-1 analogues. “These are good agents. That’s why their A1C was so good at the start. I also treat my patients with lifestyle changes. But it’s not one or the other. Both medicine and lifestyle changes are important,” he said.

“When you use the two together, they work much better,” he added.

Zonszein also noted that the Denmark group was “an unusual population.” None took insulin, and no one had complications. And, at the start of the study, their blood sugar was already fairly well-managed. That would likely be much different in a U.S. population with type 2 diabetes.

One reason Ried-Larsen hoped to lower the need for medication is to save money. Although metformin is available in a generic form and isn’t generally expensive, some of the newer type 2 diabetes medications can be costly.

“I think this study calls for a thorough discussion about the resources we need to allocate to help people to adhere to a lifestyle treatment and what responsibility the society has in this regard,” Ried-Larsen said.

“We do acknowledge that the lifestyle treatment is extensive and could be regarded as not economically viable in clinical care,” Ried-Larsen noted. “However, consider the willingness to introduce newer classes of drugs that come with extreme prices. If we could get doctors and patients to allocate that sort of money and resources to lifestyle treatment, I think we could change things.”

Zonszein added that when people rely solely on lifestyle management, it doesn’t always bring blood sugar levels down enough.

“It’s important to consider the cost-effectiveness of medications along with their cost. A lot of expense comes from treating diabetes complications,” he said.

The report was published in the Journal of the American Medical Association.

Source: HealthDay


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Higher BMI Linked with Increased Risk of High Blood Pressure, Heart Disease, Type 2 Diabetes

Results of a new study add to the evidence of an association between higher body mass index (BMI) and increased risk of cardiometabolic diseases such as hypertension, coronary heart disease, type 2 diabetes, according to a study published by JAMA Cardiology.

A connection between higher BMI and cardiometabolic disease risk usually arise from observational studies that are unable to fully account for confounding by shared risk factors. Mendelian randomization (a method of analysis using genetic information) is an approach that partially overcomes these limitations. Using mendelian randomization, Donald M. Lyall, Ph.D., of the University of Glasgow, Scotland, and colleagues conducted a study that included 119,859 participants in the UK Biobank (with medical, sociodemographic and genetic data) to examine the association between BMI and cardiometabolic diseases and traits.

Of the individuals in the study, 47 percent were men; average age was 57 years. The researchers found that higher BMI was associated with an increased risk of coronary heart disease, hypertension, and type 2 diabetes, as well as increased systolic and diastolic blood pressure. These associations were independent of age, sex, alcohol intake, and smoking history.

The authors write that the results of this study has relevance for public health policies in many countries with increasing obesity levels. “Body mass index represents an important modifiable risk factor for ameliorating the risk of cardiometabolic disease in the general population.”

A limitation of the study was that the sample lacked data on a complete range of potential mediators, such as lipid traits and glucose levels.

Source: The JAMA Network

Study: Self-monitoring of Blood Sugar Had No Effect on Long-term Glucose Levels in Those Not Taking Insulin

Steven Reinberg wrote . . . . . .

People with type 2 diabetes who aren’t taking insulin don’t necessarily need to check their blood sugar levels, a new study contends.

Many of these patients use “finger prick” blood sugar monitors, but “testing blood sugar didn’t have any impact on their blood sugar,” said study author Dr. Laura Young, an assistant professor of medicine at the University of North Carolina.

“The best way to control blood sugar is to take your medication the way your doctor asks you to and to take good care of yourself,” she said. “The key is really taking your medications.”

Monitoring might be helpful when starting a new medication or changing doses, Young said.

“But if someone is on insulin, they absolutely need to be tested regularly,” she said. Insulin predisposes people to have blood sugar that’s too low, a condition called hypoglycemia. Hypoglycemia can cause dizziness and weakness and, if not treated, lead to coma, Young said.

“Patients should have a conversation with their doctor about whether or not they should be checking blood sugar,” she said.

For the study, Young and her colleagues randomly assigned 450 patients with type 2 diabetes who weren’t taking insulin to monitor their blood sugar once a day with a typical blood sugar meter, once a day with a monitor that gave them a feedback message, or to not monitor blood sugar at all.

The participants in the study were from 15 primary care practices in North Carolina. Their average age was 61, and they’d had diabetes for an average of eight years. About three-quarters were monitoring their blood sugar at the start of the study.

After a year, the researchers found no differences between the groups in how well their blood sugar was controlled or in their quality of life.

It’s possible that these results were skewed by people who dropped out of the trial. An improvement in blood sugar seen in hemoglobin A1c levels was seen in the early months of the trial, but wasn’t significant at the end of the trial, the researchers reported. Hemoglobin A1c is a blood test (usually done at the doctor’s office) that provides an average of about two to three months of blood sugar levels.

One diabetes expert agreed that routine blood sugar checks may not be necessary for these patients.

“The value of self-monitoring of blood sugar levels in patients not treated with insulin is minimal,” said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

“In my practice, I advocate that every patient with diabetes needs to have a monitor, needs to know how to check blood sugars, and needs to check blood sugars from time to time, when they are sick and when treatment is changed,” he said.

Zonszein agreed that the main reason to check blood sugar is not to see if it’s too high, but to check if it’s too low.

This is especially true for patients taking sulfonylureas, such as chlorpropamide (Diabinese), he said.

“These agents can cause hypoglycemia, and low blood sugar is something we want to diagnose and treat. Those patients on hypoglycemic agents such as sulfonylureas need to monitor more often, as they can have a low blood sugar and not even know about it,” Zonszein said.

The majority of his type 2 diabetes patients are treated with metformin and one of the newer medications, such as a liraglutide (Victoza) or canagliflozin (Invokana) or combinations of those drugs.

“These patients tend to have a normal A1c and they rarely need to check their blood sugars, as these agents don’t cause significant hypoglycemia,” he said.

In other studies, frequent blood sugar monitoring has been found to not be beneficial, and might also lead to depression, Zonszein said.

“The authors proved what I have been telling my patients,” he said. “Monitoring blood sugar is somewhat painful and very costly, and when it is done, it has to have a reason.”

The findings were published in the journal JAMA Internal Medicine, to coincide with a presentation of the study at the American Diabetes Association’s annual meeting, in San Diego.

Source: HealthDay


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Is Coconut Palm Sugar a Better Sweetener for People with Diabetes?

Lana Barhum wrote . . . . . .

What is coconut palm sugar?

Coconut palm sugar is made from the sap of the coconut palm. The sugar is extracted from the palm by heating it until the moisture evaporates. After processing, the sugar has a caramel color and tastes like brown sugar, making it an easy substitution in any recipe.

Coconut palm sugar is considered a healthier option for people with diabetes because it contains less pure fructose than other sweeteners.

The digestive tract does not absorb fructose as it does other sugars, which means that the excess fructose finds its way to the liver. Too much fructose in the liver can lead to a host of metabolic problems, including type 2 diabetes.

Can people with diabetes eat coconut palm sugar?

While the American Diabetes Association (ADA) do find coconut palm sugar to be an acceptable sugar substitute, they do not appear to endorse its use.

Coconut palm sugar and glycemic index

Some people believe coconut palm sugar is more healthful because it is lower on the glycemic index (GI).

People with diabetes are encouraged to consume foods with a low GI because they will not raise blood sugar levels as much as foods with a high GI level. Any GI value of 55 or less is considered low, and anything above 70 is high on the GI.

Both honey and cane sugar have GIs of around 50, while the GI of coconut palm sugar, as reported by the Food and Nutrition Research Institute of the Philippines, is 35.

However, the University of Sydney have measured the GI of coconut palm sugar at 54. Based on its chemical makeup, this is thought to be the most likely value. Despite the difference in opinion, coconut palm sugar is still considered to be a low GI food.

Issues with looking at GI

There are several factors that contribute to blood sugar levels after eating, including how the food is prepared.

In the United States, there is no official GI rating system. The ADA note, however, that GI numbers for specific foods differ based on their source, and this would likely apply to coconut palm sugar.

According to the Joslin Diabetes Center, the GI is not the best guideline for what happens to blood sugar levels after eating.

There are many factors that influence the process, including:

  • the individual
  • the content of the food
  • how food is prepared
  • what other foods are consumed
  • the rate of digestion

Therefore, the ADA advise people to treat coconut palm sugar as they would any other sweetener, including pure cane sugar. It is also important to include the number of calories and carbohydrates it contains when planning meals.

People should always check the nutritional labels on coconut palm sugar. This is because coconut palm sugar may contain other ingredients, including cane sugar, which means its GI will be much higher than noted in a rating system.

Coconut palm sugar contains inulin

Inulin is a fermentable prebiotic fiber, beneficial to gut bacteria that may help with controlling sugar levels in type 2 diabetics.

At least one research study finds coconut palm sugar contains significant amounts of inulin.

A study from 2016 found that fermentable carbohydrates might help to improve insulin sensitivity. They may also have unique metabolic effects for those who are at high risk for diabetes.

Benefits for women with type 2 diabetes

Another study finds that inulin provides some benefits for women with type 2 diabetes, including blood glycemic control and antioxidant status. Antioxidants protect the body from disease and damage.

More research is needed to further identify and understand these findings to extend to other populations with type 2 diabetes.

Nutritional value of coconut palm sugar

Coconut palm sugar contains the same number of calories and carbohydrates as regular cane sugar.

In addition, coconut palm sugar and cane sugar both contain:

  • fructose, which is a monosaccharide, or single sugar
  • glucose, which is a monosaccharide
  • sucrose, which is a disaccharide that is made up of two sugars: half fructose, half glucose

However, the proportion of these sugars is different in cane sugar and palm sugar.

Other nutrients found in coconut palm sugar

Coconut palm sugar may be considered a better option, as it has more nutritional value than some other sugars.

Unlike cane sugar, it contains:

  • iron
  • calcium
  • magnesium
  • potassium
  • other important minerals

However, people should bear in mind that cane sugar contains tiny amounts of these nutrients. Most people only consume a few teaspoons of coconut palm sugar at a time, which actually contains less than 2 percent of all nutrients.

Healthful whole foods will provide dramatically more of these same nutrients for fewer calories.

Conclusion

There is not enough sufficient research to back up claims coconut palm sugar is more healthful, better, or different than any other sugar for blood sugar.

While coconut sugar contains inulin, it may not contain enough to significantly affect blood sugar levels. In addition, coconut palm sugar is also just as high in calories as regular cane sugar.

Coconut palm sugar seems to be slightly more beneficial than regular sugar but is still best consumed in moderation. Therefore, individuals with type 2 diabetes should treat it the same as other sugars and use it sparingly, as it still might raise blood glucose levels, despite its possibly lower GI.

Source: Medical News Today


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Type 2 Diabetes: The Basics

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood.

Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet.

What Causes Diabetes?

Your pancreas makes a hormone called insulin. It’s what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don’t use it as well as they should. Doctors call this insulin resistance.

At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can’t keep up, and the sugar builds up in your blood instead.

Usually a combination of things cause type 2 diabetes, including:

Genes: Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight: Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity.

Metabolic syndrome: People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver: When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people’s livers don’t. They keep cranking out sugar.

Bad communication between cells: Sometimes cells send the wrong signals or don’t pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.

Broken beta cells: If the cells that make the insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood glucose can damage these cells, too.

Risk Factors and Prevention

While certain things make getting diabetes more likely, they won’t give you the disease. But the more that apply to you, the higher your chances of getting it are.

Some things you can’t control.

  • Age: 45 or older
  • Family: A parent, sister, or brother with diabetes
  • Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American

Some things are related to your health and medical history. Your doctor may be able to help.

  • Prediabetes
  • Heart and blood vessel disease
  • High blood pressure, even if it’s treated and under control
  • Low HDL (“good”) cholesterol
  • High triglycerides
  • Being overweight or obese
  • Having a baby that weighed more than 9 pounds
  • Having gestational diabetes while you were pregnant
  • Polycystic ovary syndrome (PCOS)
  • Acanthosis nigricans, a skin condition with dark rashes around your neck or armpits
  • Depression

Other risk factors have to do with your daily habits and lifestyle. These are the ones you can really do something about.

  • Getting little or no exercise
  • Smoking
  • Stress
  • Sleeping too little or too much

Because you can’t change what happened in the past, focus on what you can do now and going forward. Take medications and follow your doctor’s suggestions to be healthy. Simple changes at home can make a big difference, too.

Lose weight: Dropping just 7% to 10% of your weight can cut your risk of type 2 diabetes in half.

Get active: Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.

Eat right: Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.

Quit smoking: Work with your doctor to avoid gaining weight, so you don’t create one problem by solving another.

Symptoms

The symptoms of type 2 diabetes can be so mild you don’t notice them. In fact, about 8 million people who have it don’t know it.

  • Being very thirsty
  • Peeing a lot
  • Blurry vision
  • Being irritable
  • Tingling or numbness in your hands or feet
  • Feeling worn out
  • Wounds that don’t heal
  • Yeast infections that keep coming back
  • Getting a Diagnosis

Your doctor can test your blood for signs of diabetes. Usually doctors will test you on two different days to confirm the diagnosis. But if your blood glucose is very high or you have a lot of symptoms, one test may be all you need.

A1C: It’s like an average of your blood glucose over the past 2 or 3 months.

Fasting plasma glucose: This measures your blood sugar on an empty stomach. You won’t be able to eat or drink anything except water for 8 hours before the test.

Oral glucose tolerance test (OGTT): This checks your blood glucose before and 2 hours after you drink a sweet drink to see how your body handles the sugar.

Long-Term Effects

Over time, high blood sugar can damage and cause problems with your:

  • Heart and blood vessels
  • Kidneys
  • Eyes
  • Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
  • Wound healing
  • Pregnancy

The best way to avoid these complications is to manage your diabetes well.

  • Take your diabetes medications or insulin on time.
  • Check your blood glucose.
  • Eat right, and don’t skip meals.
  • See your doctor regularly to check for early signs of trouble.

Source: WebMD