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A Comox Valley family is urging the government to provide coverage for a breakthrough diabetes monitoring system.

Lisa Christensens 11-year-old daughter, Lillithe, was diagnosed with Type 1 diabetes three years ago.

Type 1 diabetes involves continuous monitoring of blood glucose a finger poke to draw blood, which is then applied to a strip, so a machine can calculate the numbers.

You must constantly be aware of your blood glucose number, as if it gets too high for too long, you can develop both acute and long-term complications, said Lisa. If it gets too low, you are in danger of unconsciousness, or if you do not receive help it could lead to potential death.

Type 1 diabetics are dependent on insulin, either by syringe or by pump. The glucose monitoring tells the diabetic if insulin is needed.

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RELATED: Getting kids to a good weight by 13 may help avoid diabetes

Lisa said when the family first began monitoring Lillithes glucose levels, a good nights sleep was not an option.

In order to be safe, because blood glucose can change quickly for many reasons especially with children we had to get up and poke her fingers multiple times a night, explained Lisa. We caught some lows this way before they could become dangerous but we were constantly feeling exhausted by the lack of quality sleep and the worry.

Thanks to a grant from Bear Essentials (Childrens Health Foundation of Vancouver Island), and the Help Fill a Dream Foundation, the family secured funding for a flash glucose monitor, which was a marked improvement, but still had its drawbacks.

We found that while the quantity of the data greatly improved our experience in treating our daughters condition, the results were not always accurate, so we were still doing a lot of finger poke tests to confirm we were dosing off of accurate information, said Lisa. A flash monitor does not come with the ability to broadcast your results to a phone or device, it must be physically scanned. This means you still have to get up in the night to go and check on things.

The Christensens were introduced to a continuous glucose monitor the Dexcom G6. Administrators of the aforementioned grant program agreed to switch funding over to the Dexcom G6, and Lisa says the switch has been life-changing.

This is an amazing life- and sanity-saving device, said Lisa. The accuracy of the G6 has been pretty much spot on for us, you can dose insulin without the need for painful finger pokes. Because of the transmitting ability of the device, both my husband and I can access the blood glucose at any time on our phones.

I no longer have to get out of bed to check her numbers at night, and I can rest assured that if numbers climb or fall the G6 will automatically alert me. When she goes over to see a friend, I can keep an eye on her numbers from any distance, and she can call me to get advice on how to treat.

The government is investigating if this technology could be beneficial enough to warrant providing PharmaCare coverage.

We need them to say yes, said Lisa. It is unconscionable to force people who have to take a medication that has the potential, when dosed incorrectly or affected by activity, to be extremely dangerous to make decisions based off of insufficient and inaccurate data when there is an easy alternative.

PharmaCare only considers coverage if manufacturers apply to have their products covered by PharmaCare. Every submission is reviewed by the Drug Benefit Council (DBC), an independent advisory body, after which, the DBC will make recommendations to PharmaCare.

When contacted by The VI Free Daily, a Dexcom spokesperson confirmed that Dexcom Canada has applied to have Dexcom G6 coverage with BC PharmaCare.

The VI Free Daily has also reached out to the DBC to inquire about whether the board has made a recommendation to the government regarding the G6.

Meanwhile, Lisa said her grant money has run out and the family will have to revert to the poking method to test glucose levels.

This causes deep anxiety as I am not sure how I will go about finding the funds if the government does not accept the G6 to fair PharmaCare, she said.

Lisa added that CGM technology is only marginally more expensive than using the outdated technology of strips and the painful finger pokes that the government plan currently covers. She said the upfront costs would pay for themselves over time.

I would argue that that cost is far more than recovered in the savings from reducing complications and hospital stays in the long run, she explained. As well as increasing productivity of type ones and their caregivers who are no longer exhausted by chasing numbers. And perhaps most importantly of all, by reducing the risks of death for people with this manageable, yet potentially dangerous condition.

For more information on the Dexcom G6 continuous glucose monitoring system, go to http://www.dexcom.com

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Vancouver Island mom calls on government to fund breakthrough diabetes monitoring system - vancouverislandfreedaily.com

Genetics, diet, and lifestyle are well-known factors that contribute to type 2 diabetes risk. But there may be a social component that strongly affects your chances of developing the disease, too, suggests a study published in September 2020 in Diabetologia.

Specifically, feeling lonely even if you dont live alone and you do have social interactions in your daily life is associated with a higher risk for type 2 diabetes, the authors found.

For the study, researchers assessed loneliness by asking more than 4,000 adults without type 2 diabetes how often they felt they lacked companionship, felt left out, or felt isolated from others. Responses were averaged on a scale from 1 to 3 points, with higher scores indicating more frequent feelings of loneliness.

After about a decade of follow-up, a total of 264, or 6.4 percent, of participants developed type 2 diabetes. People with type 2 diabetes by the end of the study started out with average loneliness scores of 1.42, compared with 1.33 for individuals who didnt develop type 2 diabetes.

Loneliness was associated with 46 percent greater odds of developing type 2 diabetes, the study found.

The study shows a strong relationship between loneliness and the later onset of type 2 diabetes, says the lead study author,Ruth Hackett, PhD, of the Institute of Psychiatry, Psychology, and Neuroscience at Kings College London in the United Kingdom.

What is particularly striking is that this relationship is robust even when factors that are important in diabetes development are taken into account, such as smoking, alcohol intake, and blood glucose, as well as mental health factors such as depression, Hackett says. There was an independent effect of loneliness on the development of diabetes, above and beyond health behavior.

RELATED:9 Secret Signs of Loneliness

This is the first study to demonstrate that loneliness is linked to an increased risk of developing type 2 diabetes, says Andrew Steptoe, a doctor of science and doctor of philosophy and the head of the department of behavioral science and health at University College London in the United Kingdom.

Previous research has tied social isolation to a risk of type 2 diabetes, but this isnt the same thing as loneliness, says Dr. Steptoe, who wasnt involved in the current study. Loneliness is a subjective experience of dissatisfaction with social and personal relationships, and may not necessarily be linked objectively with how many close friends or social activities people have, Steptoe says.

Fewer close friends and social contacts are, however, associated with an increased risk of developing type 2 diabetes, according to a study published in December 2017 in BMC Public Health. This study looked at how many close friends and family members people had regular contact with in their daily lives and found that each one-person reduction in the size of these social networks was associated with a 12 percent higher chance of developing type 2 diabetes for men and 10 percent greater chance for women.

Isolation has also been tied to a greater risk of premature death in previous research, including a study published in December 2019 in Heart. For one year, this study followed individuals who had been hospitalized for heart problems. Women in the study who reported high levels of loneliness were three times more likely to die during the study, and lonely men were about twice as likely to die.

RELATED: Connected but Alone: What Toll Does Loneliness Take on Our Health?

One limitation of the current study is that researchers assessed loneliness only at a single point in time. Another is that the three-question loneliness evaluation used in the study didnt enable researchers to examine nuanced variations in how people experience loneliness, social isolation, or living alone.

The study wasnt designed to show how loneliness might cause type 2 diabetes. But its possible that so-called psychosocial stress that develops as a result of feeling lonely might lead people to have persistently elevated levels of the stress hormones epinephrine and cortisol, both of which can play a role in the development of type 2 diabetes, says Yacob Pinchevsky, PhD, of the faculty of health sciences at the University of the Witwatersrand in Johannesburg, South Africa.

Put simply, the regular activation of stress-related biological systems due to chronic loneliness may lead to further wear and tear on the body, which could result in increased risk for the development of type 2 diabetes, says Dr. Pinchevsky, who wasnt involved in the latest study.

RELATED: Introvert or Extrovert: What Are Your Best Options for Social Connection?

Its not clear from the study whether managing stress or making an effort to make more friends or to create a more active social life might reduce the risk of developing type 2 diabetes, says Sabine Rohrmann, PhD, MPH, of the Epidemiology, Biostatistics, and Prevention Institute at the University of Zurich in Switzerland.

Because loneliness can be subjective, more friends or social contacts dont necessarily mean people will feel less lonely, says Dr. Rohrmann, who wasnt involved in the study. Some people who push outside their comfort zone to socialize more may also feel stress as a result that triggers a surge in the cortisol and inflammation that contribute to the development of type 2 diabetes, Rohrmann adds.

This means people who worry about loneliness leading to type 2 diabetes may want to focus their prevention efforts on things that dont cause stress for them, like eating healthier foods or exercising more.

A walk in the park even by oneself is a good start, Rohrmann suggests.

Read more:
Loneliness Linked to Higher Type 2 Diabetes Risk - Everyday Health

New technology could allow doctors new insight into the link between choroidal thickness and diabetic retinopathy (DR).

A team based in South Korea, led by Min Gyu Choi, Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, analyzed the effects of systemic and ocular profiles on subfoveal choroidal thickness (SFChT) in treatment-nave eyes with diabetic retinopathy.

In the retrospective, observational, cross-sectional study, the investigators examined 136 total eyes from 136 patients with diabetes and 30 eyes from 30 age-matched healthy controls between September 2016 and April 2018.

Only patients with treatment-nave eyes without any previous ocular treatment for diabetic retinopathy or diabetic macular edema were included in the study.

The ophthalmologic examination included the measurement of best-corrected visual acuity (BCVA), intraocular pressure (IOP), and refractive error; slit lamp examination; fundus examination and photography; and swept-source optical coherence tomography (SS-OCT).

For the regular systemic workup, the investigators examined body weight, height, body mass index (BMI), blood pressure (BP), complete blood cell count, hemoglobin A1c (HbA1c) level, liver function tests, and kidney function tests and analyzed microalbumin and creatinine levels in urine and the urinary (micro)albumin/creatinine ratio (ACR).

The study included only patients who underwent systemic workups within a span of 4 weeks of the ophthalmologic evaluations.

The investigators excluded patients with prior retinal surgery or panretinal photocoagulation (PRP), intravitreal injection, sub-Tenon's injection, history of ocular trauma or any other eye diseases (such as retinal and choroidal diseases), refractive error greater than 3.0 diopter (D), and systemic diseases besides diabetes or hypertension.

Using generalized linear model analyses, the investigators found that the SFChT in treatment-nave eyes positively associated with the diabetic retinopathy grade and estimated glomerular filtration rate (eGFR) (P = 0.001).

However, the study drug was negatively associated with age (P <0.001) and serum phosphorus levels (P = 0.001). Treatment-nave eyes with proliferative diabetic retinopathy(PDR; 313.4 9.0 m) or severe nonproliferative DR (NPDR; 299.7 9.7 m) had thicker choroid than eyes with mild to moderate NPDR (251.7 11.1 m) or no DR (231.2 14.5 m) after adjusting for age, eGFR, and phosphorus levels.

Choroid is affected by renal function and the grade of DR in patients with diabetes, the authors wrote. Advanced retinopathy is associated with choroidal thickening, and the severity of concomitant renal disease is associated with choroidal thinning.

Diabetic retinopathy is currently the leading of vision loss and blindness in both advanced and developing countries.

The use of enhanced-depth imaging optical coherence tomography allows investigators to view the choroidal thickness in patients with diabetic retinopathy.

Previously, the researchers found SFChT increases as the disease progresses in severity, while several other studies have suggested it decreases in patients with diabetes.

The study, Effects of Systemic Profiles on Choroidal Thickness in Treatment-Nave Eyes With Diabetic Retinopathy, was published online in Investigative Ophthalmology & Visual Science.

Continued here:
Advanced Diabetic Retinopathy Linked to Choroidal Thickening - MD Magazine

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For millions of us, starting the day without a coffee doesnt bear thinking about.

But experts warn it is better to hold off from the caffeine hit until after breakfast because regularly drinking coffee beforehand may raise the risk of developing type 2 diabetes in the long term.

Researchers at the University of Bath asked 29 volunteers to drink a strong black coffee about an hour after getting up to understand how this would affect their blood sugar after breakfast.

After then having a sugary drink similar in calorie content to cereal or toast with jam their blood sugar was around 50 per cent higher than when they went without a coffee. The caffeine in the drink is thought to prevent muscles from absorbing the sugar.

This may not be an immediate problem, but frequently raised blood sugar over the years can lead to diabetes and heart disease, the study in the British Journal of Nutrition said.

Professor James Betts, senior author of the study, said: 'Nearly half of us will wake in the morning and, before doing anything else, drink coffee - intuitively the more tired we feel, the stronger the coffee.

'I love coffee too, and I'm not necessarily telling people to go without it, as it has some benefits.

Gallery: The Worst Things You Can Do for Your Health This Fall, According to Doctors (Best Life)

'Perhaps people should wait just a little while later, or until they get to work, so they don't have caffeine in their system when they eat a breakfast containing carbohydrates and sugar.'

Around 40 per cent of people in the UK are believed to drink a coffee as soon as they wake up.

Researchers wanted to see its effects in sleep-deprived people, so asked study participants to set an alarm to go off every hour during the night.

When they woke, to make sure they didn't fall asleep, researchers texted them questions such as simple sums every 30 seconds, to which they had to reply.

The study looked at people's blood sugar and insulin levels on three occasions - after a full night's sleep at home with no coffee, after broken sleep in their bed with no coffee, and after broken sleep and coffee.

This was 300mg of strong black coffee - about the equivalent of two standard cups.

Participants' blood sugar was tested following the breakfast drink, which they had around 30 minutes after the coffee.

The study, published in the British Journal of Nutrition, did not find coffee or sleep deprivation had an impact on insulin levels.

However, strong black coffee consumed before breakfast substantially increased the blood glucose response, repeated blood tests over two hours showed.

Professor Betts said: 'This study is important and has far-reaching health implications as up until now we have had limited knowledge about what coffee is doing to our bodies, in particular for our metabolic and blood sugar control.'

The rest is here:
Coffee before breakfast could give you diabetes, experts warn - msnNOW

The case for expanding screening for pancreatic cancer in those with new onset of diabetes and weight loss.

Pancreatic cancer is a major cause of cancer-related deaths worldwide due to a lack of effective screening and resistance to chemotherapy. It is also difficult to diagnose during the early stages due to the lack of distinct symptoms. Symptoms associated with pancreatic cancer typically include weight loss, fatigue, jaundice, abdominal pain, and nausea and can be associated with many other conditions. The location of the pancreas also makes it difficult for physicians to see during routine physical exams. Therefore, diagnosis is generally made at advanced stages when it has already affected other organs such as the lungs, liver, and lymph nodes. Pancreatic cancer is commonly known as Pancreatic Ductal Adenocarcinoma. There is a 5-year survival rate in the United States. Unfortunately, no screening test has been shown to lower the risk of dying from this cancer. However, radiologists, gastroenterologists, surgeons, pathologists, and genetic counselors work together to find new tests to detect pancreatic cancer early. Currently, the most common tests used are endoscopic ultrasound or MRI.

A high body mass index or obesity has been associated with pancreatic cancer for many years. Diabetes, along with weight changes, has recently been associated with an increased risk of pancreatic cancer....

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Diabetes and Subsequent Weight Loss Linked to an Increased Risk of Pancreatic Cancer

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There are many different types of headaches, and your diet can play a role in how often you get them. In fact, your sugar consumption may be an important factor, especially if you have diabetes, as abnormal blood sugar levels are known to trigger headaches.

Eating too much or too little sugar can lead to headaches. This is because how much sugar you consume impacts your blood sugar levels. For example, eating too much sugar can cause your blood sugar to become too high, which is called hyperglycemia.

"With high blood sugar, small amounts of swelling can happen in and around blood vessels and surrounding brain tissue, which can cause headache," says Evan Barnathan, MD, a family physician at Central Maine Healthcare in Maine.

Additionally, high blood sugar is often accompanied by dehydration, which may trigger headaches.

On the other hand, eating too little sugar can cause blood sugar to become too low, which is known as hypoglycemia. When your blood sugar is too low, your body turns to alternate sources of energy from fat and protein, called ketones. The process is called ketosis, and it can lead to headaches, too.

For most healthy individuals, their bodies are able to regulate blood sugar levels and keep them within normal levels, even if they eat a big piece of cake. But those with diabetes aren't able to effectively regulate blood sugar, so what they eat will have a bigger impact.

As a result, people with poorly controlled diabetes will experience headaches from high or low blood sugar more often, says Barnathan. If you don't have diabetes, you're most likely to experience sugar-related headaches if you go on a sugar detox or start a no-carb diet like the Keto diet, because your body may start ketosis for energy after a few days.

Normal blood sugar levels are between 80 mg/dL and 130 mg/dL. When your blood sugar is higher or lower than that, it can cause headaches.

Hypoglycemia is when blood sugar levels are lower than 70 mg/dL. In addition to headaches, the symptoms of hypoglycemia can include:

If untreated, hypoglycemia can lead to more severe symptoms, like blurred vision and seizures.

Hyperglycemia is when your blood sugar is 130 mg/dL or higher before eating, or 180 mg/dL or higher two hours after eating. Other symptoms can include:

Barnathan says headaches will occur more often when blood sugar levels are above 200 mg/dL. For people with type 1 diabetes, hyperglycemia can lead to a dangerous condition called diabetic ketoacidosis (DKA), which can lead to coma or even death.

If you have a headache and you suspect it is from high blood sugar levels, make sure you are hydrated, says Barnathan. Your headache may be partly from the dehydration caused by hyperglycemia. You can also take an over-the-counter pain medicine like acetaminophen (Tylenol) or ibuprofen (Advil) to help relieve your headache.

If your headache is a result of hypoglycemia, it is usually because you haven't eaten, so eating a healthy meal will help. For example, eating small meals throughout the day full of whole grains, fiber, and lean protein can help avoid hypoglycemia.

If you have diabetes, make sure you always have a fast-acting carbohydrate with you, like juice or glucose tablets. These carbs can be quickly broken down into sugar, so you can raise your blood sugar fast before it drops dangerously low.

If you don't have diabetes, but recently cut sugar out of your diet and are experiencing headaches, make sure your body has complex carbs to break down for energy. That will help avoid ketosis and the accompanying headaches. Complex carbs include:

While anyone can experience a headache from eating too much or too little sugar, it is most common for people with diabetes.

It is important for diabetes patients to follow the treatment plan designed by their doctor in order to maintain healthy blood sugar levels, says Barnathan. This will help prevent headaches and other diabetes-related symptoms.

"If you're experiencing chronic headaches and you're worried this is due to poorly controlled diabetes, you should discuss this with your doctor," says Barnathan.

Read more:
Sugar can cause headaches, and it's more likely if you have diabetes - Insider - INSIDER

DUARTE, Calif.--(BUSINESS WIRE)--Leading diabetes scientist Debbie C. Thurmond, Ph.D., has been named the new director of City of Hopes Diabetes & Metabolism Research Institute, which continues diabetes research at City of Hope that was started more than 70 years ago. Arthur Riggs, Ph.D., who developed the technology in 1978 that resulted in the first synthetic human insulin, impacting millions of lives worldwide, will continue to conduct research within the institute.

Debbies depth of experience as a highly successful diabetes scientist and leader, as well as her vision for the DMRI, will lead us to continue to be one of the premier diabetes institutes in the nation, said Riggs, Samuel Rahbar Chair in Diabetes & Drug Discovery and director emeritus of Beckman Research Institute of City of Hope. A rising star in the diabetes field, Debbie will continue to be an excellent mentor to younger, independent scientists who, along with our senior scientists, are working on innovative diabetes research.

Thurmond joined City of Hope in 2015 as professor and founding chair of the Department of Molecular & Cellular Endocrinology within the Diabetes & Metabolism Research Institute. She became deputy director of the institute last year.

I am absolutely delighted and humbled to be named director of City of Hope's DMRI," said Thurmond, Ruth B. & Robert K. Lanman Chair in Gene Regulation & Drug Discovery Research. Art has built a phenomenal institute, and I have the great pleasure of facilitating its continued growth and prominence in the diabetes space.

In addition to leading the institutes support of ongoing diabetes research, Thurmond will support its focus on the intersection of diabetes and cancer, helping to answer the reasons why diabetes is significantly associated with an increase in cancer. As such, the institute recently established a new department the Department of Diabetes & Cancer Metabolism. The institute also provides endocrinology care to cancer patients, since type 2 diabetes significantly increases the risk of cancer. In addition, a growing number of highly effective cancer therapies can also cause insulin-dependent diabetes.

With the power of City of Hopes comprehensive cancer center alongside us, we are the only diabetes institute uniquely designed to focus on how to cure both diseases and to develop treatments to help prevent them, Thurmond added.

The Diabetes & Metabolism Research Institutes research in other initiatives includes cellular therapies to treat type 1 and type 2 diabetes; discovering new biomarkers to identify those at risk for developing type 2 diabetes and its complications; developing drugs that precisely target the receptor molecules responsible for diabetes; improving islet cell transplantation; and reviving and/or replacing the cells that make insulin.

The institute plans to open a clinical trial for the first type 1 diabetes vaccine tested in the U.S., part of The Wanek Family Project for Type 1 Diabetes, a $50 million initiative to find a cure for type 1 diabetes.

Thurmond and her teams research efforts include identifying cellular and molecular mechanisms in diabetes development and finding therapies to stop or reverse the diseases progression. One project focuses on boosting the bodys ability to create and preserve insulin-producing beta cells in order to maintain healthy blood sugar levels, as well as to boost muscle insulin responsiveness to combat prediabetes and type 2 diabetes.

Thurmonds work is supported by five research awards from the National Institutes of Health (NIH), the JDRF and Larry L. Hillblom Foundation. In fall 2018, Thurmond and her lab team were highlighted in an issue of the journal Diabetes for their discovery and identification of a new potential target that can keep the immune system stable and islet beta cells healthy, ultimately keeping type 1 diabetes in check. She was also awarded the prestigious John K. and Mary E. Davidson Lectureship and Award in the Department of Physiology at University of Toronto, Canada, in 2018, being the first female recipient in the history of the award.

Thurmond is also one of 21 accomplished female leaders, representing health organizations from across the U.S., awarded the Carol Emmott Fellowship in 2020. The fellowship expands the leadership capacity of women, who are already influential in their fields, so that they may increase their ability to make an impact and ultimately contribute to improving gender equity in health leadership through their own career advancement.

Prior to City of Hope, Thurmond was a professor of pediatrics and associate director of the Basic Diabetes Research Group within the Herman B. Wells Center for Pediatric Research at Indiana University School of Medicine, where she received the Trailblazer in Research Award in 2010.

Thurmond received her Ph.D. and postdoctoral training at University of Iowa, and her M.S. and B.S. degrees from University of California Davis. She serves on multiple editorial boards, including as associate editor for Frontiers in Endocrinology and a past associate editor of Diabetologia, as well as on national and international grant review panels, including as chair as one of the five NIH metabolism-focused grant review panels.

City of Hope has a long and impressive history of groundbreaking discoveries in the field of diabetes. It spans more than four decades of investigation since Rachmiel Levine, M.D., who discovered the role of insulin in glucose transport, launched diabetes research at City of Hope.

In 1978, Riggs and his colleagues synthesized human insulin from bacteria, a legendary scientific first. Synthetic human insulin was the first biologic approved by the U.S. Food and Drug Administration, and the product that launched the biotechnology industry. Decades later, millions of diabetes patients benefit from the daily medication they use to manage the disease. In another landmark contribution, Riggs led the team that developed the technology for creating monoclonal antibodies. Custom humanized antibodies produced using bacteria are behind numerous treatments addressing a host of conditions, including cancer and autoimmune conditions such as arthritis, multiple sclerosis and Crohns disease.

About City of Hope

City of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threatening diseases. Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hopes translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin and numerous breakthrough cancer drugs are based on technology developed at the institution. A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope has been ranked among the nations Best Hospitals in cancer by U.S. News & World Report for 14 consecutive years. Its main campus is located near Los Angeles, with additional locations throughout Southern California. For more information about City of Hope, follow us on Facebook, Twitter, YouTube or Instagram.

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City of Hope Distinguished Scientist Debbie Thurmond Named New Director of Diabetes & Metabolism Research Institute - Business Wire

Novo Nordisk wants the heart disease community to join the diabetes conversation. As Type 2 diabetes drugs nab approvals for reduced cardiovascular risksincluding Novos own Ozempic and Victozathe need to communicate across specialties has grown.

To help bridge the gap, Novo Nordisk is partnering with the American College of Cardiology (ACC) in a two-year, two-pronged initiative. First, the partners will studyreal-world data to determine patterns and adherence to guidelines. Next, they'll explorehow to help Type 2 patients improve their heart health, workingthrough ACC clinicians and healthcare providers, Novo Chief Medical Officer Todd Hobbs said.

RELATED: Novo's Ozempic scores major win with heart-helping FDA approval. Is Rybelsus next?

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The effort is a natural progression of Novo Nordisks relationships built up in the cardiovascular community over the past several years, he said.

Weve looked at smaller cuts of research, like with Cleveland Clinic and others, that show theres a lot of people out there with diabetes who really should be on one of the agents, either GLP-1 or SGLT2, that are proven to lower (cardiovascular) risk, and they just arent, Hobbs said.

While not an explicitpart of the study, COVID-19 has magnified the risks for people with diabetes and with heart disease. The partnership was in the works before the pandemic, but the novel coronavirus has made the initiative even more timely and relevant, Hobbs said.

The first part of the workevaluating data assessing adherence to ACC guidelines among a cohort of people with CV diseasewill be done within a year. The second stage will roll out specific treatment strategies to selected regional practices and hospitals, delivered through ACC healthcare ambassadors.

RELATED: Novo shifts Victoza ad message with spots highlighting heart-benefit trifecta

In January, Novo's next-gen GLP-1 drug Ozempic won an FDA toadd CV risk-reduction language to its label, specifying the benefits for patients with Type 2 diabetes andestablished cardiovascular disease.

Ozempic launched in early 2018 and took off quickly, nabbing $1.64 billion in 2019 sales. It's expected to reach $2.64 billion this year.

Novos newly launched Rybelsus, the oral version of Ozempic, is currently being studied as a CV preventive for patients with Type 2 diabetes. The company'solder GLP-1 diabetes med Victoza got a similar CV approval from the FDA in 2017 to add that it reduces the risk of heart attack, stroke and cardiovascular death.

While the ACC partnershipdoesnt includeany specific products, Hobbs said, If we can highlight the guidelines, whether thats ACC or ADA treatment guidelines, then our products will do well because theyre on the data.

Read more:
Heart to heart: Novo Nordisk teams with ACC to open diabetes discussion - FiercePharma

Almost half of people with HIV with unexplained liver enzyme elevations or other abnormal liver markers had NASH and a third had stage F3 or F4 fibrosis, and advanced liver damage was strongly associated with type 2 diabetes, a four-country study reports in Clinical Infectious Diseases.

Fatty liver disease occurs when fat builds up in the liver. Greater fat accumulation can lead to non-alcoholic steatosis (NASH), in which liver cells balloon and become inflamed. Unchecked, NASH leads to scarring of liver tissue (fibrosis) and eventually to cirrhosis, in which normal liver functions decline.

Although a high prevalence of non-alcoholic fatty liver disease (NAFLD) has been reported in people living with HIV, its unclear what proportion of these cases already have NASH or advanced fibrosis. The only way that these conditions can be diagnosed definitively is through liver biopsies (direct sampling of liver tissue).

Thickening and scarring of connective tissue. Often refers to fibrosis of the liver. See also cirrhosis, which is more severe scarring.

Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non-serious condition called fatty liver, by which fat accumulates in the liver cells. A small group of people with NAFLD may have a more serious condition named non-alcoholic steatohepatitis (NASH).

A procedure to remove a small sample of tissue so that it can be examined for signs of disease.

In NASH, fat accumulation is associated with liver cell inflammation and different degrees of scarring. NASH is a potentially serious condition that may lead to severe liver scarring and cirrhosis. It sometimes affects older people living with HIV.

A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

To learn more about the frequency of NASH in people living with HIV, investigators at hospitals in the United Kingdom, Italy, Canada and the United States carried out a retrospective study of biopsy samples from 166 people with HIV who had been referred for investigation of unexplained increases in liver enzymes or other abnormalities in laboratory markers of liver disease between 2001 and 2019.

The analysis excluded people with hepatitis B or C, any active cancer, alcohol consumption above 21 units a week for men or 14 units for women, or any other cause of chronic liver disease.

Study participants had a median age of 48 years, 93% were male, 72% were white and the median duration of antiretroviral treatment was nine years. The median CD4 cell count was 638 cells/mm3. None had taken older nucleoside analogues associated with steatosis (stavudine, didanosine). The median body mass index was 29 kg/m2 (borderline obesity), 53% had high blood pressure and 25% had diabetes.

Biopsies showed that 63 of 116 people had NAFLD (54%) and 57 (49% of the entire cohort) had NASH. Thirty-six people (31%) had F3 stage fibrosis and three (2%) had F4 fibrosis (cirrhosis).

"Theinvestigators recommend consideration of liver biopsy as a screening tool in people with HIV who are obese, especially those with type 2 diabetes."

Multivariate analysis showed that after controlling for metabolic factors associated with NAFLD (model 1) or HIV-related factors (model 2), the only factor associated with NAFLD was higher body mass index (adjusted odds ratio 1.20 in both models, p=0.001).

Advanced fibrosis (F3 or above) was the only factor associated with type 2 diabetes in multivariate analysis (aOR 3.42, 95% CI 1.00-11.71) and this association was on the borderline of statistical significance (p=0.05).

Using biopsy results as a gold standard, investigators also assessed whether laboratory markers could accurately identify patients with advanced fibrosis. They found that both the FIB-4 and NAFLD Fibrosis scores performed poorly in identifying advanced fibrosis but showed good sensitivity (93%) in ruling out cases where the collagen proportionate area (CPA) was above 7.6%. CPA measures the percentage of liver tissue that is fibrotic and a level above 7.6% has been shown to predict long-term adverse liver disease outcomes.

The poor prognostic value of non-invasive markers for liver fibrosis in people living with HIV leads the investigators to recommend consideration of liver biopsy as a screening tool in people with HIV who are obese, especially those with type 2 diabetes.

However, they also note that 41% of people referred for biopsy did not have NAFLD. Their liver enzyme elevations remained unexplained but 15 of these 53 patients had advanced fibrosis (Ishak score 3 or above). The only factor associated with advanced fibrosis in those without NAFLD was time since HIV diagnosis (21 years vs 11.5 years, p= 0.005), even though age was similar between the two groups.

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Diabetes raises the risk of liver damage in people with HIV - aidsmap

Diabetes is a chronic condition that affects how your body uses insulin. This hormone controls how much blood sugar, also known as glucose, is released into your cells to be used as energy.

Over 34 million people in the US have diabetes, according to the Centers for Disease Control and Prevention (CDC). While there is no cure for diabetes, it can be managed with lifestyle and dietary changes, or medication like insulin.

Here's what you need to know to manage diabetes and lower blood sugar levels.

With all types of diabetes, your body either doesn't produce enough insulin, or isn't able to use insulin effectively.

Insulin is necessary to move blood sugar into your cells, where it is stored and used for energy. Without insulin, a condition called hyperglycemia can occur, where blood sugar builds up in your bloodstream instead of traveling into your cells.

Type 1 diabetes makes up just 10% of all diagnosed diabetes cases in the US, according to the CDC. It is most commonly diagnosed in children, teenagers, and young adults.

Although the cause is unknown, type 1 diabetes may be due to an autoimmune response caused by an infection or other trigger. Your body mistakenly attacks and damages the beta cells in your pancreas that make insulin, so little or no insulin is produced.

There are not many risk factors for type 1 diabetes, though genetics is believed to play a role. The odds of the children of men with type 1 diabetes developing the condition is 1 in 17, according to the American Diabetes Association (ADA). For the children of women with type 1 diabetes, the odds are 1 in 25 if the woman is under the age of 25, or 1 in 100 after the age of 25.

A type 1 diabetes diagnosis requires some important lifestyle changes. You must take insulin every day in order to survive. Your blood sugar level needs to be frequently monitored. It's essential to carefully plan your meals and count carbohydrates.

"This can be a frustrating and tiresome adjustment, but it is crucial that patients educate themselves on how certain foods impact glucose levels," says endocrinologist Rocio Salas-Whalen, MD, of New York Endocrinology.

Type 2 diabetes makes up about 90% of all diagnosed diabetes cases in the US. It is most often diagnosed in adults, but the CDC notes that it is becoming increasingly diagnosed in children and teenagers.

With type 2, your body can produce insulin, but it is not able to use it effectively. This is called insulin resistance, which happens when your liver, muscle, and fat cells don't effectively take in the blood sugar from your blood to use it for energy. As a result, your blood sugar level increases, which can eventually lead to type 2 diabetes.

You are more at risk for type 2 diabetes if you:

In addition to eating a healthy diet, it's very important for people with type 2 diabetes to maintain a healthy weight, Salas-Whalen says, because this can also help them control blood sugar levels.

Pregnant people may develop gestational diabetes, which is caused by the body's inability to produce the extra insulin needed during your pregnancy. Gestational diabetes can put your baby at risk for health problems later in life, such as obesity or type 2 diabetes.

About 7% of pregnant people in the US are diagnosed with gestational diabetes. It usually begins in the middle of your pregnancy, without any symptoms. You should be tested for it between your 24th and 28th weeks of pregnancy. It typically goes away after your baby is born, but you will have a higher risk of developing type 2 diabetes later in life.

If you have gestational diabetes, you'll need to work with your doctor to develop a healthy eating plan, and you should also remain physically active to help keep your blood sugar levels low. If a healthy diet and exercise don't lower your blood sugar levels, you may need to take insulin.

Prediabetes is a condition where your blood sugar levels are elevated, but not yet high enough for a diabetes diagnosis. However, if left untreated, prediabetes can develop into type 2 diabetes.

More than a third of all US adults over 88 million have prediabetes, yet 84% of them don't know they have it, the CDC notes.

With lifestyle changes like a healthy diet, losing weight, and getting regular exercise, it's possible for prediabetes to be reversed or delayed. Your doctor may also prescribe medication to help lower your blood sugar level.

"A prediabetic still has the potential to avoid diabetes, which should be avoided in every possible way," Salas-Whalen says.

The signs of all types of diabetes can include the following:

However, these symptoms develop slowly over time, and it may be difficult to recognize them, especially if you have type 2 diabetes. The signs of type 1 diabetes may be more severe, and can also include nausea or vomiting.

Target blood sugar levels are different for those with diabetes. The follow chart depicts normal blood sugar levels for diabetics and non-diabetics:

Yuqing Liu/Insider

Many people with diabetes with need to learn how to check their blood sugar multiple times a day using a glucose meter or a continuous glucose meter.

"Try not to think of blood sugars as 'good' or 'bad' or as a reflection of how well or bad you are doing," says Shelley Nicholls, DNP, APRN, CDCES, director of patient education at the Diabetes Research Institute. "Having a good understanding of what affects blood sugars and which of them a person can control or influence is the best tool a person with diabetes can have."

To treat diabetes, it is important to lower your blood sugar level and make sure it stays in a healthy range.

Doing this will not only increase your energy, but according to the ADA, each percentage point of A1C lowered reduces the possibility of long-term health complications which could include serious heart, kidney, brain, eye, or foot problems by 40%.

These are some of the best natural ways to lower and manage your blood sugar levels over time:

It's important for people with diabetes to be careful about the foods they eat because they can impact your blood sugar levels."Some foods can worsen diabetes, while other foods can actually improve diabetes control," Salas-Whalen says.

Carbohydrates and fiber especially affect your blood sugar levels in the following ways:

It can be helpful to follow a diet to manage your diabetes, as planning out your meals and snacks will help you control blood sugar levels effectively.

"Every person has different needs, so there is no one diet that is recommended for people with diabetes," Nicholls says. "The best option is to meet with a dietitian to determine individual needs and goals."

Here are some of the best diets for diabetics:

The Mediterranean diet includes plant-based foods, lean meats, and healthy fats.

According to a 2009 study published in Diabetic Medicine, people who strictly followed a Mediterranean diet for three months had lower A1C percentages and lower blood sugar levels after meals than those who followed it less strictly.

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is mainly used to lower blood pressure, but it can also help lower blood sugar.

A 2017 study published in the ADA journal Diabetics Spectrum suggests that the DASH diet can lower insulin resistance and help you lose weight. A 2016 study published in the journal Nutrition found that a DASH diet can also help lower the risk for gestational diabetes by as much as 71%.

This high-fat, low-carb diet limits carbs to 20 to 50 grams daily in an effort to put your body in the metabolic state of ketosis, where you burn fat instead of carbs for fuel.

A 2017 study published in Nutrition & Diabetes found that overweight adults with type 2 diabetes or prediabetes who followed a keto diet had lower A1C levels and lost over 4% more weight after one year than those who followed a moderate-carbohydrate/low-calorie/low-fat diet.

There are also some health risks associated with the keto diet. If you have type 1 diabetes, your lowered blood sugar level may lead to hypoglycemia and serious brain, kidney, or liver complications.

Another issue associated with this diet are "keto flu" symptoms that may include headache, nausea, and vomiting. It's important to consult with your doctor or a registered dietitian before starting a keto diet.

People with type 1 diabetes need to take insulin every day in order to survive. If people with type 2 diabetes are unable to reach their blood sugar target levels with diet and exercise, they may also need medication like insulin or metformin.

People with type 1 diabetes generally need to take three to four doses of insulin every day, according to the ADA. Women with gestational diabetes may need to take insulin daily during their pregnancy if their bodies aren't producing enough of it naturally. Many people with type 2 diabetes may need one dose each day with or without other medications.

Insulin is injected in the fat under your skin using a syringe, insulin pen, or pump. It should be injected in the same area of the body, but not the same place each day. It's best to inject insulin at mealtime so it is more effectively processed in your body.

There are many different types of insulin, and your doctor may even prescribe two or more of the following types:

"The challenge with taking insulin is that it's tough to know precisely how much to take," Nicholls says. The amount is based on factors that may change throughout the day, such as food, exercise, and stress. "So, deciding on what dose of insulin to take is a complicated balancing act."

Taking an extra dose of insulin can also help you lower blood sugar fast if it's an emergency, though you may want to check in with your doctor beforehand.

If you have type 2 diabetes, your doctor may prescribe metformin, a medication that lowers blood sugar by slowing your liver's production of glucose. It is the drug most commonly prescribed to treat type 2 diabetes.

Metformin is available in a liquid, pill, or extended-release tablet. You take it orally at mealtime two to three times a day. The extended-release tablet only needs to be taken once daily.

According to a 2012 scientific review published in Diabetes Care, metformin can effectively reduce A1C levels for people with type 2 diabetes by an average of 1.12%.

Although it's possible to control your diabetes and lower blood sugar levels, there is no specific cure.

"Because of this reality, lifestyle changes must be permanent and not temporary in order to avoid the potential long-term complications of diabetes," Salas-Whalen says.

To develop the best plan of treatment for diabetes, it's important to meet with your doctor for individualized recommendations.

Link:
What is diabetes? A comprehensive guide to lower blood sugar and manage the condition - Insider - INSIDER

September 25, 2020 -A group of Senators has introduced a bill that would expand access to the Medicare Diabetes Prevention Program through telehealth.

S 4709 was introduced this week by Senators Tim Scott (R-SC), Mark warner (D-VA), Kevin Cramer (R-ND), Kyrsten Sinema (D-AZ), Tom Cotton (R-AR) and Tina Smith (D-MN). Titled the Prevent Diabetes Act, it addresses a long-standing issue with a Medicare program designed to help members at increased risk of developing type 2 diabetes.

Its no secret that diabetes is a disease that has disproportionately affected minority communities across the country, Warner said in a press release. To ensure that all individuals have the tools needed to combat this preventable disease, the Prevent Diabetes Act would help expand access to virtual classes under the existing Medicare Diabetes Prevention Program. This commonsense and cost-saving expansion will ensure that more Americans at-risk of developing diabetes who are living in either rural or medically underserved communities, can participate in this critical program that has been proven to delay the full onset of this preventable disease.

The original Diabetes Prevention Programwas developed by the National Institutes of Healths National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), and focused on in-person classes and one-on-one coaching. Based on that model, which is administered by the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services created the National Diabetes Prevention Program for Medicare beneficiaries and launched that program in 2018.

But the Medicare Diabetes Prevention Program Expanded Model conducted by the Center for Medicare and Medicaid Innovation doesnt reimburse care providers for using connected health platforms. Telehealth and mHealth advocates have been lobbying for years to add those services, saying a virtual platform would reach far more people at risk and enable providers to make better use of limited resources.

More than 70 healthcare providers are now listed on the CDCs DPP website, though only a handful have been recognized as offering proof that their online programs reach recognized benchmarks for activity and weight loss.A growing number of programs are using virtual careas a means of expanding the programs reach and making the most of limited resources, and theyre asking CMS to cover those services.

Last year, a group of Senators including those sponsoring the Prevent Diabetes Act wrote a letter to Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma asking that the program be expanded to include CDC-recognized virtual DPP providers.

Virtual delivery of MDPP has the ability to empower beneficiaries to access MDPP regardless of where they live, and in the format of their choosing, the Senators wrote. Because of the outcome-focused reimbursement structure, CMS has insulated from reimbursing for ineffective treatment. Medicare Advantage plans have also been vocal in their desire to deploy virtual DPP for their beneficiaries. Given this, we also encourage CMS to consider ways for Medicare Advantage plans to use virtual providers to ensure that all Medicare beneficiaries have access to a CDC fully-recognized DPP.

In April, that same group lobbied again for the inclusion of virtual care providers, saying the coronavirus pandemic has created further barriers to in-person care.

The new bill, which as of September 25 contains no text or summary, is supported by several organizations, including the American Diabetes Association, American Medical Association, Connected Health Initiative and National Kidney Foundation, along with digital health companies Livongo, Noom and Omada Health.

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New Bill Would Add Telehealth to Medicare Diabetes Prevention Program - mHealthIntelligence.com

Frequent hot tub bathinghada positive impact on glycemia, blood pressure, and body weight in patients with type 2 diabetes, in the first real-world study to analyze the effect of this type of heat therapy in such individuals.

"The data from our analysis showed that the frequency of hot tub bathing could have beneficial influences on diabetic control, hypertension, and obesity even after adjusting for confounding factors," HisayukiKatsuyama, MD, told Medscape Medical News.

Katsuyama presented the findings as a poster at the virtual European Association for the Study of Diabetes (EASD) Annual Meeting 2020. The study aimed to explore the real-world influence of habitual hot tub bathing on the control of type 2 diabetes and other cardiovascular risk factors.

"Heat therapy, shown here with hot tub bathing, can be one effective therapeutic option for type 2 diabetes in daily life. An alternative form of heat exposure might be nutrition therapy and exercise," noted Katsuyama, from Kohnodai Hospital, Ichikawa, Chiba, Japan.

But Lucy Chambers, PhD, head of research communications at Diabetes UK, was not so enthusiastic about the results.

"While this research suggests there might a link between taking regular hot baths and better health in people with type 2 diabetes, it raises more far more questions than it answers," she said.

"It could be that people who bathe more frequently have a healthier lifestyle in general perhaps they are more physically active we just don't know from the limited data collected."

"It isnot possible to say from this research whether bathingcan benefit yourphysicalhealth," she noted in a statement from Diabetes UK.

Prior to the current study, there were no large studies looking at the effects of hot tub bathing on metabolic parameters in patients with diabetes.

One cohort study in Finland revealed that frequency of sauna bathing was inversely associated with fatal cardiovascular events in middle-aged adults (BMC Med. 2018;16:219). And a prior small before-and-after study in patients with diabetes showed a significant reduction in fasting glucose and A1c (N Engl J Med. 1999;341:924-925), Katsuyama noted.

Most homes in Japan, where bathing is a traditional and common practice, have hot tubs, which prompted the researchers' idea for a real-world study, he explained.

Katsuyama and colleagues studied the frequency of hot-tub bathing using a self-reported questionnaire completed by 1297 patients with type 2 diabetes who regularly visited Kohnodai Hospital over 6 months.

They took anthropometric measurements and used blood test results to analyze associations between hot tub use and different variables. Patients were divided into three groups according to frequency of bathing: group 1, 4 baths/week; group 2, 1-<4 baths/week; and group 3, < 1 bath/week.

Mean age was 67 years, weight was 67 kg, BMI was 25.9 kg/m2, and A1c was 7.2%. There were more men than women (713/584).

Most participants, 693, were in group 1 ( 4 baths/week), 415 were in group 2 (1-< 4 baths/week); and 189 were in group 3 (< 1 bath/week).

The mean frequency of bathing was 4.2 times/week and mean duration of bathing was 16 minutes.

Body weight, BMI, waist circumference, diastolic blood pressure, and A1c were all significantly better in group 1 (most frequent bathing) compared with group 3 (least frequent bathing) (Table).

Table. Effects of Frequency of Hot Tub Bathing on Metabolic Parameters

Group 1 4 baths/week

BP = blood pressure

Katsuyama pointed out that animal studies have suggested heat stimulation might improve insulin sensitivity and enhance energy expenditure, an effect also observed during exercise.

"I expect that patients can benefit in a similar way with heat therapy," he added, noting that hot tub bathing might be particularly beneficial for patients who cannot exercise.

"It would probably [also] be beneficial for the prevention of diabetes," and potentially, diabetes complications, he said. Indeed, "cohort studies have shown the possibilities that heat therapy could prevent cardiovascular diseases."

Katsuyama pointed out that a key strength of the study was the relatively large number of participants compared with previous studies.

But there were also limitations due to the nature of the cross-sectional study, which "means we cannot guarantee causality, and secondly, various confounding factors, such as diet and other life habits, could influence the results."

"A well-designed prospective study will be needed to confirm the beneficial effects of the heat therapy," he concluded.

EASD 2020. Presented September 22, 2020. Abstract 342.

Katsuyama has reported no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

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Hot Tubs Improve A1c, BMI, and Blood Pressure in Type 2 Diabetes - Medscape

Dublin, Sept. 25, 2020 (GLOBE NEWSWIRE) -- The "Worldwide Diabetes Reusable Insulin Delivery Pen Market: Demand, Insights, Trends, Analysis, Opportunities, Growth Potential and Forecast to 2026" report has been added to ResearchAndMarkets.com's offering.

The Worldwide Diabetes Reusable Insulin Delivery Pen Market size is expected to touch US$ 6 billion by 2026.

The report offers the most up-to-date industry data on the actual market situation and future outlook for the worldwide diabetes reusable insulin delivery pen market. The report provides historical market data for 2013 - 2019, and forecasts from 2020 until 2026.

The report contains a granular analysis of the present industry situations, market demands, reveal facts on the market size, reusable insulin pen volume, revenues for reusable insulin delivery pen, and illustrative forecast to 2026. It also provides 16 countries with an all-round analysis of an overall number of patients with diabetes and insulin users. A comprehensive analysis has been done on the market share of the countries-based market.

The report explores essential insights into worldwide diabetes reusable insulin delivery pen market for the top 16 countries, comprising the United States, the United Kingdom, Canada France, Italy, Spain, Germany, Netherlands, Poland, Sweden, Turkey, Australia, Japan, China, India, and Brazil until 2026. The report also provides a detailed description of growth drivers and inhibitors of the worldwide diabetes reusable insulin delivery pen market.

The report concludes with the profiles of major players in the worldwide diabetes reusable insulin delivery pen market. The key market players are evaluated on various parameters such as company overview, product portfolios and recent development of the worldwide diabetes reusable insulin delivery pen market

Key Questions Answered in this Market Research Report:

The Major Companies Dominating this Market for its Products, Services and Continuous Product Developments are:

Key Topics Covered:

1. Executive Summary

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5. Diabetes Reusable (Cartridge) Insulin Delivery Pen Market Share (%), 2013 - 2026

6. Key Market Drivers & Inhibitors of the Diabetes Reusable (Cartridge) Insulin Delivery Pen Market6.1 Market Drivers6.2 Market Inhibitors

7. Diabetes Reusable (Cartridge) Insulin Delivery Pen Market & Forecast (2013 - 2026) - Major 16 Countries Data Analysis7.1 United States7.1.1 Overall Diabetes Population & Forecast (Volume) 7.1.2 Insulin Users & Forecast (Volume) 7.1.3 Diabetes Reusable (Cartridge) Insulin Delivery Pen Users (Volume) 7.1.4 Diabetes Reusable (Cartridge) Insulin Delivery Pen Market & Forecast (Value) 7.2 Canada7.3 Germany7.4 France7.5 Italy7.6 Spain7.7 United Kingdom7.8 Netherlands7.9 Poland7.10 Sweden7.11 Turkey7.12 Australia7.13 Japan7.14 China7.15 India7.16 Brazil

8. Key Companies Analysis8.1 Business Overview8.2 Insulin Pen Products Portfolio8.3 Recent Development

For more information about this report visit https://www.researchandmarkets.com/r/nmbp1s

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Worldwide Diabetes Reusable Insulin Delivery Pen Market Report 2020: Demand, Insights, Trends, Analysis, Opportunities, Growth Potential and Forecast,...

A leading manufacturer of automated insulin delivery systems, Dexcom (NASDAQ:DXCM) signed a five-year collaboration agreement with the University of Virginia on Thursday . The company will fund research at the university that could expand its addressable patient population.

Dexcom already has clinical trial evidence that shows its constant glucose monitoring (CGM) technology reduces the amount of time Type 1 diabetes patients spend with blood sugar levels that are too high or too low. Through its collaboration with the university, the company will test its CGM technology for use among people with Type 2 and gestational diabetes, as well as for hospitalized patients.

Image source: Getty Images.

The University of Virginia's Center for Diabetes Technology will lead the research efforts, but the collaboration will employ experts from multiple disciplines across the University of Virginia System.

This isn't the first time these two have conducted research as partners. In 2019, the collaboration partners presented successful results of a trial with Type 1 diabetes patients that used Dexcom's CGM technology to control their blood sugar levels.

In 2020, Dexcom expects revenue to grow by about 25% to around $1.85 billion. While there has been some uptake of Dexcom's CGM systems among insulin-dependent Type 2 patients, the relative lack of evidence of a benefit is severely limiting the company's total revenue.

In 2017, the American Diabetes Association estimated the number of Type 1 diabetes cases in the U.S. at 1.3 million. In 2012, it estimated the number of Type 2 diabetes patients at 27.8 million.

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Dexcom and University of Virginia to Advance Diabetes Research Together - Motley Fool

My name is Dr. Vishwanath Pattan and I am the Medical Director of Endocrinology at Wyoming Medical Center in Casper. Endocrinology is the study of hormones, and as an endocrinologist I treat patients for a wide variety of diseases related to hormonal deficiencies and imbalances. That includes many patients with diabetes.

At my clinic, Wyoming Endocrine and Diabetes, I treat patients from across Wyoming, and I have noticed an alarming trend for my diabetic patients in relation to the COVID-19 pandemic: an inability to monitor and control glucose or maintain weight in the summer months.

In a typical year, diabetic patients tend to lose weight and achieve better glucose control in the summer because they are able to live a much more active outdoor lifestyle. During the winter, I often see the opposite trend of added weight, less stable glucose levels, seasonal depression, and an increase in overall stress.

2020, however, has not been a typical year, and I have noticed a deviation from the typical summer pattern in my diabetic patients. Many of these patients have actually gained weight, exhibited less than stable glucose control, and had an increase in their overall stress levels.

I have a few theories on why this might be. When COVID-19 was first acknowledged as a public safety concern, people were quick to stock up on everything they could. As we know, the shelf life of heavily processed foods is what makes them some of the first to go amidst a global crisis.

These foods are built to stand the test of time, but for a diabetic patient, they can easily contribute to an unsafe fluctuation of glucose. There was also a lot of uncertainty, fear, and confusion that caused millions to be left without a job and the added stress of strict isolation measures. People were forced to live a much more sedentary lifestyle, whether they wanted to or not, and eat food that does not promote a healthy glucose level. I also saw a major decrease in correspondence with many of my patients with uncontrolled diabetes, further contributing to an atypical summer for the diabetic population.

So, why does this raise a red flag?

Although patients with diabetes are not at any further risk of contracting COVID-19, they are much more likely to suffer greater complications because of it. These complications could lead to the need for ventilator support, further intensive care, and even higher death rates by several folds. This leads me to my main concern with so many of my diabetic patients experiencing poor glucose control prior to a season in which it is already difficult to manage: A person with uncontrolled diabetes in the summer is more likely to have uncontrolled diabetes in the winter, especially during a global pandemic. With the dual-threat of COVID-19 and this upcoming flu season, it is paramount that people with diabetes put their health and safety at the forefront.

I strongly urge people with diabetes and their families to safely support one another through the winter months with the helpful information discussed below.

People with diabetes should:

Monitor glucose regularly, per your healthcare providers recommendation

Make sure to follow up with your healthcare providers, either in person or by utilizing virtual visits. (Healthcare facilities take utmost care and precautions, and put your health as a top priority, so in-person visits should be safe). In the coming months, it is essential to keep your providers up-to-date on your progress, and you should discuss individualized glucose goals with your doctor

Contact your healthcare provider immediately if your blood glucose is above target

Remain compliant with medication regimens and dietary treatment plans

Aim to eat a balanced diet, exercise regularly and get adequate sleep at least between 7 and 8 hours per night

Maintain a healthy immune system by prioritizing glucose control, managing stress levels and taking a Vitamin D supplement. In Wyoming, most people are naturally deficient during the winter months and are encouraged to seek their healthcare providers recommendation for proper supplementation.

Family members of diabetic patients should:

Encourage your loved one to keep appointments with healthcare providers

Assist them with technology for virtual visits

Avoid social gatherings, practice proper hand hygiene, and always wear a mask in public spaces to keep your loved one safe

Help with cooking balanced and healthy meals

Ensure that your loved one has at least 4 to 6 weeks worth of diabetic supplies on hand in case of supply issues later on. These include testing strips, insulin, and necessary insulin administration equipment

Remind patients to take their medication on time and encourage compliance with glucose monitoring

Help to maintain a stress-free environment at home

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Concerning trend found in patients with diabetes - Green River Star

Consuming more than 3 cups/day of white ricesignificantly increases the risk of diabetes compared with eating lower amounts, a new analysis of the multinational, multiethnic Prospective Urban Rural Epidemiology (PURE) study suggests.

In addition, the results show that those living in South Asian countries ate the most white rice and subsequently had the highest likelihood of developing type 2 diabetes.

Compared with participants who ate less than 1 cup/day (150 g/day) of cooked white rice, those who ate more than 3 cups/day (> 450 g/day) had a 20% higher risk of developing diabetes over a mean follow-up of 9.5 years (P = .003).

However, among South Asian participants, who consumed a median of 630 g/day of white rice, the risk of diabetes was 61% higher compared to those who consumed less than 150 g/day (P = .02), Balaji Bhavadharini, MD, McMaster University, Hamilton, Ontario, Canada, and colleagues report in their article, published online in Diabetes Care.

As the authors point it, excess white rice consumption, in particular, is known to lead to postprandial glucose spikes. These spikes, in turn, trigger compensatory hyperinsulinemia to help maintain euglycemia.

"Over time, -cells become exhausted, leading to -cell failure and diabetes," the researchers write.

"Among people of middle and lower socioeconomic status, rice consumption is very high because other food choices meat, fish, chicken, vegetables, and fruits are all quite expensive," second author Viswanathan Mohan, MD, PhD, DSc, chairand chief diabetologist at Dr. Mohan's Diabetes Specialties Centre, India, told Medscape Medical News in an email.

"Hence, people make up the calories [they need] by eating 'polished' rice. What we are suggesting is that protein intake should be increased, and this can come...in the form of beans and legumes, whichif consumed along with the rice, would help reduce the overall glycemic load of the diet," he added.

A total of 132,373 participants aged 35 to 70 from 21 different countries were included in the new analysis, which excluded anyone with diabetes at baseline.

Cooked white rice consumption was categorized as less than 1 cup (< 150 g/day); 1 to 2 cups (150 to < 300 g/day); 2 to 3 cups (300to < 450 g/day), or more than 3 cups/day (> 450 g/day). In the overall cohort, the median consumption of white rice was 128 g/day.

Participants from South East Asia (Indonesia, Malaysia, Thailand, Vietnam, and Cambodia, among other countries) ate a median of 239 g/day of white rice, while those from China ate a median of 200 g/day, investigators note.

Those living in South Asian countries (including India, Pakistan, Bangladesh, Nepal, Bhutan, Sri Lanka and the Maldives) ate the most white rice, at a median of 630 g/day.

During the study interval, 6129 individuals developed incident diabetes.

Among those living in South East Asia, the Middle East, South America, North America, Europe, and Africa, the risk of diabetes was 41% higher among those with the highest levels of white rice consumption compared to those with the lowest levels(P = .01), the investigators report.

And as already noted, the risk was even higher, at > 60%, in those living in South Asia.

In contrast, the effect of consuming the greatest quantity of white rice versus the lowest on diabetes risk was minimal among Chinese participants and did not reach statistical significance, the authors note.

"There could be several reasons for this," Mohan said. "Firstly, the actual intake of white rice in China was substantially lower than it was in other countries, especially among those living in South Asia. Secondly, the type of rice the Chinese consume may be slightly different than elsewhere in that it is 'sticky,'" he speculated.

Probably more importantly, however, "in China, they do consume a lot of animal protein as well as vegetable protein," he noted.

In contrast, protein intake tends to be low and carbohydrate intake mostly in the form of white rice is higher in South Asia than in any other region of the world.

In fact, in South Asia white rice makes up 70% to 75% of a typical person's daily calorie intake, Mohan observed.

As the authors point out, until a few decades ago, most of the rice consumed in India was pounded by hand, or "unpolished," and thus was a much coarser grain, similar to brown rice. But this fell out of favor because it's easier to store highly polished white rice than brown rice, which turns rancid more quickly.

In addition, there were only a handful of rice mills in India until the early 1970s, a situation which has now completely changed: there are now over a million rice mills in the country.

"This naturally led to increased consumption of high polished white rice," Mohan emphasized, "and in general, people like the color, taste, and smell of white rice better [than brown rice] plus brown rice takes longer to cook and is difficult to chew," he noted.

The solution to this public health conundrum is multifold. As Mohan sees it, the most obvious solution is to reintroduce brown rice as a widespread food commodity and make it less expensive than white rice.

Alternatively, food manufacturers could develop healthier varieties of white rice with resistant starch that would lower both the glycemic index and overall glycemic load, he observed.

People also need to be encouraged to increase their intake of beans, legumes, and other types of vegetable proteinsor pulses, which in India include chickpeas, green gram, black gram, and thoor dal. When these are consumed along with white rice, it improves the overall quality of the diet and would be expected to reduce the risk of diabetes.

Lastly, people need to be encouraged to be more physically active, which would also help reduce obesity rates and with it, diabetes risk, Mohan emphasized.

The study was funded by a number of pharmaceutical companies including AstraZeneca, Sanofi, Boehringer Ingelheim, Servier, and GlaxoSmithKline.

Bhavadharini and Mohan have reported no relevant financial relationships.

Diabetes Care. Published online September 1, 2020. Abstract

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More Proof That High White Rice Intake Ups Type 2 Diabetes Risk - Medscape

People with diabetes have a more difficult time regulating their blood sugar. Those with type 1 diabetes are not able to produce insulin, the hormone that helps the body convert blood sugar into energy. And those with type 2 diabetes cannot use insulin effectively.

As a result, blood sugar levels are often much higher for people with diabetes, especially in the morning. Here's why.

As your body prepares to wake for the day, it releases glucose stored in the liver to give you the energy you need to get going. However, people with diabetes are not able to utilize this blood sugar, so roughly half of diabetics experience high blood sugars in the morning. This is known as the dawn phenomenon.

If you have diabetes, your doctor will work with you to set a target range for your blood sugars. In general, blood sugar levels between 70 to 130 mg/dl are considered healthy for diabetes.

If your levels are consistently above your target in the morning, and you have not eaten yet, you might be experiencing dawn phenomenon. This is most common in people with type 2 diabetes.

Blood sugars typically peak about 2 to 3 hours before waking and can remain high as you wake up. For most people, that means the early morning hours, but if you have an abnormal sleep schedule you can experience this spike at any time.

"For individuals who work night shifts, the 'dawn' phenomenon may occur at dusk, since it's related to an individual's normal waking time, not the specific time of the day," says Joseph Barrera, MD, an endocrinologist with Mission Hospital in Orange County, California.

The Somogyi effect is a second explanation for high blood sugars in the morning, and this occurs most often in people with type 1 diabetes. It happens when people experience hypoglycemia or low blood sugar during the night. In an attempt to correct that, the body releases more stored glucose, which can then lead to high blood sugars in the morning.

The Somogyi effect is more rare than the dawn phenomenon, but that's mostly because fewer people have type 1 diabetes than type 2 diabetes. When a 2015 study published in Diabetology & Metabolic Syndrome followed 85 people with type 1 diabetes, it found that 82.4% of them had high blood sugars in the morning, and 60% of those were caused by the Somogyi effect, compared with just 12.9% caused by the dawn phenomenon.

To determine if your high blood sugars in the morning are caused by the Somogyi effect, Barrera says you'll need to see your blood sugar levels about 4 to 5 hours before you wake up, which can be done with a continuous glucose monitor.

You should talk to your doctor if you regularly experience high blood sugars in the morning, Barrera says. Your team will make recommendations on changing your treatment regimen that might help you avoid this morning hyperglycemia.

"High blood sugars in the morning can generally be addressed by careful attention to a diet and exercise regimen, and adjustments in diabetic medication by a qualified health professional," Barrera says.

To avoid dawn phenomenon, your doctor might tell you to take these steps:

People who continue to have trouble with the dawn phenomenon might be advised to take insulin before bed, Barrera says. However, this has to be done carefully, so that it doesn't cause the Somogyi effect.

People who experience the dawn phenomenon often find that it gets worse over time. In fact, it's considered an indicator that diabetes is progressing, so it's important to talk to your doctor about treating it.

On the flip side, making the necessary changes to regulate the dawn phenomenon can lower blood sugar over time. In fact, research has found that it can result in a 0.5% decrease in A1C levels a long-term measure of blood sugar which can reduce your risk for health complications from diabetes.

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Why your blood sugar is high in the morning and how to lower it - Insider - INSIDER

The global Millimeter Wave Diabetes Treatment Devices market is segregated on the basis of Type as Under 50 GHz and Above 50 GHz. Based on Application the global Millimeter Wave Diabetes Treatment Devices market is segmented in Type 1 Diabetes and Type 2 Diabetes.

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ThursdaySep24,2020at11:08AM

DURHAM The University of New Hampshire announced it will receive $1.8 million from the National Institutes of Health to further molecular research to better understand drug interactions at the cellular level and help lead to the development of new targeted drugs to treat wide-spread metabolic, growth, neurological and visual disorders including diabetes and cancer.

"This is an exciting opportunity to support some of our preliminary research that showed promise in new protein drug targets involved in several diseases," said Harish Vashisth, associate professor of chemical engineering and recipient of the NIHs Outstanding Investigator award. "The NIH MIRA award (Maximizing Investigators' Research Award) is meant to provide flexibility to investigators and will allow us to explore new ideas and change direction based on our findings during the process."

Vashisth and his team will use computational techniques combined with experimental data to explore new and more suitable stages in the signaling cycle of a cell protein to target drug interventions. One of the studies will focus on better understanding the folding and binding mechanisms of novel peptides, a short string of amino acids that are building blocks of proteins and perform biological functions. Researchers will look at how they affect cell surface receptor proteins, part of the tyrosine kinase family, to signal responses within the cell. Small peptides can fold and bind to the receptor and mimic the normal physiological effects of natural peptides. The goal is to understand the folding and binding and ultimately find drugs to work around the fold.

"Imagine a cell as a flexible bag with the outer surface as the cell membrane containing proteins that act as gate keepers to communicate, or sense, specific conditions outside the cell that in turn trigger a cascade of signaling inside the cell," said Vashisth.

Their second research project will take an unconventional approach to target protein-protein interactions in proteins inside the cell, part of the G-protein coupled receptor family, that are important in touch, smell and sight and are implicated in many diseases. This work would create new small molecule drugs that would cross inside the membrane rather than bind to an outside receptor. These drugs would be synthetic and not naturally occurring.

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UNH receives $1.8 million for biomolecular research in diabetes and cancer - Seacoastonline.com

Why does diabetes make people particularly vulnerable to COVID-19? There is no persuasive evidence that this is because they are more likely to catch the virus in the first place and we, as yet, have no answers. Research is underway to understand the biological reasons why diabetes might allow the virus to get a firmer hold. A pro-inflammatory state, vascular damage, and upregulation of ACE2 receptors, all of which are associated with diabetes, have been suggested as potential contributors to severe COVID-19 in people with the condition7. The type of basic science needed to explore the virus mechanisms of attack and its interplay with diabetes takes time and is vital for understanding how we might better protect and care for people living with the condition.

Recently emerging is some limited and anecdotal evidence that COVID-19 might be triggering new cases of type 1 diabetes, accelerated progression of type 2 diabetes, or a new type of diabetes altogether. Again, we need to look to science for answers only long-term studies will reveal whats really going on and, crucially, help to inform care. To find answers, a global database of new cases of diabetes in patients with COVID-19, called the CoviDiab Registry Project, has been established8. The Post-HOSPitalisation COVID-19 (PHOSP COVID) study, a national consortium to understand and improve long-term health outcomes in people who have had the virus, will also shed light on the long-term implications of COVID-19 for people with diabetes.

Investment in science has never been more important. Last year, UK charities, including Diabetes UK, invested 1.9 billion into medical research more than half of all public spending nationally. But the sector is facing a dramatic and deeply concerning drop in income due to COVID-19 and research is at risk. The Association of Medical Research Charities (AMRC) has predicted a 310 million shortfall in research spend in 2020/21, with an estimated four-year recovery period.

AMRC and its members, including Diabetes UK, are urging the Government to commit to the Life Sciences Charity Partnership Fund (support at #Researchatrisk) co-investment scheme. This will allow medical research charities to emerge from this pandemic intact and in a strong position to continue to fund research that transforms healthcare and saves lives. Now more than ever, investment is needed in the sector to mitigate the impact of COVID-19 and future pandemics, on the health of the nation.

References

1 International Diabetes Federation, (2019). IDF Diabetes Atlas, 9th edn.Brussels, Belgium: IDF. Available at: https://www.diabetesatlas.org

2 Estimated from NCVIN (2016), Diabetes Prevalence Model for England + estimated growth between 20152020 from APHO (2010) Prevalence Models for Scotland and Wales.

3 Barron, E., Bakhai, C., Kar, P., Weaver, A., Bradley, D., Ismail, H., Knighton, P., Holman, N., Khunti, K., Sattar, N. and Wareham, N.J., (2020). Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. The Lancet Diabetes & Endocrinology.

4 Diabetes Prevalence Model. Quality and Outcomes Framework (QOF) 2017/18. Public Health England. Available at: https://fingertips.phe.org.uk/profile/diabetes-ft/data

5 Holman, N., Knighton, P., Kar, P., OKeefe, J., Curley, M., Weaver, A., Barron, E., Bakhai, C., Khunti, K., Wareham, N.J. and Sattar, N., (2020). Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. The Lancet Diabetes & Endocrinology.

6 Williamson, E.J., Walker, A.J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C.E., Curtis, H.J., Mehrkar, A., Evans, D., Inglesby, P. and Cockburn, J., (2020). OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature.

7 Apicella, M., Campopiano, M. C., Mantuano, M., Mazoni, L., Coppelli, A., & Del Prato, S. (2020). COVID-19 in people with diabetes: understanding the reasons for worse outcomes. The Lancet Diabetes & Endocrinology.

8 Rubino, F., Amiel, S. A., Zimmet, P., Alberti, G., Bornstein, S., Eckel, R. H., & Del Prato, S. (2020). New-Onset Diabetes in Covid-19. New England Journal of Medicine.

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COVID-19 and diabetes: What do we (not) know? - Open Access Government