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As the days of the lockdown dragged on, Prayash Bajracharya, 60, thought about getting back to his ambitious writing project. His days were free, and it seemed to him he should make his days productive, but in the following days, he felt agitated and unable to concentrate. He felt exhausted before he even started doing anything.

"As days turned into weeks, I was spending more time in my bed and on the couch. And the next thing you know my blood pressure was high, he says. Bajracharya has hypertension and has been taking medication for high blood pressure for many years. A few weeks back when I got up, my head was feeling dizzy, so I checked my blood pressure, and it was super high. I was scared that it would be too serious, says Bajracharya.

Being housebound, Bajracharya was also over-snacking, sleeping and lazing around the house and passing his time watching TV. And that consequently affected his health, shooting up his blood pressure. For people like Bajracharya, who have hypertension and diabetes, the lockdown can have more severe health implications, say doctors, especially if they dont exercise self-control and healthy habits.

The country-wide lockdown to curb the spread Covid-19 has largely brought life indoors. And with it, many people have developed sedentary behaviours as they surrender to the languor of the time. A lot of people, because of the lockdown, may have stopped exercising or could be over-eating," says Doctor Alok Dhungel, a consultant physician at Norvic International Hospital. "Many probably have become more indolent. For patients of diabetes and hypertension, impassiveness can be very risky."

Uncontrolled eating habits, in addition to an unhealthy diet, can increase the risk of diabetes and hypertension. Many might develop sugar, or have fluctuation in sugar level, and its the same with people with hypertension. Their blood pressure could abruptly become very high, making them dizzy with a headache, he says.

While it's best to visit a doctor to check the increase or decrease in sugar level or blood pressure, maintaining some control and discipline is the best way to keep our health in check right now under the circumstances, say doctors. Here are three questions you need to keep asking yourself to keep your blood pressure and diabetes in check, says Dhungel.

Are you exercising?

With the lockdown, some people might have stopped going for walks. They probably have developed more impassive behaviours. But exercise for people with diabetes and hypertension is very important, says Dhungel. Physical exercise for people with diabetes can help lower their glucose levels, and for those with hypertension, it can decrease high pressure. Physical activity is also necessary for general well being, according to research studies. Regular workout prevents the severity of health conditions, boosts energy, controls weight and gives you better sleep. It also improves blood circulation decreasing risks of cardiovascular diseases.

While you are not allowed to go for walks outside your home, you can still walk around the terrace or your home. And resort to light exercises to keep yourself fit and energetic, says Dhungel. Even light exercises as sit-ups, walks and stretching is good enough, he says.

Are you eating healthy?

For much of the first few weeks of the lockdown, Bajracharya found himself snacking a lot. Even when I was not hungry, I found myself in the kitchen munching on chips and dalmut. I guess that is what our boredom does to us or you could say I was stress-eating, he says.

His unrestrained eating habits had increased his cholesterol, his body weight and his sugar-level. As a result, Bajracharya felt more tired and lethargic.

According to studies, an unhealthy diet is one of the prime reasons for hypertension and type-2 diabetes. A good, nutritious diet ensures a healthy life but with the lockdown, many people probably could be eating less fibrous food, say doctors.

What you eat has a direct impact on your health so having a proper diet is imperative, especially if you are already diabetic and have high blood pressure," he says. "The lockdown might have made people go easy on themselves, but you see that is not going to help them. Instead, its going to create problems in the future. Try and eat food with more fibre, food that can give you energy and strength.

Are you stressed?

Stress is another reason for high blood pressure, says Dhungel. When people are stressed, the human body produces a surge of hormones, which can temporarily spike blood pressure. And as we live through an uncertain time, in a disrupted routine, people are bound to become stressed and anxious. And so, if you realise that you are in stress, make sure you talk to people around, says Dhungel. Its necessary to let out what you feel, he says.

Besides talking to reduce stress Dhungel also suggests curbing screen time and spending time doing things you love. Too much of Covid news can stress us even more, and so you should know when to stop. Distance yourself from what is upsetting you, he says.

Stress can also make people anxious, agitated, and short-tempered and thus to relieve stress, doctors recommend exercising and engaging in activities that can help in reducing mental tension.

However, if your sugar level and hypertension is frequently fluctuating, you need to visit or consult a doctor, says Dhungel. The ongoing lockdown has also created a fear of visiting hospitals, but there are many hospitals in the country that have started giving online medical consultations.

Bajracharya too, after consulting with his doctor, has become more mindful of his daily routine, with mandatory walks for half an hour at least in the morning besides other exercises.

Its a difficult time. But when the lockdown is over, I want to be able to live my life to the fullest not be dragged down by my health issues to the hospital again. I already have had enough of home-time, so I am exercising and trying to keep myself fit, says Bajracharya.

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Here's how you can keep your pressure and diabetes in check at home - The Kathmandu Post

A medical helpline run by a team of top doctors are offering people glucose intolerance tests so they can find out if they might have diabetes amid COVID-19.

Dr Mortons,which offers callers direct access to experienced healthcare professionals, is concerned about the estimated one million people in the UK who are unaware they have diabetes.

This is because newly published research has shown COVID-19 mortality rates are higher among those with type 1 or type 2 diabetes. In addition, those who survive tend to spend more time in hospital than those who do not have diabetes and have tested positive for coronavirus.

Dr Vicky Hordern, a consultant endocrinologist and adviser to Dr Mortons, said: One in 15 people in the UK have diabetes, but an estimated one million people in the UK have undiagnosed type 2 diabetes. There has never been a more important time to know if you are one of them.

Individuals with diabetes are definitely amongst the most vulnerable to COVID-19 and we know this from data released describing the patients who have sadly died from COVID-19.

We also know that the COVID-19 virus binds to ACE2 receptors in the lungs to gain entry to these cells and infect them, and researchers have found that there are differences in the ACE2 receptors in some groups of people who are at higher risk including those with diabetes, high blood sugars appears to affect these receptors.

Public health advice for people with diabetes has been that you should consider yourself more vulnerable to the severe consequences of infection with COVID-19 and therefore you should take action to avoid catching the virus.

In these days of great uncertainty, and as we begin to think about going back to some sort of normal life, we must all judge our own risk from this virus that will continue to circulate until a vaccine is developed, and adapt our way of living accordingly.

To help people who may be worried that they might be one of the undiagnosed people with diabetes, Dr Mortons is offering its very own X19 GT Test Kit for glucose intolerance.

This can be carried out in the safety of peoples own homes. These glucose intolerance tests involve blood samples that can be sent via post to be tested.

Dr Karen Morton, founder of Dr Mortons, said: Of course, a healthy diet and regular exercise are critical to preventing and controlling diabetes, but knowing that you have glucose intolerance could be the trigger to sorting out an improved diet, particularly if you are given the right advice.

So, after a great deal of thought, Dr Mortons has decided to start offering our patients what could be a lifesaving test. The result of such tests in no way say who will or will not get COVID-19, but it could be really helpful in improving your resilience and general health.

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Glucose intolerance tests available to those concerned they may have diabetes - Diabetes - Diabetes.co.uk

Diabetes should be considered as a risk factor for the rapid progression and bad prognosis of COVID19, researchers have said.

A Chinese team have been looking at whether diabetes might influence the progression and prognosis of coronavirus by studying a total of 174 consecutive people with coronavirus.

All the participants had their demographic data, medical history, symptoms and signs, laboratory findings, chest computed tomography (CT) as well the treatment measures collected and analysed.

The research team said that people with diabetes who tested positive with COVID19, who did not have other comorbidities, were at higher risk of severe pneumonia, release of tissue injuryrelated enzymes, excessive uncontrolled inflammation responses and hypercoagulable state associated with dysregulation of glucose metabolism.

Rapid deterioration

Furthermore, serum levels of inflammationrelated biomarkers such as IL6, Creactive protein, serum ferritin and coagulation index, Ddimer, were significantly higher (P <.01) among those with diabetes, compared with those without, suggesting that people with diabetes are more susceptible to an inflammatory storm eventually leading to rapid deterioration of COVID19.

The researchers concluded: Our data supports the notion that diabetes should be considered as a risk factor for a rapid progression and bad prognosis of COVID19.

More intensive attention should be paid to patients with diabetes, in case of rapid deterioration.More intensive attention should be paid to patients with diabetes, in case of rapid deterioration.

To read the study in full, click here.

Picture credit: Shane

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Diabetes should be considered as 'risk factor' for COVID-19 rapid progression - The Diabetes Times

Junk food and what it has to do with COVID-19 deaths.

Thecoronavirushas killed 60,000 people living in the United States as of this past Wednesday, 29 April, and quickly. Though most of the more than1-Mknown to be infected do not become seriously ill and many do not show symptoms those who are hardest hit often suffer rapid declines.

As scientists struggle to understand the overall effect of the virus and how to best address it, there are certain established truths that we can not afford to take for granted when it comes to protecting our health going forward.

A Key truth, and I have been writing about it in this column for at least 10 yrs, is the kind, quality and quantity of our food is essential to the quality of our health.

Young people who are obese are at particular risk and that overall obesity may be one of the most important predictors of severe coronavirus illness. That is no small matter in a nation where more than 67% of adults and about 33% of children and our youth are obese.

The findings are particularly frightening for Blacks and other people of color, who account for adisproportionate amount of obesityin the United States and are tragically proving to make up adisproportionate shareof COVID-19 deaths.

As the casualties rise it is important to note that there are many complex factors fueling obesity in Black communities. But some are easily addressed, such as the daily junk food marketingaimed at them.

University of San Diego Professor Aarti Ivanic, who studies the intersection ofrace and food marketing, found that many companies target their advertising of unhealthy fast food and junk food to Black and Hispanic populations, while promoting more healthy food choices to affluent White consumers.

Her work is supported bya report released last yearby the Council on Black Health and the University of Connecticut Rudd Center for Food Policy & Obesity that found restaurants, food, and beverage companies often target Black and Hispanic consumers for their least nutritious products, primarily fast-food, candy, soda/sugary drinks, and snacks.

The American Medical Association (AMA) has recognized the dangers of this targeted marketing and haswarned thatthat junk food advertising is so detrimental to the health of all young people, Black and Hispanic youth in particular that it should be sharply limited.

Jennifer Harris, senior research advisor at the Rudd Center, says these companies targeting youth in communities of color with their junk food advertising should be held responsible for putting their profits over young peoples health and even their lives.

Folks in the public health nutrition world are hopeful that this pandemic shines a spotlight on the tragic consequences of the health disparities created by inequalities in our food systems, she said.

The Harvard T.H. Chan School of Public Healthhas issued guidancesaying it is imperative for governments to promote policy and environmental changes that make healthy foods more accessible and decrease the availability and marketing of unhealthful foods.

The people that eat that way are walking a Death Walk daily.

It should not take a pandemic to cure Americans of their complacency on this issue. After all, it is no secret that diet-related chronic disease has been on the rise in the US for decades and now impacts about 50% of all American adults, or more than 100-M people, according to the USDepartment of Health and Human Services (HHS)

The Death March of this disease through our nations chronically ill population should be a wake-up call for all Americans.

Food quality, food access, food marketing and food choices are not casual concerns. They are proving to be matters of life and death

Eat healthy, Be healthy, Live lively

Have a healthy day, Keep the Faith!

adults, black, coronavirus, death, diabetic, food, health, HHS, Hispanic, junk, life, obese, youth

Paul A. Ebeling, polymath, excels in diverse fields of knowledge. Pattern Recognition Analyst in Equities, Commodities and Foreign Exchange and author of The Red Roadmasters Technical Report on the US Major Market Indices, a highly regarded, weekly financial market letter, he is also a philosopher, issuing insights on a wide range of subjects to a following of over 250,000 cohorts. An international audience of opinion makers, business leaders, and global organizations recognizes Ebeling as an expert.

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CDC Sites High Levels of Obesity and Diabetes in Coronavirus Victims - Live Trading News

Introduction:

Fastingduring the holy month of Ramadhan is ordained for all healthy Muslim adults.People who are exempted includes children, pregnant or breastfeeding women, theelderly and anyone who might get themselves ill by fasting. Often people askwhether a diabetic patient can observe fasting. In fact, most of them canobserve fasting safely during Ramadhan, No wonder about 80 percent of 120million Muslims with diabetes all over the world undertake fasting duringRamadhan.

What happens to sugars during Fasting: During a fast, at about eight hours after your last meal, your body starts to use energy stores to keep your blood glucose (sugar) levels normal. For most people this is not harmful, but if you have diabetes, your body cannot use the glucose as well as it should. With diabetes especially if you take certain tablets or insulin you are at risk of hypoglycemia (low blood glucose levels). Ramadhan fasting not only alters the timings of meals but it may also disturb sleeping patterns and hormonal rhythms, all of which can affect a persons metabolic state.

What are the benefits of fasting: Fasting during Ramadhan can also be beneficial. It may provide an opportunity to reduce caloric intake, facilitate weight loss, and smoking cessation. It may help to strengthen the therapeutic alliance between patient and physician, and provide an opportunity to improve diabetes management, with a focus on self-care and the regulation of medication and meal timing.

What are the challenges of Fasting: In people with complicated diabetes it may cause hypoglycemia (decrease in blood glucose level), hyperglycemia (increase in blood glucose levels), dehydration and diabetes ketoacidosis. During fasting time, patients may suffer from hypoglycemia due to lack of glucose while after evening people might encounter increased glucose levels due to excessive intake of food.

What is Pre-Ramadhan counselling: Many people with diabetes can safely keep fast during Ramadhan after discussion with their doctor. However this decision may vary from person to person based upon his/her physical condition, HbA1c, concurrent complications, age, and type of antidiabetic medications etc. It is always advisable to consult your physician well in advance (at least 2-3 months before Ramadhan) to discuss a plan about lifestyle modification, diet and medication accordingly. This is called Pre-Ramadhan counselling which unfortunately is unheard of in our setting.

Which diabetic patients should avoid fasting: People with type 1 diabetes mellitus (T1DM). There is some evidence to suggest that, as long as they are otherwise stable and healthy, they can do so safely. However, strict medical supervision and focused education is essential. Pregnant women with diabetes (especially those on insulin) are stratified as very high risk and are advised not to fast. Fasting is also not advisable to patients with following issues e.g. Frequent low and high sugars (so called brittle diabetes); hypoglycemia unawareness (patient does not perceive symptoms of low sugars; history of diabetic ketoacidosis or severe hypoglycemic episode during the past three months; Hospital admission for very high blood or low blood glucose during the past three months; Very poor control of diabetes (high HbA1c) or presence of complications of diabetes such as problems with kidneys, heart and eyes; Chronic kidney disease patients especially those on dialysis .Lastly any acute illness during this period prevents a person to fast.

Which diabetic patients can undertake fasting: Well controlled type 2 diabetic patients on diet therapy or on any of these drug classes viz; metformin, second generation sulphonylureas, Incretin mimetics, glitazones, SGLT2 inhibitors and on single dose insulin can undergo fasting safely.

What dietary alterations can I make: Keep sensible portions in mind and follow the same guidelines for healthy eating that you do the rest of the year with an emphasis on whole grains, lean sources of meat, fish and poultry, small amounts of heart healthy fats and limit added sugars. The meals should be varied and should not consist of only dates, sweet drinks and fried rice.Meals should include extra fiber, which is found in whole grains, legumes, vegetables, salads, and fruits. Fiber helps to avoid constipation. There should be low intake of salt especially with pickles and salted sauces. Suhoor meal should contain a balance of whole grains, apple, nuts, legumes (complex carbohydrates) as well as some protein (lean meat) to help slow the digestion and help the feeling of fullness last as long as possible into the day. Try to take Suhoor meal a little late. (of course within stipulated time) to spread out you energy intake more evenly.

Traditionallythe fast is ended (Iftaar) with the eating of dates and drinking water. Limitintake of dates to 1-2 each evening. Simple carbohydrates like bread cereals,rice or pasta can be taken. Chose water as your main drink. and take plenty ofwater and sugar free beverages throughout the evening, While I agree that theIftaar meal is a celebration time, but aim is not to overeat.

Avoidcaffeine beverages as they can be dehydrating. Limit the amount of ladoos,jalebi and barfi. Avoid energy dense foods like samosas, pakodas, parantas,purees, ghee, margarines and butter. Limit the amount of oil in cooking to 2tablespoons for a four-person dish. Here is an example of a healthy Ramadhanplate eg 1 cup of vegetables, 2 cups of whole grain rice, a cup ofbeans/lentils/peas, a small portion (4 oz) of lean protein. Add one small sliceof watermelon, 2 dates and one glass of low fat milk.

Can I go for exercise during fasting: Avoid moderate to highly vigorous exercise However, patients can continue with their routine morning walks and time spent during Taraweeh prayers should be counted as part of exercise activity.

What about alterations in anti-diabetic medications: Individualization of anti diabetic treatment options is the proper approach .Consult your doctor for changes in medications schedule and alteration in insulin regimes. In fact your previous years successful Ramadhan experience is a useful guide for changes in drug regimens. Oral drugs that are safe include Metformin, Glipizide, Gliclazide, Glitazones, DPP4 inhibitors, Incretin mimetics, SGLT2 inhibitors, Rapid acting insulin analogues are preferred due to less chances of low sugar and minimal post meal sugar spikes. Premixed insulin [50/50} is a good option in patients who are on two doses of insulin.

Can I do fingerprick sugar tests during fasting: Self monitoring of sugars can be done at home. It does not amount to breaking a fast, Ideally it should be done multiple times a day, However you can do it Pre-Suhoor and Pre-Iftaar and whenever symptoms of low sugar are felt.

At what level of sugars I may have to break my fast: A fast will have to be ended if glucose levels fall too low (usually less than70mg/dl ) or if it shoots up to more than 300mg/dl . For low sugars about 15 grams of carbohydrate can be taken to raise glucose levels to normal. Carbohydrates can be taken in the form of 4 glucose tablets, or fruit juice or candy. Wait for 15 minutes and recheck sugar level again and adjust the medications accordingly. For high sugars apart from increasing the doses of medications, a doctors consultation is a must before one continues with fasting. Remember high sugars can lead to dehydration and changes in mental status.

Do I need to go for a Post Ramadhan follow up: A follow up meeting with your doctor is advisable to assess how you handled fasting and to discuss medication readjustments. Lastly remember Eid- ul Fitr is not the time of overindulgence. May the blessings of Ramadhan be on all of us and may Allah grant our prayers and fasts, Ramadhan Kareem!

Dr Mohammad Hayat Bhat is Consultant Endocrinologist at Govt Superspeciality Hospital, GMC, Srinagar

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Diabetes and Ramadan: Frequently asked questions - Greater Kashmir

AstraZeneca has begun a global trial to assess whether one of its diabetes medicines could be repurposed for Covid-19 patients at risk of serious complications such as organ failure.

The Cambridge-headquartered company is working with Saint Lukes Mid America Heart Institute to explore the potential of the drug dapagliflozin, sold as Farxiga, in reducing the risk of disease progression, clinical complications and death for patients with cardiovascular, metabolic or kidney problems.

Poorer outcomes have been recorded for such patients who have been hospitalised with Covid-19.

Mene Pangalos, executive vice president, biopharmaceuticals R&D, said: AstraZeneca is committed to finding new solutions to fight Covid-19 by investigating the application of our new and existing medicines.

With the Phase III DARE-19 trial, we aim to test whether Farxiga can prevent serious complications such as organ failure in those patients with pre-existing health conditions, a critical goal when treating Covid-19.

The design of the randomised, double-blind global trial is supported by extensive data on the protective effect of Farxiga in patients with heart failure with reduced ejection fraction, chronic kidney disease or type 2 diabetes.

Mikhail N Kosiborod, a cardiologist at Saint Lukes Mid America Heart Institute, and vice president of research at Saint Luke's Health System, is the principal investigator of the DARE-19 trial.

He said: Dapagliflozin has demonstrated cardio and renal protective benefits and improved outcomes in high-risk patients with type-2 diabetes, heart failure with reduced ejection fraction, and chronic kidney disease.

Patients with Covid-19 and underlying cardiometabolic disease appear to be at the highest risk of morbid complications.

Through DARE-19, we hope to decrease the severity of illness, and prevent cardiovascular, respiratory and kidney decompensation, which are common in patients with COVID-19.

The trial is open for enrolment in the US and other European countries with a high Covid-19 burden and aims to recruit approximately 900 patients.

AstraZeneca also began a clinical trial in record time of its blood cancer drug Calquence (acalabrutinib) to assess its effectiveness at decreasing inflammation and reducing the severity of Covid-19 induced respiratory distress in severely ill patients.

The company is also working on new antibody therapies, which it hopes to trial in three to five months.

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Link:
AstraZeneca launches trial to assess whether diabetes medicine can be repurposed for Covid-19 patients - Cambridge Independent

As the worsening coronavirus pandemic continues to spread across the country, millions of Americans living with diabetes face heightened risks from COVID-19.

Around 30 million Americans have diabetes, mostly of the type II (previously called adult-onset) variety. A quarter of U.S. adults with diabetes are over 65, an age that has been shown to delineate increased COVID-19 mortality rates.

One issue is you have the confounding factor of age. As people age, type II diabetes becomes more and more prevalent, Dr. Mark Snyder, an endocrinologist in San Francisco, told Yahoo News. Its hard to tease out all of these issues. Aging is also a risk factor for complications with COVID-19.

Diabetes is a disease of the pancreas that impairs the bodys ability to process blood glucose. When left untreated, high blood sugar levels can lead to a variety of life-threatening complications, such as heart disease, kidney failure and stroke.

COVID-19 is especially worrisome for older diabetics, who may already be suffering from heart disease, another risk factor for those who contract the virus.

Diabetes and high glucose levels are associated with increased complications, respiratory failure and mortality in hospitalized patients with COVID-19, the American Association of Clinical Endocrinologists states on its website.

Data compiled on the 2,112 U.S. deaths from COVID-19 through March 28 showed 10.9 percent had diabetes, the most frequent underlying health condition among those who had died. Still, health experts caution that more still needs to be learned about the link between diabetes and COVID-19.

There is not enough data to show whether people with diabetes are more likely to get COVID-19 than the general population, the American Diabetes Association says on its website. The problem people with diabetes face is primarily a problem with worse outcomes, not greater chance of contracting the virus.

In China, where the virus is believed to have originated, the data does show that people with diabetes had much higher rates of serious complications and death from COVID-19 than people without it, the ADA reported.

Story continues

The complications from viruses pose a heightened risk for diabetics, which is why they are encouraged by doctors to receive a flu shot every year. Roughly 30 percent of the adults hospitalized with influenza each year have diabetes, according to the CDC.

People with high blood sugar from diabetes can be more severely affected by common infections, such as influenza and pneumonia, the University of Michigan wrote on its website. This is why immunizations for influenza (the flu) and pneumococcal disease are recommended for people who have diabetes.

Given that initial data shows COVID-19 is three times more infectious than the seasonal flu, diabetics should take extra precautions, health officials warn.

If you do get one of these common illnesses, your diabetes is going to be messed up and youre likely going to end up in the hospital, Snyder said.

In part thats because viral infections in diabetic patients greatly increase the risk of diabetic ketoacidosis (DKA), a condition that occurs when cells dont receive sufficient glucose. It can lead to coma and death.

DKA can make it challenging to manage your fluid intake and electrolyte levels which is important in managing sepsis. Sepsis and septic shock are some of the more serious complications that some people with COVID-19 have experienced.

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Click here for the latest coronavirus news and updates. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC and WHOs resource guides.

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Coronavirus poses special risk to millions of Americans with diabetes - Yahoo News

Diabetes is a killer, and Texas has a higher percentage of diabetes cases than the national average.

According to the American Diabetes Association, the disease is among the leading causes of disability and death in the United States. Uncontrolled diabetes causes blindness, nerve damage, kidney disease and other health problems, but nine out of 10 adults with pre-diabetes dont know they have it, according to The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center and more than half of type 2 diabetes is preventable.

Find out if you are at risk with a 60-second test and then see your primary care physician if you are.

The good news? People who are at risk for type 2 diabetes can improve their prospects with simple lifestyle changes. Heres how to get started.

Your doctor can do a blood test called A1c. It uses red blood cells to create a picture of average blood sugar levels over the last two to three months. For people without diabetes, the normal A1c range is 4% to 5.6%. A test reading of 5.7% to 6.4% means you have a higher chance of getting diabetes. A level of 6.5% or higher means you have diabetes. Knowing where your A1c falls can guide your next steps.

Fruits, vegetables and legumes are loaded with vitamins, minerals and fiber and chances are good youre not eating enough of them. (Most Americans arent.) Working with a dietitian or nutritionist can help. So can joining a whole-foods, plant-based diet Facebook group. Not sure what to eat? The American Diabetes Association has a long list of cookbooks that will help you solve that dilemma.

The sugar found in fruits and vegetables isnt what you need to be concerned about. Its the added sugars in processed foods that are harmful. Among the fastest ways to get sugar out of your diet are to replace soda with unsweetened tea or water; skip desserts and sugary snacks; forgo condiments such as ketchup, barbecue sauce and sweet chili sauce; and trade cold breakfast cereal for oatmeal.

Change begins with a single step sometimes literally. If you dont already have an exercise regimen and you can walk, do it. A 15-minute walk around the block once a day is a start. So is a gentle yoga class once a week. If you cant walk, you can still exercise! Start with light hand weights or resistance bands and find a YouTube video with an easy upper-body routine. Work up to longer walks or heavier weights. To get all the health benefits of physical activity, work up to a combination of aerobic and strength exercises at least five times a week.

Being overweight impacts more than your risk of developing type 2 diabetes. According to the American Diabetes Association, it leads to unhealthy cholesterol, high blood pressure, heart disease, high blood sugar and even stroke. Losing just 10 pounds can make a big difference. If youre overweight and engage in the first four activities listed here, weight loss may happen without additional effort. Improving your diet and exercising regularly are the best ways to lose weight and keep it off.

If you have been diagnosed with diabetes, these tips still apply to you. Additionally, Baylor Scott & White Health has local programs to teach people of every age to manage the disease and improve their overall quality of life. Find a diabetes education program near you.

Original post:
Learn what you can do to prevent diabetes during National Diabetes Month - The Dallas Morning News

In light of the COVID-19 pandemic, ENDO 2020, the annual meeting of the Endocrine Society, was postponed until June 2020. In lieu of the meeting, which was originally scheduled for March 2831, 2020, in San Francisco, organizers held virtual news conferences March 30 and 31 to share the latest emerging science in endocrinology. All ENDO 2020 studies will be published in a supplemental issue of the Journal of the Endocrine Society.

The worlds first use of a drone to deliver insulin to a patient living in a remote community was performed late last year in Ireland, an accomplishment that has implications for wider use of drones to deliver medications in trying circumstances. Such circumstances might include infectious-disease pandemics like the COVID-19 outbreak.

An international team of researchers spent a year planning the drone test flight from Galway, Ireland, to the Aran Islands, about 12 miles off the west coast of Ireland. The drone was used to drop off insulin and return with the patients blood sample so that a doctor could check the patients glucose levels, says Spyridoula Maraka, MD, an endocrinologist at the University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System in Little Rock.

The project was conceived after healthcare professionals in Ireland noted the difficulties people faced obtaining critically needed medications during a 2017 hurricane and a 2018 blizzard in Ireland, Dr. Maraka says. People with diabetes who require insulin could fall critically ill if they run out of their medication, she says. Drones are already used in remote parts of Africa to deliver blood supplies.

Medicine has a track record of practicing for emergencies before they happen, Maraka said. There are multiple medical delivery drone opportunities.

Irelands Diabetes Drone Mission was launched with a team of experts across different fields, including medical, pharmaceutical, technical, flight operations, telecommunications, and regulatory agencies. The team selected a Wingcopter 178 drone for the first flight and received Irish Aviation Authority approval to conduct the mission.

The team plans to scale up the program to deliver medications to remote areas in the future. It will be important to gain the publics confidence in the program, as well as negotiate with airspace authorities to allow delivery access, Maraka says. That may be challenging in more densely populated areas.

RELATED: 9 Diabetes Care Tips During the COVID-19 Pandemic

A common chemical called PFAS detected in the blood of pregnant women is linked to a higher risk of obesity in their granddaughters. PFAS per- and polyfluoroalkyl substances are man-made chemicals used as oil and water repellents and coatings for common products including cookware, carpets, and textiles, according to the Environmental Protection Agency. They are known as endocrine-disrupting forever chemicals because they persist when released into the environment and accumulate over time.

The study, by researchers at the Public Health Institute in Berkeley, California, featured an analysis of data from a project known as the Child Health and Development Studies. Blood samples from pregnant and postpartum women in the 1960s were collected and stored. In the early 2000s, the researchers measured the weight, height, and waist circumference of a subset of the study participants daughters and granddaughters. They determined the risk of total obesity and abdominal obesity in the daughters and granddaughters. The study included 213 sets of grandmothers, mothers, and granddaughters. The California Department of Toxic Substance Control then measured PFASs and other chemicals in the stored blood of the grandmothers.

The study showed that a granddaughters combined risk of abdominal and whole-body obesity increased 53 percent with a doubling of PFAS blood levels in her grandmother, when her grandmother also had lower cholesterol (in the bottom 25 percent). This translated to an estimated 2.3-fold increase in the combined risk of abdominal obesity and whole-body obesity for women whose grandmothers were in the top 25 percent of PFAS exposure compared with the bottom 25 percent of PFAS exposure. Cholesterol is somehow involved in the transport and metabolism of the chemicals, the researchers note.

Pregnancy appears to be based on our study and animal research and other work in progress a critical window of exposure for three generations in humans, says the lead author of the study, Barbara A. Cohn, PhD, the director of Child Health and Development Studies, who is based in Oakland, California.

These findings may help to explain the current U.S. and worldwide increases in obesity in young adults, she says. We dont understand the mechanisms for this association. We do know it has implications for the current epidemic of obesity if this can be confirmed.

Consumers can reduce their exposure to the chemicals by avoiding eating out of take-out and to-go food containers and using glass or stainless steel food storage containers. Another source of exposure is stain- and water-resistant carpet.

But, she says, Personal measures probably are not going to be enough because, like other legacy compounds, they have been so ubiquitous. There is so much everywhere.

RELATED: New Report Finds Toxic Forever Chemicals in Drinking Water in 31 States

People with diabetes who have a stroke have a better chance of preserving cognitive function if they have good blood glucose control after the stroke, according to a study from the Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University in Israel.

The study involved patients who had lacunar strokes, which are a common type of stroke that occurs in a blocked artery deep within the brain. The stroke can cause neurological damage. Researchers looked at 942 adults with diabetes who had a lucunar stroke to assess their A1C management following the stroke. A1C is a measurement doctors use to assess how well a person with diabetes is managing his or her glucose. Its also used to diagnose diabetes, according to the Centers for Disease Control and Prevention. The study showed better glucose management was linked to greater cognitive function and less cognitive decline. The research was observational, meaning that it only links better glucose management with cognitive benefits following stroke. A clinical trial could help prove a causal effect between the two, the authors said.

Still, Understanding potentially modifiable risk factors has large public health implications. One such factor may be A1C control, says the study's lead author, Tali Cukierman-Yaffe, MD, a physician and researcher at the Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University. For example, she says, It may be that individuals with cognitive impairment who have difficulty managing their disease would have worse glucose control.

Current medical recommendations urge healthcare providers to screen older people with diabetes for cognitive impairment, she notes.

Cognitive assessment should be part of the routine checkup of older people with diabetes, she said. The reasons for that are, one, the relationship between cognitive dysfunction and diabetes self-care; and the other is that cognitive function is another complication of diabetes that we should be looking for.

RELATED: Why Some Researchers Are Calling Alzheimers a Type 3 Diabetes

A minimally invasive endoscopic technique that has been approved in Europe can help people with poorly managed type 2 diabetes improve their A1C. The procedure, called Revita duodenal mucosal resurfacing (DMR), has not been approved for use yet in the United States.

During the procedure, doctors insert a balloon catheter through the mouth into the duodenum, which is part of the upper small intestine. They deliver thermal energy to remove or ablate the duodenal lining. After the damaged duodenal lining is removed, a new layer of tissue eventually forms.

Data from a new study of 70 people, dubbed REVITA-2, showed that people who received DMR had improved blood glucose levels and liver insulin sensitivity three months following the procedure compared with patients who underwent a sham procedure.

The novel technique is based on research that shows the duodenal lining is critical to the hormone changes and hormone signaling that lead to insulin resistance. Destroying the lining can interrupt the process underlying diabetes, the study authors say.

A major question about DMR is how long the effects last. Researchers reported evidence that some patients have improved diabetes control for up to two years. But its not known if the procedure will have to be regularly repeated.

This procedure would be for patients who have not been helped by previous treatments, says the study investigator David Hopkins, MBChB, a physician and the director of the Institute of Diabetes, Endocrinology, and Obesity at Kings Health Partners in London. But, he adds, treatment earlier in the course of diabetes could likely produce the most benefit by changing the course of disease.

RELATED: How to Stabilize Your Blood Sugar

In another study on bariatric surgery released from ENDO 2020, researchers at the University of Michigan in Ann Arbor have found that bariatric surgery that takes place prior to the development of diabetes is more effective in facilitating weight loss.

Researchers studied 714 participants who had either gastric bypass or sleeve gastrectomy surgery. All of them had a body mass index (BMI) of more than 40 prior to surgery. Those without diabetes at the time of surgery had a 1.6 times higher chance of losing at least 50 percent of total body weight, regardless of the type of surgery.

The presence of diabetes before surgery is a predictor of future weight loss outcomes, says a study coauthor, Yingying Luo, PhD, of the University of Michigan.

The study suggests that having bariatric surgery before developing diabetes may be an important preventive strategy, says a lead researcher,Elif A. Oral, MD, of the University of Michigan. More research is needed to confirm the study results, the authors said. Yet doctors and patients should consider the timing of bariatric surgery.

We know that bariatric surgery may protect or delay the onset of diabetes, Dr. Luo says. We need a larger sample size. If we can find a true impact on the presence of diabetes, maybe it suggests we should take a step forward to have the surgery.

RELATED: Bariatric Surgery Cuts Heart Risks in People With Obesity and Diabetes

People with diabetes who lose a gland that helps lubricate the eye by producing tears may have elevated blood glucose levels, say the authors of a study from the University of California in San Francisco.

People with diabetes can experience dry eye and eye discomfort. They may have a loss of the meibomian glands in the eyes. The study looked at people with type 2 diabetes diagnosed with dry eye. People with higher A1C levels, a measure of blood glucose levels, were more likely to have the loss of the meibomian glands compared with those with more controlled A1C levels. Even among people who did not have diabetes, those with higher A1C levels had greater loss of meibomian glands.

Doctors should check the eyelids of individuals with diabetes who complain of dry eye, says the coauthor Gloria Wu, MD, an adjunct faculty member at the University of California in San Francisco.

Some people have severe discomfort and pain, she says. This is an easy diagnostic way of looking at diabetes.

RELATED: 5 Ways to Lower Your A1C Levels

People with type 1 diabetes using the Medtronic MiniMedTM 670G insulin pump system are able to maintain blood glucose levels in the targeted range over 71 percent of the time, according to a study that analyzed some 6 million days of real-world data.

The data compares favorably to the results found in clinical trials that led to approval of the device. The MiniMed TM 670G system is the first hybrid closed-loop system approved by the U.S. Food and Drug Administration (FDA) for people with type 1 diabetes.

Sometimes referred to as an artificial pancreas, the device consists of an insulin pump with a tiny infusion catheter worn under the skin and a small continuous glucose monitor that is also placed under the skin. The device measures glucose levels every five minutes and sends the results to the pump to dispense insulin as needed. Individuals upload data from the device to a website so that physicians can monitor their patients.

The real-world study involved more than 51,000 people. Researchers found that individuals were able to maintain blood glucose levels in the targeted range more than 71 percent of the time. When managing diabetes, the goal is to be in the target glucose range of 70180 milligrams per deciliter (mg/dL) more than 70 percent of the time.

Real-world experience does not necessarily live up to the results seen in a clinical trial that recruits highly motivated participants who are under close supervision, says the study's principal investigator, Robert Vigersky, MD, the chief medical officer of Medtronic Diabetes, in Northridge, California. Our results demonstrate that the glycemic control using the MiniMedTM 670G in the real world is excellent and mirrors the results of the small pivotal trials that led to the systems approval.

In February, the FDA announced Medtronic had recalled MiniMed 670G insulin pumps with broken or missing retainer rings following reports that a broken or missing part could lead to incorrect dosing. Insulin pumps with the retainer ring intact do not need to be returned to Medtronic.

Read the original post:
ENDO Online 2020: The Top Diabetes News From March 30 - Everyday Health

Roche is offering free access to its mySugr Pro diabetes management app in the UK to relieve pressure on the NHS during the COVID-19 coronavirus pandemic.

The Swiss pharma is offering a years free access to the app to help both patients and clinicians at a time when the UK is thought to be approaching a peak of patients with the disease.

Usually costing 20.99 per person per year, the app aims to improve the experience of digital and telephone appointments for people with diabetes by remotely providing blood glucose monitoring information.

mySugr allows users to enter blood glucose results from any monitor and is already used by more than 2 million registered users worldwide.

Eligible patients can use a code that can be redeemed until 30 September this year and supports NHS guidelines on management of diabetes, while protecting resources for response to the coronavirus.

As there is no capacity within the NHS currently for healthcare providers to install additional software, so the healthcare provider need only provide an email address for people with diabetes to send PDF reports to.

Dr Claire Marriott, medical affairs lead at Roche Diabetes Care, said: Supporting people with diabetes is essential at this time. Tools that support someone living with diabetes in their glucose management can also enhance remote consultations. This then has the added benefit of freeing up valuable time of our healthcare providers.

mySugr was founded in 2012 to provide an all-round care service for people with diabetes, combining coaching, therapy management, test strips and data tracking.

Roche had been partnering with mySugr since 2014 and decided to acquire the digital health firm in 2017 for an undisclosed sum.

The Swiss pharma is one of several that have invested in digital services to support patients with diabetes.

Eli Lilly is working closely with the diabetes digital health firm Livongo and in 2018 began a collaboration looking at how real-world evidence could be used to improve care and reduce the burden of disease.

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Roche offers free access to diabetes app to relieve pressure on NHS - - pharmaphorum

DUBLIN, April 1, 2020 /PRNewswire/ -- The "Digital Health: Diabetes Apps and Virtual Coaching" report has been added to ResearchAndMarkets.com's offering.

This special technology-based report provides an overview of diabetes, wearable glucose monitoring devices, smartphone-based digital health technologies, and attempts to answer the question: can digital health help improve diabetes?

Smartphone-based digital health technologies are expected to transform the diabetes management market over the next decade by substantially improving diabetes outcomes and reducing healthcare costs. These technologies are engaging and empowering patients, improving glycemic control, and lowering complications.

Digital health technologies are defined in this report as: diabetes smartphone apps integrated with blood glucose monitoring devices (both standard blood glucose meters and continuous glucose monitoring systems) and personalized virtual diabetes coaching services.

The adoption of smartphone-based digital health technologies for diabetes management is being driven by:

the large and growing prevalence of diabetes

heavy patient burden and treatment complexity

poorly controlled diabetes

spiraling diabetes-related healthcare costs

the rise in global smartphone usage and increased accessibility to smartphone-based telehealth

positive clinical data supporting reduced complications and healthcare costs

Key Topics Covered

Executive Summaryi. Digital health is transforming diabetes managementii. Benefitsiii. Clinical dataiv. Limitationsv. Security concernsvi. Conclusionvii. Bibliography

1. Diabetes Overview 1.1 Type 1 diabetes: 5% of the diabetes population are insulin dependent1.2 Type 2 diabetes: 95% of the diabetes population1.3 Diabetes prevalence: rising by 50% over next 25 years1.4 Complications: tight glycemic control can prevent complications1.5 Prevention1.6 Bibliography

2. New Guidelines for Achieving Glycemic Control2.1 ADA's target A1c: 2019 Standards of Medical Care in Diabetes2.2 The importance of self-monitoring of blood glucose2.3 The DCCT study2.4 New 2019 ADA guidelines for glycemic targets: time-in-range2.5 Medtronic's TIR goa2.6 Bibliography

3. Blood Glucose Monitoring and the Rise of Smartphone-Driven Diabetes Apps3.1 Ascens3.2 DarioHealth3.3 LifeScan3.4 Welldoc's BlueStar for diabetes3.5 Glooko3.6 mySugr3.7 BibliographyExhibit 3-1: Selected standard blood glucose meters and diabetes appsExhibit 3-2: OneTouch Verio Flex and OneTouch Reveal appExhibit 3-3: OneTouch Reveal Plus powered by Welldoc's BlueStar technologyExhibit 3-4: Welldoc's BlueStar AI-driven smart diabetes appExhibit 3-5: Glooko Mobile appExhibit 3-6: mySugr app

4. Virtual Diabetes Coaching4.1 Lark Technologies4.2 Livongo4.3 Onduo4.4 One Drop4.5 Virta Health4.6 BibliographyExhibit 4-1: Onduo for diabetesExhibit 4-2: The One Drop digital diabetes management portfolioExhibit 4-3: Virta app

5. Revolutionary Continuous Glucose Monitoring Systems5.1 Abbott5.2 Dexcom5.3 Medtronic5.4 Nemaura Medical5.5 Senseonics5.6 BibliographyExhibit 5-1: Selected continuous glucose monitoring systems with diabetes appExhibit 5-2: The FreeStyle Libre CGM 14-day sensor and LibreLink appExhibit 5-3: The Dexcom G6 CGM System with extended 10-day sensorExhibit 5-4: Dexcom CLARITY diabetes management software-Exhibit 5-5: The Guardian Connect CGM System with Sugar.IQ appExhibit 5-6: The SugarBEAT systemExhibit 5-7: The Eversense CGM and mobile app

6. Clinical data - Can Digital Health Help Improve Diabetes?6.1 Meaningful Reduction in HbA1c6.2 Clinical review of diabetes apps/digital health technologies6.3 Emerging full-service virtual diabetes clinics6.4 BibliographyExhibit 6-1: Selected studies, average reduction in HbA1c with use of diabetes apps and/ or digital app-based coaching programs

Story continues

Companies Mentioned

Abbott

Ascensia Diabetes Care

Dario Health

Dexcom

Glooko

IBM Watson Health

Insulet Corporation

Lark Technologies

LifeScan

Livongo Health

Medtronic

mySugr

Nemaura Medical

Omada Health

Onduo

One Drop

Roche

Sanofi

Senseonics

Tandem Diabetes Care

Virta Health

Welldoc

For more information about this report visit https://www.researchandmarkets.com/r/iklur6

Research and Markets also offers Custom Research services providing focused, comprehensive and tailored research.

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The Future of the Diabetes Management: Apps & Virtual Coaching - Yahoo Finance

But what is most worrisome is the racial disparity in prior health conditions that exist in the United States. As Bloomberg reported about a study of the deaths in Italy: Almost half of the victims suffered from at least three prior illnesses, and about a fourth had either one or two previous conditions. More than 75 percent had high blood pressure, about 35 percent had diabetes and a third suffered from heart disease.

According to the Centers for Disease Control and Prevention, high blood pressure is most common in non-Hispanic black adults (54 percent), and black people have the highest death rate from heart disease.

As for diabetes, the 2015 National Medical Association Scientific Assembly, held in Detroit, where my friend died, delivered these stark statistics:

African-American patients are more likely than white patients to have diabetes. The risk of diabetes is 77 percent higher among African-Americans than among non-Hispanic white Americans. The rates of diagnosis of diabetes in non-Hispanic African-Americans is 18.7 percent compared to 7.1 percent.

The group went on to say that in 2006, African-Americans with diabetes were 1.5 times more likely to be hospitalized and 2.3 times more likely to die from diabetes than non-Hispanic whites.

In addition, many Southern states refused to expand Medicaid under the Affordable Care Act, and there is a rural hospital crisis in this country. But that crisis is compounded in the South, where, as the magazine Facing South points out, the rural areas have higher poverty rates, higher mortality rates, and lower life expectancies than other rural regions of the country.

This all worries me, because I take a lesson from the H.I.V./AIDS crisis. In the beginning, it was largely seen as a New York and San Francisco problem affecting white men who were gay. Over the decades, treatments became available, and those cities saw their new infection rates plummet.

But the disease remained very much alive, particularly in the South, particularly among black people, where it has reached epidemic proportions. In the United States, more than 40 percent of people living with H.I.V. and 40 percent of people with new infections are black, according to the C.D.C., and African-American men accounted for three-quarters of new H.I.V. infections among African-Americans in 2016, and 80 percent of these were among African-American gay and bisexual men.

See more here:
The Racial Time Bomb in the Covid-19 Crisis - The New York Times

The global diabetes care devices market is expected to reach US$ 39,382.3 Mn in 2027 from US$ 23,354.3 Mn in 2018. The market is estimated to grow with a CAGR of 6.1% from 2020-2027.

Premium market insights recently published a report titled Diabetes Care Devices Market Size and Forecast to 2026. The report includes an authentic and accurate research study into the global Diabetes Care Devices market based on a qualitative and quantitative assessment by leading industry experts. The report highlights the current market scenario and how it is likely to change in the future. This report examines growth determinants, micro and macroeconomic indicators, opportunities, developments and key market trends that are likely to have a major impact on global market growth for Diabetes Care Devices.

The Global Diabetes Care Devices Market is growing at a faster pace with substantial growth rates over the last few years and is estimated that the market will grow significantly in the forecasted period i.e. 2020 to 2026.

Request a Sample Copy of this Report @

https://www.premiummarketinsights.com/sample/AMR00013478

This report includes the following Companies; We can also add other companies you want:

World Health Organization, American Diabetes Association, National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes UK

Diabetes Care Devices Market: A Competitive Perspective

The report also provides an in-depth analysis of the competitive landscape and behavior of market participants. In this way, market participants can familiarize themselves with the current and future competitive scenario of the global market for Diabetes Care Devices and take strategic initiatives to gain a competitive advantage. The market analysts have carried out extensive studies using research methods such as PESTLE and Porters Five Forces analysis. Overall, this report can prove to be a useful tool for market participants to gain deep insight into the global market for Diabetes Care Devices and to understand the main perspectives and ways to increase their profit margins.

Diabetes Care Devices Market: Drivers and Limitations

The report section explains the various drivers and controls that have shaped the global market. The detailed analysis of many market drivers enables readers to get a clear overview of the market, including the market environment, government policy, product innovation, development and market risks.

The research report also identifies the creative opportunities, challenges, and challenges of the Diabetes Care Devices market. The framework of the information will help the reader identify and plan strategies for the potential. Our obstacles, challenges and market challenges also help readers understand how the company can prevent this.

Diabetes Care Devices Market: Segment Analysis

The report section contains segmentations such as application, product type and end user. These segments help determine which parts of the market will improve over others. This section analysis provides information on the most important aspects of developing certain categories better than others. It helps readers understand strategies to make solid investments. The market for Diabetes Care Devices is segmented according to product type, applications and end users.

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Diabetes Care Devices Market: Regional Analysis

This section of the report contains detailed information on the market in different regions. Each region offers a different market size because each state has different government policies and other factors. The regions included in the report areNorth America, Europe, Asia Pacific, the Middle East and Africa. Information about the different regions helps the reader to better understand the global market.

Table of Content

1 Introduction of Diabetes Care Devices Market

1.1 Overview of the Market1.2 Scope of Report1.3 Assumptions

2 Executive Summary

3 Research Methodology of Diabetes Care Devices

3.1 Data Mining3.2 Validation3.3 Primary Interviews3.4 List of Data Sources

4 Diabetes Care Devices Market Outlook

4.1 Overview4.2 Market Dynamics4.2.1 Drivers4.2.2 Restraints4.2.3 Opportunities4.3 Porters Five Force Model4.4 Value Chain Analysis

5 Diabetes Care Devices Market, By Deployment Model

5.1 Overview

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Diabetes Care Devices Market Will Reflect Significant Growth Prospects during 2020-2024 by World Health Organization, American Diabetes Association,...

People wait in line to be tested for coronavirus disease (COVID-19) while wearing protective gear, outside Elmhurst Hospital Center in the Queens borough of New York, March 30, 2020.

Jeenah Moon | Reuters

People with diabetes, chronic lung disease, heart disease or those who smoke may be at increased risk of developing severe complications if they get infected with the coronavirus, the Centers for Disease Control and Prevention said Tuesday.

In its first report looking at underlying health conditions that could make COVID-19 worse, the CDC analyzed data from confirmed cases in all 50 states and four U.S. territories between Feb. 12 and March 28. The agency examined 7,162 cases where data was available on underlying health conditions or other potential risk factors.Confirmed cases among people repatriated to the United States from Wuhan, China, where the virus emerged, and the Diamond Princess cruise ship were excluded, the agency said.

Among the 7,162 U.S. cases, 37.6%, had one or more underlying health conditions or risk factors, and 62.4%, had none of these conditions reported, according to the CDC's preliminary findings. The most commonly reported conditions were diabetes, chronic lung disease and cardiovascular disease.

The CDC found that a higher percentage of patients with underlying conditions were admitted to the hospital or into intensive care than patients without underlying conditions. About 78% of ICU patients and 71% of hospitalized COVID-19 patients had one or more reported underlying health conditions, the CDC said. In contrast, 27% of the patients who were not hospitalized had at least one underlying health condition, the agency said.

"These preliminary findings suggest that in the United States, persons with underlying health conditions or other recognized risk factors for severe outcomes from respiratory infections appear to be at a higher risk for severe disease from COVID-19 than are persons without these conditions," the CDC wrote. It recommended that people with underlying health conditions keep at least a 30-day supply of medication, a 2-week supply of food and other necessities and to know the COVID-19 symptoms.

The new data comes as U.S. cases climb to more than 181,000 and deaths surpass 3,000, more than the number of people who died in the Sept. 11, 2001, terror attacks. The death toll is expected to rise over the next few weeks as more patients flood hospitals, U.S. officials say.

Public health officials have long said the virus appeared to be particularly severe in the elderly and those with underlying health conditions.Symptoms can include a sore throat, runny nose, fever, dry cough, diarrhea or pneumonia and can progress to multiple organ failure or even death in some cases, they said.

A recent study published journal Pediatrics showed that some children can develop severe or critical disease. More than 90% of the caseswere asymptomatic, mild or moderate cases. However, nearly 6% of the children's cases were severe or critical, compared with 18.5% for adults.

The CDC said Tuesday the findings were in line with data from researchers in China and Italy, where the number of confirmed cases has topped 105,000.

The CDC recommended people who are sick, especially those with underlying health conditions, should stay at home, except to get medical care.

Excerpt from:
CDC says diabetes, lung disease, heart disease and smoking may increase risk of severe coronavirus illness - CNBC

Eli Lilly wants diabetes patients who use its drugs to know that help is available, and to get the word out, itbought full-page ads in more than a dozen newspapers in the U.S. The simple print ads, which ran Monday, spoke directly to people who recently lost jobs or health insurance and told themto contact the Lilly Diabetes Solution Center for help.

Driven by COVID-19 shutdowns and job losses in the millions, Lilly hadalready seen a 32% increase in call volumes to the diabetes help call center. After the ads ran Monday, call volumejumped by 91%over the previous Monday, March 23. The 340 incoming calls markedthe highest single-day call volumesince theprogram beganin August 2018.

We expect the numbers tocontinue to rise as different states take measures from a quarantine standpoint andasmore and more people are affected through loss of job or loss of insurance, or if they just weren't aware previously of the diabetes solution center, said Andy Vicari, senior director of Lillys insulin business in the U.S.

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RELATED: Media makeover: Eli Lilly media chief switches up marketing mix and overhauls go-to-market model

Lilly did a similar ad campaign in December to highlight the diabetes help center in an effort to reach people whose healthcare deductibles were about to reset, he said. The ad tells people they may be able to get free insulin andthat the calls are simple and average 10 minutes, and it also mentions that Spanish-speaking staff members are available. Lilly's insulin meds supported through the solutioncenter include its Humalog family of products. Other Lilly non-insulin diabetes treatments not in the programincludeGLP-1 receptoragonistTrulicity and SGLT2 inhibitor Jardiance in partnership with Boehringer Ingelheim.

While Lilly doesnt deliver meds directly to patients, it can help callers navigate pharmacies thatdo, as well as sign up those who qualify for Lilly Cares, a non-profit run under the Lilly Foundation. For people with diabetes who call but dont use Lilly meds, the call center staff redirects them to assistance programs from the drugmaker whose products they do use, Vicari said.

The campaign will run on social media along with the print ads that ran in cities including New York, Los Angeles, Chicago, San Francisco, Seattle, Newark, New Jersey, and Columbus, Ohio. Digital and radio ads that began in December with the previous diabetes solution center campaign are still running and continuing through April.

RELATED: Eli Lilly's new Trulicity TV ad counters Trump with first-ever pricing information

Lillys now staying-at-home field force is also helping the effort, doing outreach to healthcare professionals. The reps are not making sales calls but rather, as Vicari said, calling to ask, What do you need and how can we help? Lilly reps can give information on the patient diabetes programs or help provide other resources, such as samples for new patients, that doctors can use.

Link:
Lilly ad campaign in U.S. newspapers offers diabetes med help for patients affected by COVID-19 shutdowns - FiercePharma

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The era of diabetes telemedicine has arrived.

In the midst of the current COVID-19 pandemic, clinicians of all specialties who were already incorporating telehealth visits into their practices are now ramping it up, while those who were not using the technologies before are now scrambling to put them in place.

A free access article, "Top Ten Tips for Successfully Implementing a Diabetes Telehealth Program," was published March 19 in Diabetes Technology & Therapeutics by pediatric endocrinologist Stephanie Crossen, MD, of the University of California, Davis, and colleagues.

Written before the COVID-19 crisis hit, the article offers detailed practical advice in 10 key areas (for more details, see further down the article):

Hardware

Video software

Diabetes software

Scheduling telehealth visits

Standardizing telehealth visit processes

Reimbursement (for the US only)

Electronic health record (EHR) integration

Patient expectations

Patient-centered care

Culture change among providers and institutions

The document focuses primarily on implementing patient-to-clinic video encounters, although it also discusses asynchronous data review of patient-generated data and clinic-to-clinic video encounters.

In an interview, senior author Aaron B. Neinstein, MD, an endocrinologist at the University of California, San Francisco (UCSF), told Medscape Medical News: "What people are realizing is that this is a lot easier and there are fewer barriers than they thought. I keep hearing this. It seems big and scary but once people start doing it they think it's great and not that hard."

"I hope these are pragmatic tips that help people get over the hump."

Even under normal circumstances, routine diabetes care, whether in an endocrinology or primary care setting, is particularly well-suited to the use of telehealth: much of it involves electronic downloading of data from devices and speaking with patients about their own self-management.

Greg Dodell, MD, an endocrinologist with Mount Sinai Hospital in New York City who moderates a Twitter chat about telemedicine for endocrinologists using the hashtag #endotwitter, spoke with Medscape Medical News.

"I think this is an excellent paper and really a 'wow!' It comprehensively covers the landscape of telehealth including the proper setup, reimbursement, scheduling, and most importantly, how it can potentially facilitate the clinical relationship by enhancing self-care and eliminating potential barriers to follow-up."

Although nearly all of the information in the article can be applied now during the COVID-19 pandemic, it doesn't address two emergency federal actions that affect reimbursement in the United States, Neinstein noted.

Effective March 6, the Centers for Medicare & Medicaid Services lifted Medicare restrictions on the use of telehealth services during the COVID-19 crisis so that physicians will be paid for telehealth services at the same rate as in-patient visits for all diagnoses, not just services related to COVID-19.

Patients can receive telehealth services in their homes, anywhere in the country from a physician anywhere in the country. And physicians can reduce or waive cost-sharing for telehealth visits.

In addition, the Office of Civil Rights of the US Department of Health & Human Services (HHS) has waived penalties for violation of the Health Insurance Portability and Accountability Act (HIPAA) so that during the COVID-19 pandemic healthcare providers can communicate with patients through technologies such as FaceTime or Skype.

Dodell said that in the current COVID-19 crisis, endocrinologists and other clinicians who see a large number of patients with diabetes are at a bit of an advantage because of how well suited the condition is to virtual care.

"As a small business owner, I'm stressed but would be a lot more stressed if I couldn't do what I do...I have a good friend who's a gynecologist and had to close," he told Medscape Medical News.

Right now Dodell is not having patients get routine lab work done, but normally that would happen prior to a telehealth visit.

And in usual practice, patients still need to come in once a year for a physical exam. Of course, those appointments are also on hold for now.

"There are tools like digital stethoscopes and the Apple watch, and home blood pressure reading is easy. I don't think any of that stuff should replace physical contact, but in a situation like we're going through with this pandemic they're great options," he notes.

Neinstein, who is director of clinical informatics at the UCSF Center for Digital Health Innovation, added that, as the situation evolves, different care models will need to be adopted.

"It will become clear that as the healthcare workforce is strained and there's less capacity [for] care for chronic disease, we need to be looking at...a lot more nonphysician visits coaches, mental health professionals, peer groups, group visits for education and a lot more...texting or chatting."

And in the non-COVID setting, Dodell points out that implementing telehealth could streamline office flow and even save money: "I can do a telemed visit in half the time [of a conventional office visit]."

There are actually far more than 10 tips in the article, but they are grouped under 10 headings.

Hardware: Basic requirements for video visits are a mobile device (smartphone or tablet), laptop, or desktop with audio and video capabilities, an internet connection, and software download capability. This section covers equipment including cameras, headphones, monitors, and room lighting.

Video software: Many options for video conferencing software are HIPAA-compliant (assuming the same rules return after the COVID-19 crisis). Patients need to download the software application or run a temporary application for the visit. Most platforms offer multiparty conferencing for calls with children, adolescents, or the elderly.

Diabetes software: Nearly all diabetes devices incorporate data-sharing platforms, although unfortunately at this time many aren't compatible with each other or with EHRs. This section lists several desirable features, including compatibility with the broadest array of devices including insulin pumps, continuous glucose monitors (CGMs), glucose meters, and smart pens, easy upload for patients, and "seamless and flexible" account administration.

Scheduling telehealth visits: The authors recommend setting aside a block of time for telehealth visits separate from in-person visits to avoid overlap.

Standardizing telehealth visit processes: Patients need to be trained in advance on how to upload their data prior to the visit, and instructed when and where to have lab work done. This section discusses the role of office support staff in these processes.

Reimbursement (United States only): In general, video visits should be coded using typical current procedural terminology (CPT) codes based on time, such as 99214 for an established patient visit lasting 25-39 minutes, with the modifier 95 and the point-of-service code 02 for telehealth. As with in-person visits, additional codes can also be added such as CPT 95251 for CGM review and interpretation. For the most recent regional and state policies on this, check the Center for Connected Health Policy's website.

EHR integration: Minimum requirements include having the correct billing codes built-in, the ability to designate a separate visit type in providers' schedules, and standardized documentation for video visits. "We're still a long way from integration," Neinstein noted. "There are still several device companies that will not let the patient move their data off the device into software that they want to use. When you're trying to run a virtual clinic that makes life really, really hard." But he also said that new HHS regulations aimed at lowering EHR burden on physicians and other clinicians should help, assuming that device manufacturers comply.

Patient expectations: Patients need to know when these visits are available, what they will cost (typically the copay is the same as an in-person visit, but not always), and when they will be expected to return in person.

Patient-centered care: Whereas traditional diabetes care is based on the provider's availability, "with telehealth, diabetes care can take place in the home at a frequency customized to the individual." This section discusses several other potential patient-centered benefits.

Culture change among providers and institutions: "Acknowledging concerns and building supportive practices will increase your likelihood of success. We have found it critical to engage all institutional stakeholders early in the process to allow for successful integration of telehealth practices into routine care," the authors write.

"Recent improvements in both diabetes technology and telehealth policy make this an ideal time for diabetes providers to begin integrating telehealth into their practices," they conclude.

Crossen has reported receiving research support from the National Center for Advancing Translational Sciences, National Institutes of Health. Neinstein has reported receiving research support from Cisco Systems; consulting fees from Nokia Growth Partners and Grand Rounds; serving as an advisor to Steady Health; receiving speaker honoraria from the Academy Health and Symposia Medicus; writing for WebMD; and being a medical advisor and cofounder of Tidepool.

Diabetes Technol Ther. Published online March 19, 2020. Full text

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Top 10 Tips for Diabetes Telehealth Prophetic in Face of COVID-19 - Medscape

The following article is part of conference coverage from the American College of Cardiology (ACC.20) /World Congress of Cardiology. The Cardiology Advisors staff is reporting on research conducted by leading experts in cardiology. Check back for the latest news from the ACC.20.

Thepresence of diabetes before liver transplantation may be an independentpredictor of sudden cardiac death after the procedure, according to studyresults intended to be presented at the American College of Cardiologys 69thAnnual Scientific Session.

Suddencardiac death has been recognized as a common type of cause-specific mortalityafter liver transplantation. To better understand the predictors of suddencardiac death, researchers prospectively collected data on clinical outcomesafter liver transplantation from 4538 adults who visited 6 centers in Australiaand New Zealand between 1985 and 2017 (median follow-up, 10.5 years).

Apanel of 2 cardiologists and a transplant physician assessed the cause of deathin this cohort, and cases of sudden cardiac death were defined as witnessedarrests or unwitnessed cases, in which patients were deemed to be healthy atthe last time of contact. In this cohort, there were 240 cardiovascular-relateddeaths (5.3%), of which 30.4% were categorized as sudden cardiac death. Suddencardiac death vs death with a different etiology occurred earlier after livertransplantation (7.5 vs 9.0 years, respectively; P =.03).

The presence of diabetes before liver transplantation was identified as an independent predictor of sudden cardiac death after adjusting for univariate predictors (ie, coronary artery disease, age, and steatohepatitis of nonalcoholic origin) in a multivariate regression analysis (hazard ratio, 2.5; 95% CI, 1.1-6.0; P <.001).

Studiesare needed to assess mechanisms of [sudden cardiac death] following [livertransplantation], and whether intensive risk factor modification in thepost-[liver transplantation] diabetic population improves survival,concluded the study authors.

Reference

Koshy AN, Gow PJ, Han HC, et al. Diabetes is an independent predictor of sudden cardiac death following liver transplantation: results from the Australian and New Zealand Liver Transplant Registry over 30 years. Intended to be presented at: American College of Cardiologys 69th Annual Scientific Session; March 28-30, 2020; Chicago, IL.

Visit The Cardiology Advisors conference section for coverage intended to be presented at the annual meeting of the American College of Cardiology (ACC.20)/World Congress of Cardiology

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Diabetes May Be an Independent Predictor of Sudden Cardiac Death After Liver Transplantation - The Cardiology Advisor

Diabetes is the No. 1 underlying condition in people who have died of COVID-19 in Louisiana, the state health department reported Monday.

Of the 185 people who have died so far, 40 percent of them were diabetic, according to a press release from the Louisiana Department of Health.

Only 3 percent of those who have died had no underlying health conditions.

Other conditions in those who died include:

Most of the 185 people 105 who died of COVID-19 in Louisiana were 70 or older. Thirty-two were ages 60 to 69, 28 were ages 50 to 59, 13 were ages 40 to 49, and six were ages 30 to 39. This count is according to the Louisiana Department of Health website and only adds up to 184 one short of the official count of those who have died.

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Diabetes Tops The List Of Underlying Conditions In People Dead From COVID-19 In Louisiana - WWNO

Dapagliflozin reduced cardiovascular morbidity and mortality in patients with heart failure with reduced ejection fraction (HErEF) regardless of diabetes status, a new study suggests.

Additional treatments are needed for heart failure with reduced ejection fraction (HFrEF), the authors, publishing in Journal of the American Medical Association (JAMA), wrote in their study. Sodium-glucose cotransporter 2 (SGLT2) inhibitors may be an effective treatment for patients with HFrEF, even those without diabetes.

To evaluate the effects of dapagliflozin in patients with heart failure with reduced ejection fraction both with and without diabetes, the exploratory analysis included patients with NYHA class II to IV with ejection fraction rates less than or equal to 40% and elevated plasma NT-proBNP. Patients (n=4,744) were given a once-daily dose of 10 mg dapagliflozin (or placebo) added to regular therapy. The primary study outcome was composite worsening heart failure or cardiovascular death, and outcomes were analyzed by diabetes status.

According to the results, 4,742 patients completed the trial. Among patients without diabetes, the primary study outcome occurred in 13.2% of patients in the dapagliflozin group and 17.7% in the placebo group (HR=0.73; 95% CI, 0.60 to 0.88). In diabetic patients, the primary study outcome occurred in 20.0% in the dapagliflozin group and 25.5% in the placebo group (HR=0.75; 95% CI, 0.63 to 0.90; P for interaction=0.80). In patients without diabetes and with a glycatred hemoglobin of at least 5.7%, the primary outcome occured in 13.7% of those in the dapagloflozin group and 18.0% in the placebo group (HR=0.74; 95% CI, 0.59 to 0.94; P for interaction=0.72).

In this exploratory analysis of a randomized trial of patients with HFrEF, dapagliflozin compared with placebo, when added to recommended therapy, significantly reduced the risk of worsening heart failure or cardiovascular death independently of diabetes status, the researcher wrote in their conclusion.

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Dapagliflozin Linked with Reduced Morbidity, Mortality in HFrEF Patients Irrespective of Diabetes - DocWire News

Treatment with ticagrelor, an anti-platelet medication, alone demonstrated cardiovascular benefit in patients with diabetes when compared with dual therapy of ticagrelor and aspirin, according to new research presented at the American College of Cardiologys Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

The findings were also published in the Journal of the American College of Cardiology.

The study, known as the TWILIGHT trial, examined whether ticagrelor alone or ticagrelor plus aspirin more effectively reduced bleeding without increasing the risk for heart attacks, stroke, death, or other adverse events caused by arterial blockages in patients who had received at least 1 stent and were at high risk for adverse events.

In the trial, 9006 patients at 187 medical centers in 11 countries were enrolled. Patients had received at least 1 stent and were at high risk for bleeding or another arterial blockage.

For the current study, 2670 patients with diabetes were evaluated. Of these patients, those who received ticagrelor plus a placebo were less likely to have clinically significant bleeding compared with those who received ticagrelor plus aspirin, 4.5% versus 6.7%, respectively.

Additionally, 4.6% of patients treated with ticagrelor plus a placebo died or had a heart attack or stroke, compared with 5.9% of those who received ticagrelor plus aspirin, according to the study findings. The authors noted that, although not statistically significant, the findings suggest that eliminating aspirin does not have any negative effects on patients.

According to the authors, patients in the study were diagnosed with diabetes, but this was not confirmed by laboratory testing, citing one of the studys limitations. Additionally, patients with the most severe type of heart attack were excluded from the trial.

These findings were consistent with the overall results of the TWILIGHT trial and were seen across all types of diabetes patients, irrespective of their clinical presentation and the treatment they were receiving for their diabetes, study author Dominick J. Angiolillo, MD, PhD, professor of medicine at the University of Florida College of Medicine in Jacksonville, Florida, said in a press release.

He noted that the results concluded that eliminating aspirin reduced bleeding without increasing risk of death, heart attack, or strokes. However, further research is needed to identify the best treatment for patients after they have completed 1 year on ticagrelor monotherapy.

Excerpt from:
Ticagrelor Monotherapy Shows Cardiovascular Benefit in Patients with Diabetes - Drug Topics