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Diabetes Professional Care Charity of the year, X-PERT Health, has appointed digital healthcare agency, Pulse, to transform their ground-breaking diabetes education programme onto a digital platform.

The new platform, which will be accessible via an app or website, will enable X-PERT Health to scale up its current group based programme, allowing hundreds of thousands more patientsto develop the knowledge, understanding and confidence to make lifestyle changes to prevent or manage Type 2 diabetes, further strengthening X-PERT Healths educate not medicate philosophy.

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The educational content will be interactive and engaging, including animated videos, games and quizzes to support discovery learning in a fun and easy-to-use way. The digital programme will also include features such as real-time tracking for diet, physical activity, health results, medication requirement and mood and sleep helping users to manage and improve their lifestyle and health. This information can then be shared with the users healthcare professional as part of their regular check-up.

Users will also have continued support from a 24/7 chatbot; group chats; access to the X-PERT health forum, and the ability to book a call with an X-PERT Health coach. In addition, users will be able to access a large database of recipes, tailored for patients with Type 2 diabetes, and they will also be able to submit their own recipeswhich can be shared with other patients.

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X-PERT Health Founder, DrTrudi Deakin, said:

The X-PERT Programmes have reached and benefitted over 300,000 patients through collaborations with the NHS, for over a decade. We selected Pulse to help us seizethe opportunity in this digital age to overcome accessibility barriers to structured education by releasing a truly innovative means of delivering our evidence based programme at scale: X-PERT Health Diabetes Digital. This programme encompasses behaviour change philosophies, lifestyle change and state-of-the-art integrations and functionalities to meet the needs of the patients and improve overall health and wellbeing.

Pulse Chief Digital Officer,Leo Miller, added:

Were delighted to have been chosen to take X-PERT Healths diabetes education programme into the digital space, and we are very much looking forward to working together with the X-PERT Health team to support patients in preventing or managing Type 2 diabetes.

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Leading Digital Healthcare Agency, Pulse, Selected to Innovate Award-Winning Diabetes Education Programme - AiThority

ARLINGTON, Va., Jan. 15, 2020 /PRNewswire/ --The American Diabetes Association (ADA) announced formal endorsement of three bills aiming to reduce the high cost of insulin and prescription drugs: the Insulin Price Reduction Act, the Safe Step Act, and the Chronic Condition Copay Elimination Act. The three bills were analyzed using ADA's newly launchedEngagement Platform.

"More than 5,000 bills and resolutions are introduced annually into Congress, and if we want to truly help people with diabetes thrive, we must cut to the chase and make it clear which bills truly impact their lives," said Tracey D. Brown, CEO of the American Diabetes Association. "By focusing on the most important insulin and drug pricing bills and giving our community easy ways to communicate their views with Congress, we will elevate the conversation from words into meaningful action."

The Engagement Platform demystifies the political rhetoric of drug pricing policies for the diabetes community. In addition to providing easy-to-understand explanations of why the ADA supports various bills, it also empowers and equips people living with diabetes and their loved ones with the tools they need to spur Congress to action.

"As the Co-Chair of the Congressional Diabetes Caucus and the father of a type 1 diabetic, I applaud the American Diabetes Association's latest initiative to analyze and endorse bills that address the skyrocketing costs of insulin and other diabetes drugs," said U.S. Representative Tom Reed (R-NY). "We care about hearing from our constituents on issues that are important to themjust like these important bills. I look forward to working with the ADA on future bills that will provide relief to the diabetes community."

ADA carefully analyzes legislation using three guiding questions. The bills that have the most potential to change the course of diabetes care are highlighted on the Platform.

"It is critical that the broader diabetes community come together to advocate for legislation that will truly improve their lives," said Kelly Close, founder and co-Chair of the Board of the diaTribe Foundation. "As someone living with T1D for nearly 35 years, I am thrilled that the American Diabetes Association has taken this step to make understanding legislation easy for the more than 30 million of us in the diabetes community. Our voices matter and the ADA's new Platform will help ensure they are heard!"

Learn more about the Platform and make your voice heard on these bills and other legislation that will improve the lives of all those living with diabetes atdiabetes.org/advocacy/platform.

About the American Diabetes AssociationEvery day more than 4,000 people are newly diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

Contact: Alex Day, 703-253-4843press@diabetes.org

SOURCE American Diabetes Association

http://www.diabetes.org

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Bills Addressing Drug and Insulin Affordability Endorsed by American Diabetes Association - PRNewswire

Imbalances in glycemic control, blood pressure, and diuretic use between treatment and placebo arms could have biased the cardiovascular and renal outcomes of recent large trials in favor of the study drugs for treating type 2 diabetes, some experts assert.

The cardiovascular outcomes trials (CVOTs) were mandated by the US Food and Drug Administration in 2008 to ensure the safety of newer agents being developed for type 2 diabetes following the debacle of rosiglitazone.

Results from some of the CVOTs and other subsequent dedicated trials showing cardiovascular and renal benefits have influenced clinical guidelines for type 2 diabetes and led to FDA approval of additional indications for some of the drugs beyond glucose lowering.

In nearly all these manufacturer-funded trials of a number of drug classes dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors glycemia and blood pressure were not strictly controlled but were left to the discretion of the treating physician, although some studies did include "rescue criteria."

Now in an article recently published online in the Journal of Pharmaceutical Policy and Practice, Japanese researchers Rumiko Shimazawa, PhD, of the Department of Clinical Pharmacology at Tokai University School of Medicine, and Masayuki Ikeda, MD, point out that A1c levels were significantly higher in placebo groups than in treatment groups in all of the CVOTs.

Those imbalances, they argue, placed patients in the placebo groups at potentially higher cardiovascular risk and thereby biased the results in favor of the study drug.

"Reanalysis with adjustment for the [A1c] imbalance is absolutely indispensable for the correct evaluation of the CVOTs," Ikeda, of the Department of Medical Informatics at Kagawa University Hospital, Japan who had no disclosures told Medscape Medical News.

Similar views were expressed in 2018 by former Bristol-Myers Squibb investigators Simeon I. Taylor, MD, PhD, an endocrinologist now at the University of Maryland, Baltimore, and nephrologist Bruce R. Leslie, MD, now of Seventh Doctor Consulting, Princeton, New Jersey.

Taylor and Leslie additionally pointout that blood pressures were also imbalanced between the CVOT study arms.

And, Leslie told Medscape Medical News in an interview, those same imbalances as well as in diuretic use also occurred in more recent dedicated trials of the effect of SGLT2 inhibitors on kidney function and heart failure, including CREDENCE and DAPA-HF.

"The imbalance is baked into how these studies are done. Whether intentional or inadvertent, there's an imbalance," asserts Leslie, who owns stock in Bristol-Myers Squibb, Pfizer, and Lilly.

Asked for comment, Silvio Inzucchi, MD, director of the Yale Medicine Diabetes Center, New Haven, Connecticut, and a senior investigator for several of these trials, told Medscape Medical News: "It is extremely difficult to conduct a trial with absolutely equal A1c levels between the treatment groups when you allow an extra drug in one arm."

"So, all of the CVOTs have shown about a 0.4% to 0.7% difference [in A1c] between the groups, sometimes even more depending on the potency of the drug. To have equal A1cs in both groups, the study sites would have to assume complete responsibility for glucose management. That would be a much more complex and much more expensive study...It's also no longer a reflection of 'real-world' practice," he explained.

And in response to similar arguments about the imbalances made in a letter to the New England Journal of Medicine following publication of the renal results of the EMPA-REG Outcome trial with the SGLT2 inhibitor empagliflozin (Jardiance, Lilly/Boehringer Ingelheim),Inzucchi and two other EMPA-REG coauthors called the differences in glycemic and blood pressure control "subtle."

They write, "Treatment with SGLT2 inhibitors results in a reduction in hyperglycemia and blood pressure, and these effects may indeed have contributed to the improved outcome with empagliflozin."

"However, the magnitude and duration of the observed reductions are unlikely to fully account for the positive renal effects...it is more likely that the effects of empagliflozin on reducing intraglomerular hypertension played a more fundamental role than glycemic or hypertension control in mediating the renal effects," they state.

In their article, Shimazawa and Ikeda analyzed results from 12 CVOTs published through December 2018 that followed the FDA's 2008 guidance.

These included three studies of SGLT2 inhibitors (EMPA-REG OUTCOME, CANVAS, and DECLARE-TIMI 58),four of DPP-4 inhibitors (CARMELINA, EXAMINE, SAVOR-TIMI 53, and TECOS),and five of GLP-1 agonists (LEADER, SUSTAIN-6, HARMONY, EXCEL, and ELIXA).

In most of the trials, patients had a high risk of atherosclerotic cardiovascular disease (CVD) or established CVD with baseline A1c levels ranging from 7.2% to 8.7%.

All received active drug or placebo, but they weren't truly "placebo-controlled" trials, as additional glucose-lowering medications were allowed, Shimazawa and Ikeda point out.

There was significantly greater use of additional glucose-lowering drugs in the placebo groups of the 10 trials that reported such data.

But regardless of use of such additional medications, A1c levels were significantly higher in the placebo groups in all the trials, ranging in percentage point difference from 0.27 (in ELIXA) to 1.00 (in SUSTAIN-6).

And despite better glycemic control in the treatment groups, heart failure rates were higher in the treatment groups in EXAMINE and SAVOR-TIMI, leading to warnings regarding this on the labels of two DPP-4 inhibitors.

Ikeda told Medscape Medical News that it shouldn't be difficult to resolve the imbalance problem by adjusting for A1c, as the CVOT investigators "have the critical data of their own, and the post-hoc analyses with adjustment for the imbalance are elementary statistics."

In fact, he noted that this was actually done in one of the CVOTs, ELIXA, resulting in a loss of a significant advantage for lixisenatide in percent change in urinary albumin-to-creatinine ratio (from P = .004 to P = .07).

Leslie is less convinced that the imbalance in glycemic control would have made a major difference in cardiovascular outcomes, at least in the short-term.

"The duration of studies is relatively short. For 3- to 5-year follow-up it seems unlikely that differences in glycemic control can explain the cardiovascular benefit," said Leslie.

However, regarding the CVOTs and other major trials of SGLT2 inhibitors, Leslie said, "My belief is that the difference in outcomes is mostly due to blood pressure difference and diuretic use imbalance, which are intimately related."

He points to evidence including some of his own work that SGLT2 inhibitors have diuretic propertiesand that they enhance the renoprotective effects of reninangiotensinaldosterone system (RAAS) inhibitors by potentiating their antihypertensive and antiproteinuric actions.

Indeed, in a letter to the New England Journal of Medicine following publication of CREDENCE, which showed renal benefit for the SGLT2 inhibitor, Leslie and coauthor Leslie E. Gerwin, JD, of Princeton University, New Jersey, write: "In this trial, canagliflozin a drug with diuretic properties was administered to patients with diabetic kidney disease, nearly all of whom were receiving a [RAAS] inhibitor."

"In the placebo group, however, fewer than half the patients were taking diuretics," they pointout.

There was also a blood pressure imbalance in CREDENCE of 3.30 mmHg (systolic) and 0.95 mmHg (diastolic).

Leslie told Medscape Medical News that the same is true of the CVOTs of SGLT2 inhibitors, including CANVAS, EMPA-REG, and DECLARE TIMI 58, potentially influencing the heart failure outcomes.

"It was the same structure. Less than half of the placebo group was being treated with a diuretic at baseline, but all the treatment group patients got a diuretic [as well as] an SGLT2 inhibitor along with RAAS inhibitors," noted Leslie.

Thus, he said, "all the SGLT2 inhibitor CVOTs, as well as CREDENCE, contain an unbalanced therapeutic design...that leaves unanswered the question of whether the cardiovascular and renal benefits they describe can be reproduced by inexpensive generic thiazide diuretics."

In response to Leslie and Gerwin's letter, CREDENCE lead investigator Meg J. Jardine, MB, PhD, of The George Institute for Global Health, Sydney, Australia, and two coauthors replied: "Diuretics have not been shown to prevent kidney failure."

"The benefits observed in the CREDENCE trial were also consistent, regardless of baseline diuretic use, so we think it is unlikely that the diuretic effect explains the benefits of canagliflozin," they note.

Leslie commented, "Diuretics don't prevent kidney failure, but neither do SGLT2 inhibitors. They just slow it down, same as diuretics."

Inzucchi, who has multiple disclosures relating to the companies conducting these trials, told Medscape Medical News he disagrees with Leslie's assertion that the diuretic effects of SGLT2 inhibitors are the same as those of thiazide diuretics.

"I don't agree that SGLT2 inhibitors are 'just like thiazides.' They work in a totally different part of the nephron, and although they are relatively weak natriuretics, their effect on sodium excretion may be more sustained than with other diuretics," he said.

"This is perhaps because they inhibit sodium reabsorption proximal to the macula densa, so the resultant loss of urinary sodium and subsequent volume contraction does not appear to simulate the normal neurohormonal compensatory mechanisms like conventional diuretics that serve to attenuate efficacy over time. These hormonal changes increases in catecholamines, renin, aldosterone, and antidiuretic hormone may also have deleterious effects on the heart," he explained.

In addition, Inzucchi said, "Thiazides have never been shown to reduce heart failure hospitalizations or mortality as do the SGLT2 inhibitors. So the gliflozins may be unique diuretics."

And in response to another letter expressing concern about the glycemia and blood pressure differences in CREDENCE, Jardine and colleagues write: "Pooled analyses of intensive blood pressure and glucose lowering have not shown clear renal benefits, so these are also unlikely explanations, particularly given the modest differences between the two groups."

"The trial protocol encouraged investigators to deliver the best guideline-based care to patients according to blood pressure and glucose and lipid levels. None of these interventions (ie, the use of diuretics and intensive blood pressure and glucose lowering) has been shown to have benefits of the magnitude observed in the CREDENCE trial, despite multiple trials," they state.

In their letter regarding CREDENCE to the New England Journal of Medicine, Leslie and Gerwin suggesta clinical trial could be conducted comparing canagliflozin added to RAAS inhibition with a generic thiazide diuretic added to RAAS inhibition in patients with diabetic kidney disease and otherwise controlled hyperglycemia.

This, they argue, "could help to determine whether the renoprotective qualities of canagliflozin are anything more than those of an expensive diuretic."

And, as for the CVOTs, Leslie told Medscape Medical News he agrees with the Japanese researchers that post-hoc analyses could provide some answers.

With regard to the diuretic question, the sponsors could address the concern with the data they already have by performing a subanalysis comparing cardiovascular or renal outcomes for patients taking study drug without a concomitant diuretic to the outcomes for patients taking a diuretic and placebo.

"This sort of post-hoc analysis is not as pure as a prespecified one, but at least the data are readily available," said Leslie.

But of course, Leslie and Gerwin also note, the fact that the companies have no incentive to conduct such analyses "exemplifies a deficiency in the pharmaceutical regulatory system."

"Sponsors are not required to ascertain whether the results of [SGLT2 inhibitor] therapy and those of more cost-effective diuretic therapy might be similar," they conclude.

Ikeda has reported no relevant financial relationships. Leslie has reported owning stock in Bristol-Myers Squibb, Pfizer, and Lilly. Inzucchi has reported serving on clinical trial executive/steering/publications committees for AstraZeneca, Novo Nordisk, Boehringer Ingelheim, and Sanofi-Lexicon; advisory boards for AstraZeneca, Novo Nordisk, vTv Therapeutics, and Abbott/Alere; and has accepted lecture fees from Boehringer Ingelheim and Merck.

J Pharm Policy Pract. Published online November 18, 2019. Full text

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Have the Blockbuster Diabetes Drug Trials Been Biased? - Medscape

A new study helps illuminate how weight loss can contribute to the remission of type 2 diabetes and how putting pounds back on can cause the disease to return.

The findings, published in December 2019 in Cell Metabolism, suggest that individuals with type 2 diabetes who achieve remission after weight loss may relapse if they regain weight in part because this leads to an accumulation of fat in the liver.

Researchers examined data on 57 overweight and obese people with type 2 diabetes who participated in a prior study, which was published in March 2019 inThe Lancet Diabetes & Endocrinology. Those study authors goal was to see if following a low-calorie diet for three to six months would help participants lose at least 15 kilograms (about 33 pounds) and lower their blood sugar levels enough to achieve remission of diabetes. Researchers checked participants weight, blood sugar, and fat levels in the liver and pancreas after 5, 12, and 24 months.

After five months, 28 people achieved the targeted weight loss and diabetes remission. By the end of two years, however, 13 of them had relapsed. People who achieved lasting remission lost more weight initially, kept more weight off than those who relapsed, and had less fat in the liver and pancreas by the end of the study.

Excess calorie intake over many years will initiate vicious cycles of fat accumulation within both the liver and the pancreas that eventually causes diabetes, says lead study author Ahmad Al-Mrabeh, PhD, of Newcastle University in the England.

Decreasing liver fat can lead to remission of diabetes, Dr. Al-Mrabeh says. When you do, he adds, the liver stops sending out excess fat to the rest of the body, and therefore pancreas fat levels decrease.

RELATED: Study Suggests How Much Weight Loss Is Needed to Put Diabetes in Remission

Type 2 diabetes is a multifactorial disease, with genetics and lifestyle both contributing to risk. The disease is also associated with obesity and inactivity, and develops when the body cant effectively use the hormone insulin to regulate blood sugar, according to the World Health Organization. The pancreas produces insulin, and must increase production when the body doesnt use this hormone efficiently. Yet theres a limit to how much insulin the pancreas can make, and diabetes results when the pancreas can no longer keep up with the bodys insulin demands to keep blood sugar levels in check.

Left untreated, type 2 diabetes can increase the risk of kidney failure, heart attacks, strokes, blindness, lower limb amputations, and other potentially life-threatening complications.

Regular exercise, eating well, and maintaining a healthy weight can help prevent type 2 diabetes. These lifestyle habits can also help lower blood sugar and minimize complications when people do develop diabetes, according to the World Health Organization.

While weight loss has long been linked to diabetes remission, the current study offers fresh insight into how the two are related, says senior study author Roy Taylor, MD, also of Newcastle University.

When people cut calories, the body will get the energy it needs by burning up fat thats stored under the skin, Dr. Taylor says. By contrast, when people consume too much food, these fat stores fill up and then excess fat starts accumulating in the liver.

Excess liver fat will lead to higher supply of fat to all tissues, including the pancreas, Taylor says.

When fat builds up in the pancreas, this interferes with insulin production, making it harder for the body to regulate blood sugar and contributing to diabetes. When people achieve diabetes remission through weight loss, regaining weight can restart the process of fat accumulation in the liver, and then the pancreas, and lead to relapse, according to the study.

RELATED: Which Types of Diabetes Can Be Put in Remission?

At the start of the study, all of the participants tended to have higher A1Cs. A1C is a blood test used to diagnose diabetes and determine how well blood sugar is being controlled. It shows the percentage of hemoglobin (a molecule on red blood cells) that is coated with sugar, and reflects average blood sugar levels over two to three months. Readings above 6.5 signal diabetes, according to the Mayo Clinic.

People who never achieved remission in the study started out with more severe diabetes, with average A1C readings of 7.9, compared with average A1C readings of 7.4 among people who did experience remission.

Weight loss initially brought about similar reductions in the percentage of fat in the liver and pancreas for people who achieved diabetes remission, as well as for those who didnt.

After five months, people in remission had 3.4 percent liver fat compared with 2.6 percent in people who didnt achieve remission but this difference wasnt statistically meaningful.

Participants also experienced similar decreases in fat levels in the pancreas after five months: a decline of 0.91 percentage points among people who went into remission and 0.17 points for those who didnt. This difference also wasnt statistically meaningful.

By the end of the two-year follow up period, though, pancreatic fat levels had dropped by 1.65 percentage points among people with sustained remission and only 0.51 percentage points among those who didnt.

One limitation of the study is that it was small, and researchers based their two-year analysis on only 20 people who sustained remission and 13 people who relapsed.

Its also not clear from the study whether people took medication for diabetes, what they ate, or how much they exercised factors that can influence whether people achieve remission.

It would have been helpful if the study included more information about how weight loss was accomplished, says Sheri R. Colberg, PhD, professor emerita of exercise science at Old Dominion University in Norfolk, Virginia.

RELATED: 6 Great Exercises for People With Diabetes

The most important message is that people have to do whatever they can with their lifestyle to improve their insulin sensitivity, says Dr. Colberg, who wasnt involved in the study. Insulin sensitivity refers to how efficiently the body can use the hormone to convert sugars into energy.

Dietary restriction can help with this and insulin resistance decreases even before significant weight loss but weight regain is very common, Colberg adds. Both a low-carb diet and consistent workouts can help people with diabetes lose weight and lower blood sugar, she says.

But many people who rely on diet alone to maintain weight loss regain many of the pounds they lose, Colberg says. Exercisers, on the other hand, can keep weight off when they continue to be active.

Physical activity is likely the most important way to keep muscles insulin sensitive and to avoid excess carbs being converted into fat and stored in the liver and pancreas, Colberg says.

RELATED: 7 Exercise Motivation Tips for People With Type 2 Diabetes

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Study Sheds Light on How Fat Loss Can Put Type 2 Diabetes in Remission - Everyday Health

All those who suffer from type 2 diabetes are in a constant tug of war with their blood sugar levels (in other words, blood glucose). Managing the condition requires being mindful of what you eat and drink. When you crave a little bit of sweetness in your life, research has shown that theres a certain sweetener that can help control blood sugar levels.

Dr Grace Farhat, a lecturer from Liverpool Hope University in food science and nutrition, revealed: Stevia a naturally-occurring sweetener could be a new player against obesity and diabetes.

Stevia is a plant-based alternative to sugar that has been used by the indigenous people of South America for thousands of years.

Previous studies have suggested certain non-nutritive (also known as artificial) sweeteners may increase appetite while also altering the make-up of the gut bacteria, resulting in several human conditions such as obesity and diabetes, added Dr Farhat.

In her experiment, test subjects were asked to drink either plain water, water mixed with 60g of sugar, or water mixed with just 1g of stevia sweetener (a non-nutritive sweetener), before having an unlimited pizza lunch half an hour later.

We wanted to see if stevia led to people eating more, because thats the presumption when theres sweetness without the calories, said the doctor.

The non-nutritive sweetener (stevia) adds a sweetening effect without adding carbohydrates or calories.

But what we found was that there was no difference in food intake between stevia, water or sugar, continued Farhat.

READ MORE: High blood pressure: Five potassium rich foods which could help lower your reading

People ate the same amount of food after these different preloads.

This finding suggests stevia doesnt increase your appetite to compensate for the lack of calories, like some other sweeteners.

Whats also important, added Farhat, is to note that those who consumed stevia were less hungry than when they just had plain water.

It shows we can reduce hunger without the need for consuming more calories.

And thats important, because if were going to control diabetes and obesity we need to control appetite and blood sugar levels.

Results such as these reveal that consuming stevia will help prevent people from overeating and consuming more carbohydrates which affects blood sugar levels.

With the NHS spending 14 billion each year - 10 percent of its overall budget - treating diabetes and its complications, and an estimated 1.2 million increase in the number of people suffering from the condition by 2030, this breakthrough study gives a glimmer of hope to more easily controlling blood sugar levels.

Dr Farhat added: While further studies are needed, our research shows stevia could be a promising option when it comes to controlling energy intake.

Therefore, it could have a beneficial effect when it comes to obesity and diabetes.

Published in the journal Nutrients, Dr Farhat concluded: Stevia lowers appetite sensation and does not further increase food intake and post-lunch glucose levels.

It could be a useful strategy in obesity and diabetes prevention and management.

Diabetes UK has reported that stevia is 200300 times sweeter than sugar and is heat stable, so it can be used in cooking and baking.

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Type 2 diabetes: This popular sugar-alternative could be key weapon in fighting condition - Express

TWO JOES is a fan book about two of The Three Stooges, Joe Besser and Joe DeRita, who stepped into the madcap act many years after it first debuted. Besser arrived in 1955 after the death of an original Stooge, and DeRita followed Besser 15 years later.

The two Joes longevity echoes what researchers found in a study published in the Journal of Internal Medicine. The study indicated that consuming two cups of filtered Joe daily over a seven-year period slashed a persons risk of Type 2 diabetes by 60% compared with folks who drank less than a cup of filtered coffee daily!

Seems coffee brewed with filter paper strains out a chemical diterpenes that raises levels of lousy LDL cholesterol. Boiled, drip, French press and espresso brews dont offer the anti-diabetes, heart-friendly benefit.

This finding comes after a 2013 study in Diabetologia that showed folks who reduced their coffee intake by a cup or more a day over a four-year period upped their risk for Type 2 diabetes by 17%.

Other health benefits of coffee, say physicians from Johns Hopkins Medicine, include a reduced risk for Parkinsons disease, heart failure, colon cancer, Alzheimers disease and stroke, and healthier kidneys and liver.

So enjoy two or more cups daily, if you can do it without experiencing a headache, gastric upset, an abnormal heartbeat or anxiety within an hour of drinking a cup. (Decaf provides some of coffees health boosters.) But stay clear of sugary, fatty additives that negate coffees benefits.

Mehmet Oz, M.D., is host of The Dr. Oz Show, and Mike Roizen, M.D., is chief wellness officer and chairman of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into The Dr. Oz Show or visit http://www.sharecare.com.

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Drs. Oz & Roizen: Fight your diabetes risk with filtered coffee - The Union Leader

The worst result, after buying shares in a company (assuming no leverage), would be if you lose all the money you put in. But if you buy shares in a really great company, you can more than double your money. For instance the Tandem Diabetes Care, Inc. (NASDAQ:TNDM) share price is 164% higher than it was three years ago. Most would be happy with that. It's also up 11% in about a month.

See our latest analysis for Tandem Diabetes Care

Because Tandem Diabetes Care made a loss in the last twelve months, we think the market is probably more focussed on revenue and revenue growth, at least for now. Generally speaking, companies without profits are expected to grow revenue every year, and at a good clip. That's because fast revenue growth can be easily extrapolated to forecast profits, often of considerable size.

Over the last three years Tandem Diabetes Care has grown its revenue at 51% annually. That's well above most pre-profit companies. Meanwhile, the share price performance has been pretty solid at 38% compound over three years. This suggests the market has recognized the progress the business has made, at least to a significant degree. That's not to say we think the share price is too high. In fact, it might be worth keeping an eye on this one.

You can see how earnings and revenue have changed over time in the image below (click on the chart to see the exact values).

NasdaqGM:TNDM Income Statement, January 15th 2020

We're pleased to report that the CEO is remunerated more modestly than most CEOs at similarly capitalized companies. But while CEO remuneration is always worth checking, the really important question is whether the company can grow earnings going forward. This free report showing analyst forecasts should help you form a view on Tandem Diabetes Care

We're pleased to report that Tandem Diabetes Care shareholders have received a total shareholder return of 53% over one year. That certainly beats the loss of about 12% per year over the last half decade. The long term loss makes us cautious, but the short term TSR gain certainly hints at a brighter future. While it is well worth considering the different impacts that market conditions can have on the share price, there are other factors that are even more important. To that end, you should be aware of the 1 warning sign we've spotted with Tandem Diabetes Care .

But note: Tandem Diabetes Care may not be the best stock to buy. So take a peek at this free list of interesting companies with past earnings growth (and further growth forecast).

Please note, the market returns quoted in this article reflect the market weighted average returns of stocks that currently trade on US exchanges.

If you spot an error that warrants correction, please contact the editor at editorial-team@simplywallst.com. This article by Simply Wall St is general in nature. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. Simply Wall St has no position in the stocks mentioned.

We aim to bring you long-term focused research analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Thank you for reading.

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Announcing: Tandem Diabetes Care (NASDAQ:TNDM) Stock Increased An Energizing 164% In The Last Three Years - Yahoo Finance

Concenter Biopharma of Jerusalem is developing a drug to treat and even prevent type 2 diabetes by restoring the bodys insulin sensitivity.

ByAbigail Klein Leichman, ISRAEL21c

Of the 463 million people in the world with diabetes, up to 95 percent have type 2 (T2D). In T2D, peripheral cells mostly muscles are resistant to insulin, a hormone made by the pancreas to stabilize blood-sugar levels and enable the body to use and store sugar from carbohydrates in food.

Medications available today treat the symptoms and complications of T2D but do not solve the core problem of insulin resistance.

Zygosid-50, a drug under development in Israel, could be the first to restore near-normal cellular sensitivity to insulin, without side effects.

Concenter BioPharmain Jerusalem is raising funds for clinical trials approved by the FDA based on evidence from earlier testing in animal models for T2D.

In December, Concenter Biopharma cofounder and CSO Prof. Mottie (Mordechai) Chevion won first place at the 17th Annual World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease.

The World Congress attracts the top researchers and clinicians, who understand the problem and the limited solutions available which arent really solutions at all, says Concenter Biopharma CEO Dror Chevion, Motties son.

To receive the award out of 80 submitted abstracts and six chosen for presentation is a real vote of confidence in our science and our achievements, Dror Chevion tells ISRAEL21c. The people sitting in that conference will be the ones prescribing our drug to patients.

Mottie Chevion developed the nonsteroidal, anti-inflammatory Zygosid family of drugs in his lab at Hebrew University-Hadassah Medical Center in Jerusalem.

Zygosids work by robustly reducing insulin resistance and normalizing all diabetes-associated parameters to the normal range, says the professor. On the molecular level, Zygosid-50 is a potent anti-inflammatory drug that forces an intra-cellular exchange removal of bad free iron with zinc, depositing the zinc ion within the cells.

In 2015, some of the lab staff and their families successfully tried using Zygosid molecules topically for skin conditions including diabetic foot ulcers and psoriasis. They experienced no negative side effects.

My father felt it was inhumane not to try to bring these drugs from the lab to patients. He asked me to join him and take this initiative forward, says Dror Chevion.

The intellectual property was licensed to the inventors through the university andhospital tech-transfercompanies.Silkim Pharma was set up as a holding company for the IP. Concenter Biopharma was founded as a subsidiary in 2019 to further develop and commercialize Zygosid-50 for treating and preventing T2D.

Concenters U.S. regulatory consultant, Dr. Susan Alpert, arranged meetings with the FDA in 2017 and 2018 to help determine which indication to focus on. The conclusion was to start with T2D and conduct clinical phase 1 and phase 2 trials in Israel while finalizing the pill formulation and preclinical toxicity studies.

One in three people in the world is diabetic or prediabetic, says Dror Chevion. The number is expected to reach 700 million by 2045. In the United States, 31 million people suffer from diabetes and 90 million are prediabetic. And the age of people with type 2 diabetes is getting younger and younger.

In animal trials, Zygosid-50 restored insulin sensitivity by over 90%, bringing blood sugar into balance and lowering chronic and systemic inflammation levels. The drug also replenishes zinc deficiency.

The FDA responded to Concenters investigational new drug (IND) application with a request for additional preclinical toxicity studies and more information on the drugs manufacturing process.

This is a great achievement for a small company, notes Dror Chevion.

We are working on a plan to accommodate those requests and to make the final formulation of the drug as a pill. We want to perform clinical studies here in Israel. Then we will submit another IND application to go to phase 2b, by the end of 2020. We are currently raising funds to do all of that.

Concenter was self-funded until six months ago. The company will launch a $5 million round for its T2D activities during 2020.

Concenter BioPharmas scientific advisory board includes three globally recognized diabetes experts: Dr. Peter Nawroth of Germany, Dr. Ralph DeFronzo from the United States, and Dr. Itamar Raz, chairman of the Israeli Council on Diabetes and the National Diabetes Prevention and Care Plan.

Diabetes is a global epidemic and is expected to grow, says Dror Chevion. The estimated cost of treating diabetes per year is over $850 billion. More than 150 companies are developing diagnostics or applications for diabetes, but there are no drugs to treat the actual problem of insulin resistance without side effects. This is what we are doing.

diabetesHebrew University-Hadassah

Read the original:
This Jerusalem pill can fix the root cause of diabetes - World Israel News

When a stranger at a party told Tom Watson he thought he had diabetes, he was horrified.

But even after being officially diagnosed with Type 2 diabetes, it took years for Tommy Two-Dinners to change his life.

A landmark birthday was the final straw for the former MP and Deputy Leader of the Labour Party and the start of a new regime which led to him losing a whopping eight stone.

Here, in an exclusive extract from his new book Downsizing, he reveals how...

I celebrated my 50th birthday on January 8, 2017 with a huge knees-up.

I booked brilliant covers band Rockaoke, laid on a free bar for the first hour or so and put on a giant buffet of my favourite sweet and savoury treats - the centrepiece an enormous cake in the shape of a large grey robot sporting my signature black-framed glasses.

The following morning I woke nursing the mother of all hangovers. Half of me felt elated because the party had gone so well but the other half felt sad and solemn.

The reality of my midlife milestone had finally started to sink in.

All my fifty-something contemporaries at the party, to a man and a woman, looked fitter, slimmer and younger than me. FIFTY AND FAB! proclaimed a birthday card. FIFTY AND FAT, more like, Id thought as Id opened it.

A voice seemed to float up from my subconscious. I dont want to die. I really dont want to die.

At well over 22 stone - the heaviest Id ever been perhaps premature death was an inevitability though.

Morbid thoughts began to swirl around my head the prospect of leaving my beloved kids fatherless; being unable to see Malachy and Saoirse grow up; never meeting my grandchildren and I felt my eyes brimming with tears.

Its time, Tom, continued the voice. Enough is enough. If you dont address your weight, you are actually going to die...

I reached for a notebook and pen and wrote three words: Project Weight Loss.

Monday August 7, 2017 was Day One. It was, at last, time for me to regain control.

I turned up a few minutes early for my first appointment with personal trainer Clayton, feeling anxious and self-conscious. I looked colossal in my new sports gear even the XXXL kit was a pretty snug fit.

First of all, Clayton asked me to do as many press-ups as I could. I could barely manage one the utter shame and collapsed in a pathetic heap.

But my desire to get healthy superseded any sense of indignity, and as I virtually crawled back home I felt a genuine feeling of elation.

Claytons session had almost killed me but I was going to return for more of the same. The switch had been flicked.

Determined to curb my long-term sugar addiction, I made a concerted effort to omit sugary carbohydrates from my diet (so no cakes, biscuits or chocolates) and I tried my best to limit starchy carbs like bread, rice, pasta and potatoes. I endeavoured to drink more water and eat more vegetables, and try to make more home-cooked meals.

The morning after my inaugural workout, I tackled a job that had desperately needed doing for months: a wholesale clear-out of my little kitchen.

This meant bidding farewell to sweet snacks (goodbye, my beloved KitKats) as well as my favourite breakfast cereals and muesli bars. Nothing remotely sugary was spared the cull.

Even many of the supposedly savoury convenience foods were laden with sugar (61.2g in a supermarket sweet n sour chicken, no less), so into the bin went a stack of microwaveable meals, shrink-wrapped frozen pizzas, tubs of instant noodles and jars of cooking sauces.

Then it was time to clear the fridge of Guinness and Coca-Cola: the drinks Id swigged more than any other in my lifetime, but which had no doubt contributed to my health problems.

I returned to Westminster in early September, following the parliamentary recess, eating more healthily, exercising more regularly and sleeping more soundly.

Then I was introduced to the low-carb, high-fat philosophy of so-called ketogenic nutrition which comprised meat, poultry, fish, dairy products, oils and vegetables. All manner of starchy carbohydrates (pasta, rice, grains and potatoes, for example) were strictly forbidden, as were sugary carbs in all their many guises.

In the first week of October I decided to fully embrace a ketogenic diet.

Id restrict starchy carbohydrates to around 20g per day and opt instead for protein-rich foods plenty of red meat, poultry, fish and dairy in addition to low-sugar fruits and vegetables like blueberries and broccoli.

To combat sugar withdrawal cravings and stop myself feeling hungry, Id increase the amount of saturated fat in my diet (including butter, cheese and double cream).

Alcohol would be strictly limited to the occasional glass of dry white wine or a vodka and low-sugar tonic.

I remember sitting down and formulating a meal plan for the week before heading off to Tesco.

Into the trolley went lamb chops, salmon steaks, chicken thighs, leafy greens and mixed salad for my main dishes. Then, for desserts, I grabbed punnets of blackberries and raspberries (both had lower fructose levels) as well as tubs of full-fat Greek yoghurt and double cream.

For snacking, I stocked up on my favourite hard and soft cheeses, and threw in a few large bags of unsalted walnuts and macadamia nuts.

My first day on the diet was Monday October 9 2017. For breakfast, I ate a two-egg omelette, with two rashers of fried bacon cooked in butter. Lunch comprised scrambled egg, again with two rashers of bacon (I still couldnt quite believe that two of my favourite foodstuffs were part of a diet).

My snack quota comprised a small handful of nuts and, when I felt a serious hunger pang, a few blackberries with double cream.

Later that day I went out for dinner with friends. That evening I eschewed my regular order of chicken dhansak, tarka dhal and peshwari naan, instead opting for tandoori chicken and a small serving of saag paneer (a tasty dish of Indian cheese with spinach puree).

As my first day on keto came to a close, my stomach felt pleasantly full. I hadnt suffered any energy slumps and had genuinely enjoyed the food Id eaten.

On days four, five and six I did experience some cravings, yet I always managed, somehow, to quell the hunger pangs by gulping down a big dollop of thick double cream. I would be lying, though, if I said this felt like a normal thing to do.

By the beginning of Keto Week Two I was waking up feeling absolutely bloody brilliant. The general malaise that used to greet me when my alarm went off aching joints, sore back, banging head, breathlessness simply disappeared.

Initially I had shed nearly two stone in two months. But when I applied strict ketogenic nutrition principles I began to see remarkable results.

After just one week, I lost seven pounds. I was totally and utterly elated. This may sound melodramatic but, apart from the birth of my kids, it was the best week of my life.

Technically, once the NHS tells you youre a type 2 diabetic, youre always a type 2 diabetic. But in January 2018, a blood test indicated Id put my type 2 diabetes into remission.

On Monday 10 June, 2019 I hit my eight-stone weight-loss target, just under two years after commencing my diet and fitness plan.

Though delighted to have shed every one of those 112 pounds I found myself being dogged by a deeper question.

If I hadnt lost that eight stone, would I still be alive today?

View original post here:
Labour heavyweight Tom Watson on how he lost 8 stone and reversed Type-2 diabetes - Mirror Online

Quin is designed to help diabetic people manage their insulin intake more efficiently. Credit: Quin

Quin chief technology officer Isabella Degen has been managing her diabetes with insulin for 26 years, and co-founded Quin five years ago. A portmanteau for Quantifying Intuition something, the companys website notes, that people who take insulin have to do several times a day the app is designed to help diabetic people manage their insulin intake more efficiently.

The app tracks many different factors, such as food and insulin intake, alongside data from diabetes devices and phones, to help patients decide how much insulin to take and when based on their past experience. Instead of being locked into a constant guessing game, app users can pull up an objective assessment of how different insulin doses have previously affected them in different circumstances, to make a more educated assessment of what the best course of action will be for them.

Unlike similar health management apps, which use an algorithm to correlate the input of all users data into a single consistent average, Quins management techniques are based entirely on a patients own data crucial when it comes to managing a condition as individualised as diabetes. Chloe Kent spoke to Degen about how the app works and where the company hopes to see it head in 2020.

Chloe Kent: How does the Quin app work?

Isabella Degen: The app works observes the trial and error of people who take insulin. They tell us when they eat something and tell us how much insulin theyre taking. The app itself is observing in the background how active they are, what time it is, things like location and menstruation and other stuff we can observe about them from the phone. Quin is essentially taking all that information and breaking it down.

Lets say youve had 100 lattes, and every time youve had a latte youve logged that and said which insulin youve taken. Sometimes you may have taken it ten minutes earlier, sometimes later, and you take one to five units depending on what else is going on. The next time you come and say okay, Im going to have a latte right now, Quin is looking to show you past decisions that worked well for you when having a latte and that match you right now, so the user can make a much more informed decision.

CK: Why does diabetes management need such individualised data?

ID: Diabetes is an umbrella term of high blood glucose. People are diagnosed with Type I and Type II, but these are umbrella terms as well. One person takes one unit of insulin with a latte but another may have a very different result to that. Our bodies are fundamentally different. For that reason we only look at remembering a single persons outcomes and what they do.

We do have a second part of our business model. Between all this different customer data, were interested in seeing whether we can tell just by looking at what people do and the outcomes they achieve if there are groups of people who have very similar ways of treating diabetes? They perhaps have a more similar base of whats broken in the endocrine or metabolic system. We can then work with researchers to further target these subgroups so we can get more targeted treatment.

CK: How does Quin compare to an artificial pancreas type system?

ID: Its actually a very different approach. Quin focuses on people who take insulin using multiple-dose injection therapies, and the artificial pancreas is for people who use a pump. And really, there is no artificial pancreas on the market, were talking about products that take over autoregulation of insulin at certain points in time. Thats had immense regulatory challenges because nobody knows how much insulin to take.

Its very hard to recommend insulin doses. What we are doing is essentially saying lets learn from people in self-trials to get us to a point where were able to close the loop.

CK: How can Quin change the life of a diabetic patient?

ID: Our vision is that they become more confident. They can see something theyve achieved in the past that they should be able to achieve again, because the data is personal to them and not just averages across many people which may not be relevant. Its hard to set confidence on what works or not, so the next step is just to release the burden.

Taking a drug where nobody knows how much of it to take, its quite stressful. To not have to do all the thinking and the fine tuning, to think what should I do at this time or to even remember to make a decision, reduces the burden so that they can focus on what they want to focus on in their life.

CK: What sort of user feedback have you had so far?

ID: We did a questionnaire in our user base and 76% said theyre more relaxed and more confident, and 35% have said that they have improved outcomes. On the medical side theyve learned more about how insulin works they can see that their blood sugar is still high, but they can also see that theyve taken insulin and know its going to come down, so I think thats where the confidence comes from.

CK: How can people access Quin?

ID: Right now we have a closed research project, so people can apply through the site to participate if they own the right kit and theyre on a treatment that we support at the moment. We give them access to a version of Quin that changes every month, and then we work together with these users to give us feedback.

CK: Where do you see Quin heading once youre out of the test stages?

ID: Were planning to do a launch of the app in late 2020, which will then become available via the App Store. It will be a subscription-based business model, initially paid for directly by the customer but maybe also picked up by insurers in the future. Were launching geographically in the CE mark [region], and were looking at getting FDA approval in the middle of this year.

Excerpt from:
Quin's diabetes management app is taking anxiety out of the equation - Medical Device Network

Young people with diabetes are at greater risk than peers without the disease of developing mental health problems or attempting suicide as they transition into adulthood, a Canadian study suggests.

Based on data for more than 1 million young people born in Quebec, researchers found that being diagnosed with diabetes is associated with increased odds of being diagnosed in an emergency room or hospital with a mood disorder like depression. Its also linked to higher odds of being admitted to a hospital for a suicide attempt, according to the report in Diabetes Care.

Between the ages of 15 and 25, adolescents and young adults with diabetes are 325% as likely to attempt suicide as their same-age peers, and 133% as likely to suffer from a mood disorder, said Dr. Marie-Eve Robinson, a pediatric endocrinologist at the Childrens Hospital of Eastern Ontario, in Ottawa, Canada, who led the study.

Past research has explored risks for psychiatric disorders in individuals with and without type-1 diabetes, Robinson and her colleagues write in Diabetes Care, but the risks during the transition from adolescence to adulthood have not been assessed.

In addition to challenges inherent to adolescence, young adults with diabetes who transition to adult care need to adapt to a new adult-care provider and a treatment facility, Robinson told Reuters Health.

Young adults tend to perceive pediatricians as more family-centered and less formal compared to adult-care providers and this can sometimes make the transition difficult, she explained.

Type-1 diabetes, formerly known as juvenile diabetes, occurs when the pancreas makes little or no insulin; the disease typically emerges in childhood or adolescence. Type-2 diabetes, the more common form of the illness, is associated with aging and overweight and occurs when the body becomes less responsive to insulin.

Young people with type-1 diabetes must also take full responsibility for managing their diabetes, Robinson said, which includes injecting insulin multiple times a day, monitoring their glucose and paying close attention to diet and physical activity.

This can be overwhelming, especially when their previous caregivers were providing significant support during childhood and adolescence.

To assess the mental health toll of these burdens, the researchers used Quebec registries to identify people born between April 1982 and December 1998 without any mental illness diagnosed before age 15. The final analysis included 3,544 adolescents diagnosed with diabetes between ages 1 and 15, and nearly 1.4 million young people without diabetes.

The study team followed the youths from age 15 to 25 and found that in addition to increased risks for a mood disorder diagnosis or a suicide attempt, youth with diabetes were almost twice as likely to visit a psychiatrist, compared to peers without diabetes.

With diabetes, young people also had a 29% higher risk of being diagnosed with any psychiatric disorder. However, there were no differences between the groups in schizophrenia diagnoses.

Even without a diagnosis of diabetes, there is a lot of anxiety and depression nowadays in the adolescent population, said Dr. Anastassios G. Pittas, co-director of the Diabetes and Lipid Center, at Tufts Medical Center in Boston.

To be diagnosed, on top of that, with a chronic, incurable medical condition that affects essentially every minute of ones life has a huge impact, Pittas, who was not involved in the current study, told Reuters Health in a phone interview.

However, depending on the age of the child, a major medical diagnosis need not always have a negative impact, he added.

For Pittas, one major limitation of the study was the large range in ages at which diabetes was diagnosed, and he would have liked to see if there were differences in mental health risk on that basis.

Children diagnosed with diabetes at age 1 or 2 do not know life without diabetes, said Pittas, adding that kids diagnosed before ages 7 or 8 tend to do better than those diagnosed in the middle of adolescence.

Even so, the study authors note in their report, endocrinologists who treat young adults rarely receive a patients psychosocial summary as part of their referral documents from their pediatric colleagues.

As children with diabetes will inevitably transfer to adult care, pediatric and adult healthcare providers should be aware of the increased risk of developing mental health problems, Robinson said.

SOURCE: bit.ly/2uvRfH0 Diabetes Care, online December 16, 2019.

Originally posted here:
Suicide rates sharply higher than average in teens, young adults with diabetes - Reuters

TULSA, Okla. A medication keeping people alive costs too much to do just that.

The price for insulin is skyrocketing, which forces some diabetics to choose between their health or paying other bills.

One woman is working to change that. Megan Quickle is a diabetes advocate and lives with type 1 diabetes.

"People are dying because they can't afford their insulin. People are rationing their insulin, they're using less than they should be and it's taking a tremendous toll on their diabetes. This is not ok."

No one seems to know why insulin is so expensive, but the American Diabetes Association blames the complicated supply chain.

A lot of hands are involved, and many factors impact how much patients pay, including the amount and type of insulin, the delivery system used, and whether insurance is involved.

It's kind of a circle, loop that people are just pointing the finger at different people."

The A.D.A. calculates, more than 30 million Americans live with diabetes.

Quickle says lawmakers are working on a bill, but that it will only help a few dealing with this disease. She hopes state lawmakers will draft and pass an insulin affordability bill for all soon.

"If we are all using our same voice and advocating our government, saying, 'This is unacceptable,' maybe they'll listen to us."

There are ways to get cheaper insulin through different company programs like the Lily Diabetes Solution Center or Novo Nordisk . Patients are also encouraged to ask their pharmacies of any a rebate program.

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Link:
Tulsa diabetes advocate: 'People are dying because they can't afford their insulin.' - kjrh.com

Often referred to as the king of fruits, mango (Mangifera indica) is one of the most beloved tropical fruits in the world. Its prized for its bright yellow flesh and unique, sweet flavor (1).

This stone fruit, or drupe, has been primarily cultivated in tropical regions of Asia, Africa, and Central America, but its now grown across the globe (1, 2).

Given that mangoes contain natural sugar, many people wonder whether theyre appropriate for people with diabetes.

This article explains whether people with diabetes can safely include mango in their diets.

Mangoes are loaded with a variety of essential vitamins and minerals, making them a nutritious addition to almost any diet including those focused on improving blood sugar control (3).

One cup (165 grams) of sliced mango offers the following nutrients (4):

This fruit also boasts small quantities of several other important minerals, including magnesium, calcium, phosphorus, iron, and zinc (4).

Mango is loaded with vitamins, minerals, and fiber key nutrients that can enhance the nutritional quality of almost any diet.

Over 90% of the calories in mango come from sugar, which is why it may contribute to increased blood sugar in people with diabetes.

Yet, this fruit also contains fiber and various antioxidants, both of which play a role in minimizing its overall blood sugar impact (2).

While the fiber slows the rate at which your body absorbs the sugar into your blood stream, its antioxidant content helps reduce any stress response associated with rising blood sugar levels (5, 6).

This makes it easier for your body to manage the influx of carbs and stabilize blood sugar levels.

The glycemic index (GI) is a tool used to rank foods according to their effects on blood sugar. On its 0100 scale, 0 represents no effect and 100 represents the anticipated impact of ingesting pure sugar (7).

Any food that ranks under 55 is considered low on this scale and may be a better choice for people with diabetes.

The GI of mango is 51, which technically classifies it as a low GI food (7).

Still, you should keep in mind that peoples physiological responses to food vary. Thus, while mango can certainly be considered a healthy carb choice, its important to evaluate how you respond to it personally to determine how much you should include in your diet (8, 9).

Mango contains natural sugar, which can contribute to increased blood sugar levels. However, its supply of fiber and antioxidants may help minimize its overall blood sugar impact.

If you have diabetes and want to include mango in your diet, you can use several strategies to reduce the likelihood that it will increase your blood sugar levels.

The best way to minimize this fruits blood sugar effects is to avoid eating too much at one time (10).

Carbs from any food, including mango, may increase your blood sugar levels but that doesnt mean that you should exclude it from your diet.

A single serving of carbs from any food is considered around 15 grams. As 1/2 cup (82.5 grams) of sliced mango provides about 12.5 grams of carbs, this portion is just under one serving of carbs (4, 10).

If you have diabetes, start with 1/2 cup (82.5 grams) to see how your blood sugar responds. From there, you can adjust your portion sizes and frequency until you find the amount that works best for you.

Much like fiber, protein can help minimize blood sugar spikes when eaten alongside high carb foods like mango (11).

Mango naturally contains fiber but isnt particularly high in protein.

Therefore, adding a protein source may result in a lower rise in blood sugar than if you were to eat the fruit by itself (11).

For a more balanced meal or snack, try pairing your mango with a boiled egg, piece of cheese, or handful of nuts.

You can minimize mangos impact on your blood sugar by moderating your intake and pairing this fruit with a source of protein.

Most of the calories in mango come from sugar, giving this fruit the potential to raise blood sugar levels a particular concern for people with diabetes.

That said, mango can still be a healthy food choice for people trying to improve blood sugar control.

Thats because it has a low GI and contains fiber and antioxidants that may help minimize blood sugar spikes.

Practicing moderation, monitoring portion sizes, and pairing this tropical fruit with protein-rich foods are simple techniques to improve your blood sugar response if you plan to include mango in your diet.

See more here:
Is It Safe to Eat Mango If You Have Diabetes? - Healthline

Patients on the road to recovery from type 2 diabetes

MONTREAL , Jan. 13, 2020 /CNW/ - What if you were told you could reverse the course of type 2 diabetes through exercise and a healthy diet? That was the challenge this past year for patients at the Montreal Heart Institute's Diabetes Prevention Clinic supported by Sun Life Financial. The health team is thrilled with the progress achieved by its 180 participants during the clinic's first year.

"These are impressive results after just one year!I congratulate the patients who undertook this challenge and I thank the clinic's health care professionals who've helped guide them on their road to recovery," said Jacques Goulet , President of Sun Life Canada. "With so many Canadians affected by diabetes, Sun Life is committed to fighting the disease and its potentially serious complications. This initiative aligns with our purpose, which is to help our Clients achieve lifetime financial security and live healthier lives. "

"Lifestyle is better than medication for treating diabetes, and doesn't involve the side effects frequently associated with medication. The clinic delivers the best tools to patients, so they can minimize complications related to their disease," said Dr. Martin Juneau , Director of Prevention at the Montreal Heart Institute and Diabetes Prevention Clinic supervisor.

A multidisciplinary team of health practitioners meets periodically with participants and gives them the tools they need to make healthy lifestyle changes and improve their health. This multidisciplinary program is offered at the Montreal Heart Institute's EPIC Center, thanks to a donation of $450,000 from Sun Life.

A tailored program to meet growing demandThe Diabetes Prevention Clinic's mission is to turn the tide on diabetes through early detection and healthy lifestyle strategies. This program meets a growing demand for preventive services for patients with diabetes and prediabetes, chronic conditions currently affecting 1 in 3 Canadians. Cardiovascular disease is the most common complication and leading cause of death in patients with type 2 diabetes1. Fortunately, many studies show that type 2 diabetics who make lifestyle changes, including a high-quality diet, regular moderate-to-vigorous physical activity, no tobacco use and moderate alcohol consumption, reduce their risk of premature death from cardiovascular disease.

Diabetes is the 5th-leading cause of premature death in the world. Hyperglycemia from the onset of diabetes has multiple adverse effects on cardiovascular risk factors, including atherosclerosis, hypertension and dyslipidemia. These issues, together with the damage hyperglycemia causes to small blood vessels, mean type 2 diabetes increases the incidence of coronary heart disease by 2 to 4 times2.

Sun Life in the community At Sun Life, we are committed to building sustainable, healthier communities for life and we're proud to hold the Caring Company designation from Imagine Canada. Community wellness is an important part of our sustainability commitment and we believe that by actively supporting the communities in which we live and work, we can help build a positive environment for our Clients, Employees, advisors and shareholders. Our philanthropic support focuses on two key areas: health, with an emphasis on diabetes awareness, prevention, care and research initiatives through our Team Up Against DiabetesTM platform; and arts and culture, through our award-winning Making the Arts More AccessibleTM program. Since 2012, Sun Life has committed $31 million globally to support diabetes awareness, prevention, care and research initiatives. In Quebec our sponsorship and donation initiatives also focus on home economics and financial education.

We also partner with sports properties in key markets to further our commitment to healthy and active living. Our Employees and advisors take great pride in volunteering over 29,000 hours each year and contribute to making life brighter for individuals and families across Canada .

About the Montreal Heart InstituteFounded in 1954, the Montreal Heart Institute constantly aims for the highest standards of excellence in the cardiovascular field through its leadership in clinical and basic research, ultra-specialized care, professional training and prevention. It houses the largest cardiovascular research center in Canada , the largest cardiovascular prevention center in the country, and the largest cardiovascular genetics center in the country. The Institute is affiliated with the University of Montreal and has more than 2,000 employees, including 245 doctors and more than 85 researchers.

Story continues

About the Montreal Heart Institute FoundationFounded in 1977, the Montreal Heart Institute Foundation raises and administers funds to support the Institute's priority and innovative projects and fight cardiovascular diseases, the world's number one cause of mortality. Its philanthropic events and the contributions of its donors have enabled this leading cardiovascular health care organization to become the largest cardiac research centre in the country. Since its creation, the Foundation has raised more than $283 million in donations. Its 27,514 donors helped make important discoveries and support specialists, professionals and researchers of the Institute to provide care at the cutting edge of technology to tens of thousands of patients in Quebec .

About the EPIC CenterThe MHI's EPIC Center is the largest centre for cardiovascular disease prevention in Canada , with more than 5500 registered members. The Center has a bit more than 80 employees and is part of the Prevention Branch of the Montreal Heart Institute. The centre is for healthy people who wish to keep it that way (primary prevention) as well as for patients who had a cardiac accident (readaptation and secondary prevention). The staff includes physicians, cardiologists, internists, emergency physicians, a physiologist, visiting professors, nurses, nutritionists, kinesiologists and rescuers.

Montreal Heart Institute Foundation Isabelle Pelletier 514 238-4178Ipelletier.pr@gmail.com

Sun LifeMylne Blanger514-904-9739mylene.belanger@sunlife.com

One year after the opening of the Montreal Heart Institutes Diabetes Prevention Clinic supported by Sun Life Financial, the health team is thrilled with the progress achieved by its participants. (CNW Group/Sun Life Financial Inc.)

Sun Life Financial Inc. (CNW Group/Sun Life Financial Inc.)

Montreal Heart Institute Foundation (CNW Group/Sun Life Financial Inc.)

SOURCE Sun Life Financial Inc.

View original content to download multimedia: http://www.newswire.ca/en/releases/archive/January2020/13/c1437.html

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First year of the Montreal Heart Institute's Diabetes Prevention Clinic supported by Sun Life Financial - Yahoo Finance

PURPOSE The purpose of this study was to assess whether primary care practices certified as medical homes differ in having the practice systems required for that designation and in attaining favorable outcomes for their patients with diabetes, and whether those systems are associated with better diabetes outcomes.

METHODS We undertook a cross-sectional observational study, Understanding Infrastructure Transformation Effects on Diabetes (UNITED), of 586 Minnesota adult primary care practices, comparing those that were certified vs uncertified as medical homes in 2017, with analyses supplemented by previously published studies of these practices. We collected survey information about the presence of medical home practice systems for diabetes care and obtained 6 standardized measures of diabetes care collected yearly from all Minnesota practices.

RESULTS Of 416 practices completing questionnaires (71% of all practices, 92% of participating practices), 394 had data on diabetes care measures. Uncertified practices (39%) were more likely than certified practices to be rural, but their patient populations were similar. Certified practices had more medical home practice systems (79.2% vs 74.9%, P =.01) and were more likely to meet a composite measure of optimal diabetes care (46.8% vs 43.2%, P <.001). A 1-SD increase in presence of practice systems was associated with a 1.4% higher probability of meeting that measure (P <.001).

CONCLUSIONS Practices certified as medical homes have more practice systems and higher performance on diabetes care than uncertified practices, but there is extensive overlap, and any differences may reflect self-selection for certification.

In the last 10 years, the concept of a medical home for patients, a patient-centered medical home (PCMH), has resurfaced from its origins in pediatrics in 1967.1,2 The idea has received enormous interest in the United States as a potential vehicle for transforming the quality, experience, and costs of medical care. It has even led to creation of a large collaborative, the Patient-Centered Primary Care Collaborative, having more than 1,000 participating organizations,3,4 to promote its spread. There have been many demonstration projects and studies, and there are a variety of national and state processes to recognize or certify practices as PCMHs; however, the definitions and criteria for what constitutes a PCMH vary widely, and most studies lack comparison groups and suffer from volunteer bias.5 There are thus still many unanswered questions, including the following6,7: how do practice systems and outcomes in a PCMH-recognized practice differ from those in others without that designation? Is there a continuum of characteristics and performance among practices that are or are not PCMH recognized, or is there a clear distinction between these groups? And are these practice systems associated with diabetes care quality and outcomes?

The most widely used recognition for what constitutes a PCMH is the process established by the National Committee for Quality Assurance (NCQA).811 Minnesota was one of the first states to implement its own voluntary certification process for primary care practices in 2010, based on demonstration that a practice met 5 standards (criteria) after thorough review12: (1) continuous access and communications with patients and family; (2) an electronically searchable registry to identify care gaps and manage services; (3) care coordination for patient- and family-centered care; (4) care plans that involve patients with chronic or complex conditions; and (5) continuous improvement in patient satisfaction, outcomes, and cost-effectiveness.

These standards must be thoroughly described in an application and demonstrated to be in routine use during required site visits, both initially and at the 3-year recertification point. They are very similar to features the Agency for Healthcare Research and Quality has identified as the key functional attributes of a PCMH: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety.13 As an incentive to apply for certification, Minnesota also developed a supplemental payment to certified practices for their Medicaid patients that depended on the complexity of their medical conditions. By late 2017, 61% of the 586 primary care practices in the state and border communities had been certified as a health care home (HCH), Minnesotas term for the PCMH.

The certification standards above require practice processes and systems that can be measured and reviewed triennially. Because all practices in Minnesota are also required to submit standardized data for public reporting on a variety of quality, satisfaction, and cost measures, these data provided us with an opportunity to test whether those practices that were adopters of HCH certification differed in systems and outcomes from uncertified practices. By exploring the differences between these 2 cohorts for adults with diabetes, we hoped to obtain answers to the 3 questions above.

We undertook a cross-sectional observational study, Understanding Infrastructure Transformation Effects on Diabetes (UNITED), of 586 primary care practices, 95% of them contained within 101 medical groups of varying size and type, that participated in Minnesotas 2017 public reporting on quality of care for adult patients with diabetes. Of these, 355 (61%) were certified as HCHs as of July 2017. Practices that were part of multisite medical groups were recruited through their medical directors.

Recruitment involved first sending a letter by Federal Express, followed in 1 week by an e-mail to the medical leader describing the study and its requirements and benefits for them. Participation required identification of the leaders at each practice site and encouragement for their completion of a single questionnaire in 2017. The only benefits for participants were provision of comparative information about their care processes and our findings on successful strategies for improving performance measures. This e-mail was followed by a telephone call from 1 of 2 physician authors (L.I.S. or K.A.P.) who are widely known to the states physicians. Follow-up calls, e-mails, or both were used until leaders verbally consented or declined, or we concluded that we would not be able to obtain an answer.

A leader of each participating practice was asked to complete an 81-question questionnaire asking about the presence of various practice systems to support high-quality care for patients with chronic conditions. The questionnaire was first created and tested for reliability by the National Committee for Quality Assurance as a way of assessing the presence of various features of the Chronic Care Model.14 It has been widely used in research and has been demonstrated to be associated with quality of care for patients with diabetes or depression, and with health care use and costs for patients with diabetes.1517

To create summary measures of practice systems in place, each question was scored as 0 (no such system was present) or 1 (a system was present). We limited our analysis to the 32 questions addressing diabetes care in the 5 domains required for certification in Minnesota (Table 1). Both the overall score and scores for each domain were calculated as a percentage of the total possible score, with equal weight for each question.

Practice Systems Questions for HCH Certification That Address Diabetes Care, in 5 Domains

Diabetes performance measures for each practice were obtained from MN Community Measurement (MNCM), the regions nonprofit organization for collecting and publicly reporting standardized performance measures for medical care.18 For diabetes, these measures include the proportions of diabetic patients having hemoglobin A1c control, having blood pressure control, using statins, using prophylactic aspirin, and not smoking, as well as a composite all-or-none measure of the proportion of patients meeting all 5 measures, indicating optimal diabetes care. Practices use direct data submission procedures to provide these patient-level measures for their diabetic population to MNCM as a part of the Minnesota Department of Health Statewide Quality Reporting and Measurement System.

We first computed summary statistics describing the practices and their diabetic patient populations by certification status, as well as their mean prevalence of practice systems and diabetes care measures. To account for differences in patient and practice characteristics, we also conducted multivariate analyses predicting the presence of practice systems (by certification status with practice characteristics as controls) and predicting patterns in optimal diabetes care (by certification status with both practice and patient characteristics as controls). Practice controls included size of the clinics medical group (large hospital-affiliated organization, small/medium-sized organization, single site), whether the practice was a Federally Qualified Health Center (FQHC), and location of the practice (urban, large rural town, small rural town, isolated rural town). Location was defined by practice ZIP code mapped to Rural-Urban Commuting Area codes (http://depts.washington.edu/uwruca). Patient controls included patient age, sex, record of a diagnosis of ischemic vascular disease, record of diagnosed depression, presence of type 1 diabetes, and insurance type (commercial, Medicare, Medicaid, dual Medicare-Medicaid, self-pay/uninsured). In addition, we mapped patient ZIP code to the American Community Survey19 to pick up measures of the income and education, wealth, and racial composition within the patients neighborhood.

The prevalence of practice systems, in total and by domain, was modeled at the practice level using linear regression with practice control variables. The probability of meeting the overall optimal diabetes care measure, and the probability of meeting each of its 5 components individually, was modeled at the patient level using a logit regression with patient and practice control variables. The practice survey data were cross-sectional (from 2017 only). Practice certification status did not control for volunteer bias, so those practices that were already providing better diabetes care may have been more likely to pursue HCH certification. For this reason, we estimated patient- level optimal diabetes care regression values including practice-level random effects to capture unobserved characteristics of the practices.

Of the 586 primary care practices providing care for adults with diabetes in Minnesota we targeted, 451 (77%) agreed to participate in the study. With diligent follow-up, we obtained completed questionnaires from 416 of these practices, for a 92% completion rate among participating practices and a 71% completion rate among the original 586 practices targeted.

Comparison of practices responding to the survey with nonresponding practices demonstrated that the former were more likely to be in large vertically integrated systems (74% vs 63%, P <.001) and to be located in urban settings (66% vs 43%, P <.001). Responding practices were also more likely to be HCH certified (64% vs 53%, P <.001) and to have patients meeting the optimal diabetes care measure (46% vs 43%, P <.001). Our use of multivariate regression analyses, however, should have normalized our results for observable differences between respondents and nonrespondents.

Among the 394 practices with both practice system data and performance measures for diabetes care, 258 (66%) were certified as HCHs whereas 136 (34%) were still uncertified. Characteristics of these practices by certification status are shown in Table 2. Certified practices were much more likely to be located in urban areas, but were no more likely to be independent or Federally Qualified Health Centers. Patient populations differed slightly by practice certification status, with small differences being statistically significant because of the large sample sizes. Certified practices did, however, have a larger share of patients covered by Medicaid and a smaller share covered by Medicare.

Characteristics of Participating Practices and Their Diabetic Patients, by HCH Certification Status and Overall

Table 3 shows summary statistics describing average HCH practice systems scores and diabetes care measures by certification status. These unadjusted results indicate that the HCH-uncertified practices had fewer practice systems in place, at least for care coordination and care plan development. The standard deviations for the practice systems scores were much larger than any differences between groups, however, indicating extensive overlap between the certification groups. Uncertified practices also had lower a level of the composite measure of optimal diabetes care, as well as lower levels of statin use and nonsmoking status.

Comparison of HCH Practice Systems Scores and Diabetes Care Measures

Table 4 allows more specific comparisons of the above differences after adjusting for differences in practice characteristics (medical group size, location, and Federally Qualified Health Center status) and, for care measures, differences in patient characteristics, in a multivariate analysis. This analysis confirmed the differences in overall practice systems, care coordination, and care plans, but access also now differed significantly by certification status; scores were a significant 4.5% to 9.5% higher for certified practices vs uncertified practices. Adjusted differences in care measures now were significantly higher for the certified group for all measures except for hypertension control, although the absolute differences were smaller (an absolute 0.1% to 5.1%) than those for systems scores.

Adjusted Differences in Practice System Scores and Diabetes Care Measures

Finally, we estimated the impact of an increase in practice systems score on the composite diabetes outcome measure, using patient-level logit regression analysis controlling for patient and practice characteristics (available from the corresponding author). As shown in Table 5, a 1-SD increase was significantly (P <.001) associated with a 1.4% increase in the probability of meeting the composite measure of optimal diabetes care, driven primarily by increases in the hypertension control and hemoglobin A1c control components of that composite.

Adjusted Association of a 1-SD Increase in Overall Practice Systems Score With Diabetes Care Measures

Our findings document that in a state with rigorous PCMH/HCH certification requirements passed by a majority of primary care practices, there were some differences between those that have been certified and those that have not 7 years after certification began. HCH-certified practices were much more likely to be in metropolitan areas and to have a higher proportion of patients covered by Medicaid, but a lower proportion covered by Medicare. Other differences in practice patient characteristics by age, sex, and prevalence of ischemic vascular disease or depression are small.

More importantly, when controlling for these differences, certified practices tended to have both more HCH-related practice systems and higher performance on some measures of the quality of diabetes care. The differences between group averages were not large, however, and there was considerable overlap between certified and uncertified practices with no clear boundary distinction between them as groups. Nevertheless, our finding that a higher practice systems score is associated with better diabetes performance measures suggests that practices wishing to improve their care and outcomes for patients with diabetes should consider how to best improve their practice systems, regardless of whether they are certified as medical homes. In another article, we describe additional analyses that identify those specific practice systems significantly associated with better results, both for all practices and for practice subtypes.20

Wiley et al21 have been studying the presence of what they call care management processes (similar to what we are calling practice systems) for chronic ill ness care in practices nationally and have reported that between 2006 and 2013, there were relatively large increases over time in the overall use of these processes for all sizes of practices. Similarly, Taliani et al22 conducted a qualitative study of care management in 25 practices with PCMH recognition. Interviews with personnel in the practices having the greatest improvement in diabetes performance measures found that they described more patient-centered care manager duties, better use of the electronic medical record for messaging and patient tracking, and stronger integration of the care manager into the care team, all systems that we measured in this study.

Although our study and the literature suggest that practice systems are associated with better performance, a key question is whether differences between certified and uncertified practices in these attributes are due to the certification process or whether they reflect self-selection as practices with more systems and better outcomes choose to become certified. Our cross-sectional study conducted at a point 7 years after certification began cannot answer that question, but other clues may help.

First, in a study of Minnesota HCH practices in 2010, we compared similar diabetes performance measures for the first 120 adult practices to be certified with the much larger sample of 518 practices that were uncertified then.12 At that time, the difference in optimal diabetes care composite scores between certified and uncertified practices was 8.0% vs the 3.5% difference in 2017. More importantly, the difference in these scores 2 years before certification was even larger for those that would become certified than for those that would not, so improvement over the period of attaining certification was actually greater for practices not working on certification.

Second, Shippee et al23 compared patient-level measures of optimal diabetes care for patients served by Minnesota HCH-certified practices with those served by uncertified practices in 2013. At that time, when there was a more equal split between certified and uncertified practices, the difference was 4.0%, similar to the 3.5% we found in 2017,12 suggesting that after certification, further improvement in diabetes scores is not greater for those that have achieved certification. This finding is also consistent with some additional testing using our data set (available from the corresponding author) showing little difference in performance between clinics achieving certification in the first year it was available (July 2010-June 2011) and clinics achieving certification more recently, indicating continued improvement is minimal once certification is achieved.

Third, as PCMH transformation was first gathering steam, the National Demonstration Project conducted a randomized trial among 36 clinics nationally that were highly interested in transformation. Results indicated that outcome measures were no better among clinics receiving extensive external help with that transformation than among those left to work on it on their own.24

Finally, Wang et al25 studied 150 small independent practices, comparing performance on 7 clinical quality measures in 2009 and 2011 between practices that had achieved PCMH recognition from NCQA and those that had not. They found significantly higher performance for PCMH practices at both time points, but the groups had improved at the same rate.

Taken together, these data suggest that practices that chose to be certified may have done so in part because they already had more systems and were performing better on outcome measures. If so, it would help to explain some of the confusing literature on whether medical home clinics provide better care. Instead, at least early adopters of innovations such as the medical home were already better. It also suggests that practices might be better off focusing limited resources on changes they believe will improve care and efficiency rather than on the work required for that designation. Once we have completed a second survey of our study practices and can measure changes over time, we may be able to address that hypothesis more directly.

Despite the unusually large sample of primary care practices in this study and the standardized measures of systems and outcomes, our analysis is limited by the cross-sectional nature of our data as well as the focus on a single state and a single chronic disease (diabetes). The practice systems survey is also limited by reliance on completion by a single participant with no objective verification of the presence of the systems being reported. In early tests of a very similar questionnaire, however, we demonstrated that such respondents did a good job of reporting, tending if anything to underreport practice systems more than overreport them.14

In conclusion, we have shown some differences in characteristics and practice systems, and in performance measures of diabetes care between practices that are certified as medical homes and those that are not. There also appears to be an association between systems and performance, so practices wanting to improve their care and performance measures should improve the number and function of practice systems, regardless of certification status. Most of the differences are small, however, so it is likely that none of these factors represent magic bullets that can be relied on to achieve large gains in performance over short periods of time. Organizational change is as slow as individual behavior change, but those interested in facilitating improvement need guidance on what changes will be most helpful, and that is the central goal of this ongoing project.

Conflicts of interest: authors report none.

To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/18/1/66.

Funding support: Research reported in this publication was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health under Award Number R18DK110732.

Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Read more:
Differences in Diabetes Care With and Without Certification as a Medical Home - Annals of Family Medicine

Diabetes is a massive market in the healthcare sector. An estimated 415 million people have diabetes worldwide, and those numbers are growing. It's also an on-going healthcare issue, one that patients have to manage, often for the rest of their lives. As such, there is a lot of recurring revenue. It's not a bad idea to find a strong company focused on this vertical to add to your portfolio.

Over the last decade, one of the biggest stocks in healthcare has been diabetes specialistDexCom (NASDAQ:DXCM), a wireless health company that allows patients and doctors to track glucose levels in real-time. Another potential winner in this space isLivongo Health(NASDAQ:LVGO), an up-and-coming small-cap that sends updates, reminders, and coaching tips to all its clients with diabetes (and other health issues). And biotech companyProvention Bio(NASDAQ:PRVB)is hoping to get approval from the Food and Drug Administration (FDA) for a drug that delays the onset of type 1 diabetes. Read more to see if any of these stocks are buys right now.

Image source: Getty Images

DexCom, a $21 billion large-cap stock, has been dominant in healthcare for a long time. Over the last 10 years, shareholders have been rewarded with a 2,563% return. DexCom achieved that impressive return with a singular focus on diabetes. Traditionally, people with diabetes had to prick their finger to check their blood in order to monitor their insulin level. DexCom introduced a wireless device inserted under their skin. This sensor, called a continuous glucose monitor (CGM), is appreciated by patients because of its ease of use and valued by doctors because of its superior data and better health outcomes.

DexCom recently signed a distribution deal withWalgreens Boots Allianceto sell the CGM device. Patients insert a tiny sensor under the skin using an automatic applicator.DexCom's sensor starts automatically and continuously taking glucose readings in the patient's interstitial fluid. A micro-transmitter sends the data wirelessly to a receiver. Patients can read their own data in any connected smart device. The CGM can also be set to alert the patient if certain glucose levels are reached.

In its most recent quarter, DexCom reported $396 million in revenue for the quarter, 49% higher than the previous year. Net income was $60 million for the quarter. DexCom's main competition in this space is withAbbott Laboratories(NYSE:ABT)that sells a popular CGM device calledFreestyle Libre. Abbott's CEO Miles White predicted in a conference call last year that his company's device would achieve sales of $5 billion a year (which would dwarf DexCom's $1.35 billion). So far, DexCom's fantastic numbers suggest DexCom is still winning in the diabetes space. Even with competition, clearly the market opportunity is vast.

Livongo Health is a fascinating company and a rising star in personalized medicine. While unprofitable, the company has phenomenal revenue growth. It brought in $46 million in sales in its most recent quarter,up 148% year over year. Over 200,000 diabetes patients are on Livongo's messaging platform, up 118% year over year, and the company has 771 enterprise clients.The company is creating additional verticals in prediabetes, hypertension, weight management, and behavioral health. Livongo specializes in helping all patients with chronic conditions, giving them advice, coaching tips, and interpretations of data readouts.

The company has conducted 48 studies measuring return on investment (ROI) and found that 90% of its clients had positive ROI in the first year. Indeed, some corporate clients are so happy with Livongo's offering, the clients are offering to reduce or eliminate the co-pay for hypertension or diabetes drugs for their employees, as long as the employees subscribe to Livongo.

So far, Livongo's stock has been a disappointment, down 30% from the company's initial public offering in July 2019.The company has a $2.5 billion market cap, $400 million in cash, and no debt. Its price-to-sales ratio is 17, about the same as DexCom, while Livongo is growing revenues three times as fast.Gross margins are 74%, suggesting the company can become profitable at any time. Right now though, the company is focused on escalating its top-line growth.Livongo has formed partnerships with MDLIVE and Doctor on Demand to enable virtual access to doctors for all its clients, which will roll out in 2020.The future looks bright for Livongo Health.

Provention Bio is an interesting biotech focused on preventing diseases before they become acute. It's a tiny company right now, with a market cap of $658 million.But the stock has been running wild, up 741% last year. What caused the stock to take off? The company reported amazing results in its phase 2 study for Teplizumab, a drug designed to delay the onset of diabetes in at-risk patients.

In this long-term study, the median patients on placebo developed diabetes in two years. That's in sharp contrast to the group on Provention's drug. Those median patients developed diabetes in four years. In fact, 73% of the people on placebo developed diabetes, compared to 43% of those on Teplizumab. Thus the drug not only delayed the onset of diabetes, on average, but many patients avoided diabetes altogether. The numbers were so good, the FDA decided the company can file its new drug application on the basis of its phase 2 study.

Provention has no profits and no revenues, so like many biotech stocks, it has to be considered speculative. On the other hand, the risk/reward ratio is very intriguing, since the diabetes market is so large.

After all, diabetes is a $45 billion market in the U.S. alone.Worldwide, the diabetes market will surpass $85 billion by 2022. It's a huge market opportunity for all three of these companies. Of the three stocks, DexCom has the largest upside. The stock has quadrupled over the last two years, so patient investors might wait for a better price.

Read more:
3 Top Diabetes Stocks to Watch in January - The Motley Fool

Of the 463 million people in the world with diabetes, up to 95 percent have type 2 (T2D). In T2D, peripheral tissues mostly muscles are resistant to insulin, a hormone made by the pancreas to stabilize blood-sugar levels and enable the body to use and store sugar.

Medications available today treat the symptoms and complications of T2D but do not solve the core problem of insulin resistance.

Zygosid-50, a drug under development in Israel, could be the first to restore near-normal cellular sensitivity to insulin, without side effects.

Concenter BioPharma in Jerusalem is raising funds for clinical trials approved by the FDA based on evidence from earlier testing in animal models for T2D.

In December, Concenter Biopharma cofounder and CSO Prof. Mottie (Mordechai) Chevion won first place at the 17th Annual World Congress on Insulin Resistance, Diabetes and Cardiovascular Diseases.

The World Congress attracts the top researchers and clinicians, who understand the problem and the limited solutions available which arent really solutions at all, says Concenter Biopharma cofounder and CEO Dror Chevion, Motties son.

To receive the award out of 80 submitted abstracts and six chosen for presentation is a real vote of confidence in our science and our achievements, Dror Chevion tells ISRAEL21c. The people sitting in that conference will be the ones prescribing our drug to patients.

Concenter BioPharma cofounder and CSO Prof. Mottie Chevion, left, receiving his award from Dr. Zachary Bloomgarden at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Diseases in Los Angeles, December 2019. Photo: courtesy

Mottie Chevion developed the nonsteroidal, anti-inflammatory Zygosid family of drugs in his lab at Hebrew University-Hadassah Medical Center in Jerusalem.

Zygosids work by robustly reducing insulin resistance and normalizing all diabetes-associated parameters to the normal range, says the professor. On the molecular level, Zygosid-50 is a potent anti-inflammatory drug that forces an intra-cellular exchange removal of bad free iron with zinc, depositing the zinc ion within the cells.

In 2015, some of the lab staff and their families successfully tried using Zygosid molecules topically for skin conditions including diabetic foot ulcers and psoriasis. They experienced no negative side effects.

My father felt it was inhumane not to try to bring these drugs from the lab to patients. He asked me to join him and take this initiative forward, says Dror Chevion.

The intellectual property was licensed to the inventors through the university and hospital tech-transfer companies. Silkim Pharma was set up as a holding company for the IP. Concenter Biopharma was founded as a subsidiary in 2019 to further develop and commercialize Zygosid-50 for treating and preventing T2D.

1 in 3 people has diabetes or prediabetes

Concenters US regulatory consultant, Dr. Susan Alpert, arranged meetings with the FDA in 2017 and 2018 to help determine which indication to focus on. The conclusion was to start with T2D and conduct clinical phase 1 and phase 2a trials in Israel while finalizing a pill formulation and completing preclinical toxicity studies.

One in three people in the world is diabetic or prediabetic, says Dror Chevion. The number is expected to reach 700 million by 2045. In the United States, 31 million people suffer from diabetes and 90 million are prediabetic. And the age of people contracting type 2 diabetes is getting younger and younger.

In animal trials, Zygosid-50 restored insulin sensitivity by better than 90%, bringing blood sugar into balance and lowering chronic and systemic inflammation levels. The drug also replenished zinc deficiency.

The FDA responded to Concenters investigational new drug (IND) application with a request for additional preclinical toxicity studies and more information on the drugs manufacturing process.

This is a great achievement for a small company, notes Dror Chevion.

We are working on accommodating those requests and making the final formulation of the drug as a pill. We plan to perform clinical studies here in Israel. Then we will submit another IND application to go to phase 2b, by the end of 2020. We are currently raising funds to do all of that.

Concenter was self-funded until six months ago. The company will launch a $5 million round for its T2D activities during 2020.

Concenter BioPharmas scientific advisory board includes three globally recognized diabetes experts: Dr. Peter Nawroth of Germany, Dr. Ralph DeFronzo from the United States, and Dr. Itamar Raz, chairman of the Israeli Council on Diabetes and the National Diabetes Prevention and Care Plan.

Diabetes is a global epidemic and is expected to grow, says Dror Chevion. The estimated cost of treating diabetes per year is over $850 billion. More than 150 companies are developing diagnostics or applications for diabetes, but there are no drugs to treat the actual problem of insulin resistance without side effects. This is what we are doing.

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More:
Finally, a pill that could fix the root cause of diabetes - ISRAEL21c

Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Sinai Health System and University of Toronto, Toronto, Ontario, Canada (M.F.)

Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.K.C., E.P., S.C.K.)

Financial Support: By the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School. Dr. Fralick received funding from the Eliot Phillipson Clinician-Scientist Training Program at the University of Toronto and the Canadian Institutes of Health Research through the Banting and Best PhD Award. Dr. Patorno is supported by a career development grant (K08AG055670) from the National Institute on Aging.

Disclosures: Dr. Patorno reports grants from the National Institute on Aging and Boehringer Ingelheim outside the submitted work. Dr. Kim reports grants from Pfizer, AbbVie, Roche, and Bristol-Myers Squibb outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2610.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.

Reproducible Research Statement:Study protocol: Available from Dr. Fralick (e-mail, mike.fralick@mail.utoronto.ca). Statistical code: Not available. Data set: Available through IBM MarketScan (e-mail, watsonh@us.ibm.com).

Corresponding Author: Michael Fralick, MD, PhD, SM, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120; e-mail, mike.fralick@mail.utoronto.ca.

Current Author Addresses: Drs. Fralick, Chen, Patorno, and Kim: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120.

Author Contributions: Conception and design: M. Fralick, S.K. Chen, E. Patorno, S.C. Kim.

Analysis and interpretation of the data: M. Fralick, S.K. Chen, S.C. Kim.

Drafting of the article: M. Fralick, S.K. Chen.

Critical revision for important intellectual content: M. Fralick, S.K. Chen, E. Patorno, S.C. Kim.

Final approval of the article: M. Fralick, S.K. Chen, E. Patorno, S.C. Kim.

Statistical expertise: S.C. Kim.

Administrative, technical, or logistic support: M. Fralick, S.C. Kim.

Collection and assembly of data: M. Fralick.

Read more:
Assessing the Risk for Gout With SGLT2 Inhibitors in Patients With Diabetes - Annals of Internal Medicine

My mother had Type 2 diabetes. While she was living with and going through that, I didn't know about the strong connection between Type 2 diabetes and heart disease; I just worked to try to make her comfortable and manage the day to day. Perhaps if I had known that people living with diabetes are twice as likely to develop and die from cardiovascular disease, we could have asked her doctor different questions and been more diligent in helping her manage the risk to the complication that would eventually claim her life.

My mother made her transitionbecause of heart failure resulting from her Type 2 diabetes.

She was a woman who truly cared about people in her community. When I wasn't around, my mother spent time with all kinds of folks she had met especially young people she adored. When she passed, so many individuals she had met wrote me cards. I had no idea that she really spoke to them and brought so much into their lives. She was a simple and hard-working woman. She never made a lot of money, but she had an impact on the lives of those she met.

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I decided that trying to help my mother continue making an impact on people's lives was a way I could honor her. That was why I teamed up with the American Diabetes Association and the American Heart Association to get the message out about the connection between Type 2 diabetes, heart disease and stroke. We are trying to help people like my mother.

For many people, when you hear news that's overwhelming like a diagnosis of diabetes you have one of two reactions: You either feel like your feet are being held to the fire and decide, Let's get moving, let's do something about this; or it's like, Oh my God, it's just all too much for me. The collaboration between the American Heart Association and the American Diabetes Association, called Know Diabetes by Heart, helps those people who are newly diagnosed with Type 2 diabetes (and their loved ones and family members) break down what to do next into bite-size portions, to get a handle on what it all means, so they can manage it and stay in the know.

One important thing we are trying to do is help people have conversations with their doctors about managing their cardiovascular health. I know from experience that it's even hard to know the right questions to begin those conversations. You can start by asking: What changes can I make today? What can I do before my next appointment? What changes can I make to take care of my heart in the long term? How will I know if those changes are having an effect?

Everyone is different so its important to always work closely with your doctor on the treatment thats right for you. Go to KnowDiabetesbyHeart.org for a discussion guide you can print out and take with you, or bring it up on your phone at your appointment.

The site also has stories from people who are dealing with this issue. They are sharing their personal stories to encourage you, and to remind you, that you are not alone. There are even good recipes on the site to help with the dietary changes. Like many people, nutrition was particularly difficult for my mother when dealing with her diabetes. You eat what you like for so many years 65 years, for her and then you get this diagnosis and you think: Now I'm supposed to change. How? Where do I start? This is one way.

The other part of this is that non-Hispanic blacks, Hispanic Americans and Native Americans are at a significantly higher risk to develop Type 2 diabetes, which researchers think is a result of a combination of factors, including genetics, lifestyle factors, environmental factors and socioeconomic conditions.

Beyond that, we all know that, in this country, there is a great disparity in access to and quality of health care, which also plays out when it comes to Type 2 diabetes and its complications.

For instance, a 2017 study by the Centers for Disease Control and Prevention showed that, though the risk of eye disease among Type 2 diabetes patients is well known, African American and Latino Medicaid patients with Type 2 diabetes were significantly less likely to be offered eye exams than white patients. A 2007 study in Family Medicine showed that even if you control for access to health care and socioeconomic status, Latino patients with Type 2 diabetes were less likely than white patients to have foot exams from their doctors, even though the risk of damage to patients' extremities is well known.

That is why it is so important that everyone has access to information, resources and support, and that they know what questions to ask their doctors and how to follow up. Through Know Diabetes by Heart we want to show people living with Type 2 diabetes that theyve been diagnosed with a new purpose. Yes, you have Type 2 diabetes and, yes, you can manage it and live your amazing life.

As told to THINK editor Megan Carpentier, condensed and edited for clarity.

Angela Bassett is an Academy-award nominated actor, a director and an activist. She is currently serving as an ambassador for Know Diabetes by Heart, a joint initiative of the American Heart Association and the American Diabetes Association.

Read the original:
A Type 2 diabetes diagnosis can overwhelm you. But with the right information, you can go on. - NBC News

Learn about addressing the emotional side of living with diabetes as part of comprehensive diabetes care.

Jeffrey Gonzalez, PhD, is a co-author of the Psychiatric and Psychosocial Issues among Individuals Living with Diabetes chapter in the NIDDK publication Diabetes in America, 3rd Edition. Here, he discusses how depression and diabetes distress affect people living with diabetes and what health care professionals can do to help their patients.

Q: Why should health care professionals be concerned about depression in patients who have diabetes?

A: Health care professionals should be aware that depression is more common in people with diabetes, and, when its present, its associated with poor health outcomes in people who have diabetes.

A 2001 meta-analysis suggested that depression could be about twice as common in people with diabetes as in people without diabetes, and that's similar to what's been found in other chronic illnesses. In 2008, some colleagues and I did a meta-analysis of the literature that found depression was consistently associated with poor diabetes self-management. Other meta-analyses have found consistent associations between depression and hyperglycemia, increased risks of diabetes complications, and even early mortality.

Q: What is diabetes distress and how is it related to depression?

A: In the medical field and in many conversations around feeling down or blue, we often use the concept, clinical depression. Thats partly because the Diagnostic and Statistical Manual of Mental Health highlights depression as a mental health disorder that can be diagnosed based on certain symptoms. However, its hard to draw the line between clinical depression and emotional reactions to stressful situations. Big events, such as loss of a loved one or loss of employment, can cause emotional responses and symptoms that are very similar to those of depression, at least over the short term.

One way that depression and diabetes distress are different is that diabetes distress is not thought of as a mental illness. Diabetes distress is a construct proposed by researchers to describe the emotional response to living with diabetes, a life-threatening illness that requires chronic, demanding, self-management. However, tools used to screen for diabetes distress dont ask only about emotions. They also ask about problems people have with their diabetes, such as a lack of social support, a poor relationship with their doctor, or difficulty accessing health care. Diabetes distress captures a persons experience with the problems associated with diabetes.

Diabetes distress is much more common than clinical depression among patients with diabetes. Recent literature reviews suggest that between 30 and 40 percent of adults with diabetes are likely to report significant levels of diabetes distress over time.

Q: How is diabetes distress related to diabetes treatment adherence and self-management?

A: A body of research shows that people who report more diabetes distress are also more likely to report more problems with self-management and medication adherence and may also have higher blood glucose levels. Some evidence suggests they may also be more likely to experience hypoglycemia and fear of hypoglycemia, which can affect their ability and willingness to take their medications

Diabetes distress and everyday diabetes management are closely linked, and its probably a two-way street. People feel stressed and have emotional responses such as feeling down or hopeless. Then, they may avoid dealing with their diabetes and experience setbacks, such as hypoglycemia, hyperglycemia, or complications. Those setbacks further contribute to their distress, and it can become a vicious cycle.

Q: Among people with diabetes, do some people have a higher risk for depression or diabetes distress than others?

A: Yes, some people with diabetes appear to have a higher risk.

Q: How can health care professionals address depression or distress in patients who have diabetes?

A: Addressing the emotional side of living with diabetes should be part of comprehensive diabetes care. Emotional distress of some kind is going to be more common in patients living with diabetes and may be caused by some of the stresses related to diabetes.

Providers can ask questions about how people are doing, how theyre feeling, and what aspects of their diabetes are causing stress. Providers can also acknowledge and normalize the idea that diabetes distress is common and could occur sometime in the course of the illness, perhaps with the onset of complications or with life changes that make following a diabetes self-management routine more difficult.

Diabetes distress can cause people to feel stuck and to benefit less from their diabetes treatments. Providers should look out for people experiencing diabetes distress and offer support by talking with patients about distress and encouraging them to think about ways to better manage their distress. Providers may also be able to make the diabetes treatment regimen less burdensome for the patient.

Its also important for providers to identify mental health professionals who can collaborate as part of the care team and provide more specialized help when its needed. Providers should think about how to help their patients find someone who can assist with depression or more significant problems with diabetes distress.

Q: Is there anything else that health care professionals should know about depression and diabetes distress in people with diabetes?

A: Depression and diabetes distress can be treated. We know about treatments for depression, from psychotherapy to pharmacological treatments. Diabetes distress seems to respond to many different kinds of interventions, including educational and supportive interventions.

A number of questionnaires are available to help providers screen for depression and diabetes distress in patients. As with any screening tool, the majority of people who screen positive wont actually have the disorder. Providers need to talk with patients after the screening to further evaluate what's going on. At times, providers may feel they need input from a mental health specialist to make that differential diagnosis and to recommend the most appropriate treatment.

Providers can find more information about screening and monitoring patients for depression and diabetes distress in Psychosocial Care for People with Diabetes: A Position Statement of the American Diabetes Association.

Q: What research is being conducted on the relationship between depression and diabetes?

A: More research in this area is needed. One area of current research is the dissemination and implementation of treatment models that we already know can be helpful.

For example, Im currently finishing a National Institutes of Health-supported trial that focuses on providing self-management support by telephone to adults with type 2 diabetes who are not at goal with their A1C. This program has been evaluated in a few previous trials, and we incorporated new components to train and support health educators in offering interventions that may be helpful for depression and diabetes distress.

Many studies are addressing how effective treatments can reach a wider number of people who need them, for example through interventions delivered by peers or community health workers. We have a mental health crisis in this country, where our mental health system does not meet the need among patients who are already identified. Screening programs that identify more people who need care will require a workforce and better reimbursements to meet that need. Over the next few years, well see more research on translating expert recommendations into care for depression and diabetes distress that can be replicated in many settings and sustained over time.

How do you address depression and diabetes distress in your patients with diabetes? Tell us below in the comments.

Follow this link:
Diabetes Distress and Depression - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)