New smart contact lens could monitor glucose for diabetics

In the United States, the number of patients diagnosed with diabetes (both Type 1 and Type 2) has doubled over the last decade. Type 2 accounts for 90-95% of all diabetes diagnoses. Over eight percent of the U.S. population is believed to have diabetes, and of those with it, an estimated 27% do not even know it. Monitoring blood glucose levels is critically important and must be done multiple times a day, which can be painful and cumbersome. Google has just announced a prototype device that retrieves information about blood sugar directly from the eyeball, via a contact lens.

Typically, a small blood sample is taken from the fingertip using a combination of a lancet, strips, and a blood glucose meter. For those who have had diabetes for a long time or require more frequent testing, it can be hard to find a spot that will bleed easily. There are embedded blood glucose monitors, but they require a device to be taped to the skin or work on a belt and require outpatient surgery for replacement. Unfortunately, because properly monitoring blood sugar is such a large commitment, many people are not doing it right. Those who choose not to manage their disease properly are at a much greater risk of developing blindness, kidney failure, or having their lower extremities amputated.

Many researchers have been seeking alternative ways to monitor glucose without the use of blood, in order to make it easier for diabetics to stay on top of their sugar levels. Some newer noninvasive glucose tests include checking saliva, urine, or tears. Tears can provide an incredibly accurate measurement, but it is not always easy to get a sample. Google’s solution to using tears is minimally invasive and can provide constant monitoring of glucose levels.

A prototype soft contact lens has been outfitted with a micro-scale computer chip, sensor, and an antenna. Once every second, the sensor monitors the glucose levels in the tears and transmits the information to a wireless device, such as a smart phone. This information could also be sent directly to the person’s doctor. Future prototypes may also include a tiny LED which would immediately alert the wearer that sugar levels are either too low or too high and to take immediate action. The technology within the lens does not impact the field of vision and should not be much different than wearing traditional contact lenses.

Currently, scientists at Google are in talks with the FDA about taking this prototype to the next level. It will be years before the contact will be available for clinical use. Google is reaching out to potential partners in order to make this a feasible option for diabetics. This has the potential to revolutionize how millions of people with diabetes manage their disease and give them the best chance to protect their eyesight, limbs, and life.

- See more at: http://www.iflscience.com/health-and-medicine/new-smart-contact-lens-could-monitor-glucose-diabetics#overlay-context=

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Nanoparticle Suspension and Ultrasound Deliver Insulin Without Regular Injections

 

Insulin injections are no fun for diabetics and they have to be taken as needed by the body, not by the patient’s personal schedule. This means if you have diabetes, you can’t just pre-inject yourself and go worry-free throughout the day. A nanotechnology developed at North Carolina State University and the University of North Carolina at Chapel Hill may end all that thanks to a self-assembling network that can release insulin whenever the patient wants.

The system consists of poly(lactic-co-glycolic) acid (PLGA) nanoparticles filled with insulin and coated with either negatively or positively charged substances. These stick to each other when mixed, so when injected into the body the solution remains together and when you want some insulin released, you simply hold an ultrasound transducer to the injection site and shake up the substance to release the insulin.

From NC State:

The researchers believe the technique works because the ultrasound waves excite microscopic gas bubbles in the tissue, temporarily disrupting Nano-network in the subcutaneous layer of the skin. That disruption pushes the nanoparticles apart, relaxing the electrostatic force being exerted on the insulin in the reservoir. This allows the insulin to begin entering the bloodstream – a process hastened by the effect of the ultrasound waves pushing on the insulin.

“We know this technique works, and we think this is how it works, but we are still trying to determine the precise details,” says Dr. Yun Jing, an assistant professor of mechanical engineering at NC State and co-corresponding author of the paper.

When the ultrasound is removed, the electrostatic force reasserts itself and pulls the nanoparticles in the Nano-network back together. The nanoparticles then diffuse more insulin, refilling the reservoir.

Advanced Healthcare Materials: Ultrasound-Triggered Regulation of Blood Glucose Levels Using Injectable Nano-Network…

original article http://news.ncsu.edu/releases/wms-gu-ultrasound2013/

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iBGStar Blood Glucose Monitoring System

Recently I was granted the opportunity to demo the iBG Star Blood Glucose Monitoring System for iPod/iPhone.
When I first saw this I was really excited and couldn’t wait to get my hands on it. Having and loving my iPhone and iPod I thought what a great way to use them to help me monitor my glucose levels.

When it finally arrived, I tore into the box and opened the case and felt like a child at Christmas. I was happy to see how un-intrusive the device was. It wax no bigger than a pack of gum but very sleek. I quickly grabbed my iPhone and downloaded the app from the App Store.
At first, it took me a minute to get everything set up. I tend not to read instruction's right off the bat just to see how intuitive things are. So once I got it synced with the app everything was really straight forward after that.

I've been using the iBG Star now for about a week and a half. One of the things that I love about it is the fact that it’s a standalone meter all by itself. You do not need to have it hooked to your phone or other supported Apple device until your ready to sync the information.
When doing some more research on the iBG Star, I saw you could get phone cases that allows you to keep the monitor connected to the phone all the time, which is handy but you still have to carry the lancets, and test strips so why not just keep the whole thing together?

One thing that I did notice that has me a bit put off is that the iBG Star seems to be off  by sometimes up to 200 points. I have been using my Bayer Contour USB Glucose Monitor along with the iBG Star and at my highest reading both machines read differently. The iBG Star read 486 where my Contour USB read 268.
I did a control test and still found it to be off by 40-60 points, which I have been told by my Diabetes Educator that is to be expected, but that its nothing to really worry about. Well being someone who is on a sliding scale for his insulin injections that’s the difference between a little and a lot of insulin. But I imagine if I was using the iBG Star as my only meter then I wouldn’t worry to much.

Getting into the app itself, I must say is very clean and easy to navigate. You have some fun features like being able to change the background on the app, as well as tailoring it to your needs by inputting your highs and lows, as well as your insulin etc..
It also gives you a nice on screen display to let you know when you need to apply your blood sample and when the meter has been disconnected or connected.
I am one for super easy, intuitive, and visually appealing software. The iBG Star merges flawlessly with the iOS.

All in all I have to say I really do love the iBG Star. I really like the fact that you do not need to keep it connected to your phone all the time and that it is a stand alone reader. I also like the fact that you can get the app for your iPod and iPad as well. Making it fully intergraded into the Apple owners life. I do not like the fact that it is only Apple based. I would like to maybe see a future version of this released to Android just to be more inclusive and opening the market for new users. 

Another feature that I really like about iBG Star is that you have the ability to share your meter readings via email with your doctors. This provides them with detailed information that allows you to get instant results, especially if you are being monitored closely for other Diabetic complications.

All in all I would give the iBG Star 9/10 stars. The only reason I did not give it a full 10 is due to it being only for iOS and not more readily available to all devices. However, that being said. I find it being one of the better devices offered for Apple that is a stand alone machine.

^{Images borrowed from Google Images. I do not claim ownership to them.}

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Biomedtrics Ditto

Recently I had the chance to test out the new Biomedtrics Ditto. The Ditto is a Bluetooth device that allows you to sync your blood glucose meters to any Bluetooth enabled device such as a smart phone, tablet, or PC.
Along with the standalone device there is an app called MyDittoLife, which allows you to keep all of your testing records on it and share it with your medical provider by emailing it directly to them. And the app is also accompanied by a website that stores all of your testing information via the Cloud, allowing you to access your information where ever there is internet access.

With Ditto you have several connection options that allow you to connect to your meter. It comes standard with a 3.5mm Male to Male audio cord that allows you to plug your glucose meter into the Ditto, a 2.5mm to 3.5mm adapter for those smaller ports, and a USB charging cable. That’s right there are no batteries that you have to deal with, its charged by plugging into any USB 2.0 plug.
And because Ditto is Bluetooth compatible that means that you can wirelessly sync your meter to your phone or tablet/PC. I have a Samsung Galaxy S3 and when I connected  my meter to the Ditto and turned on Bluetooth Sync within the app, it automatically updated the app on my phone with my most current reading for the past 3 months. I was a little disappointed in that it did not download all my readings into the app, but was impressed with how simple it was, once I had the app setup to work with the meter that I was using.

The entire Ditto program is controlled through the app. You can make all your changes right from your tablet or smart phone. It is pretty intuitive for the most part, but if you are technologically stupid, you may struggle a bit with it. I would like to have seen the over all ease of use more KISS (Keep It Simple Stupid) friendly for those who are not tech savvy.

One drawback that I did find with the Ditto was its limited number of supported glucose meters. However, many of the top name models such as Abbott, Bayer, ReliOn, and LifeScan (ie OneTouch) are supported. This is one feature that I would like to see expanded upon in future developments.

Another feature that I liked about Ditto was that you could choose which way you wanted to export your glucose data, you could have it done in PDF or CVS format. Personally I prefer PDF format because it is more universal.  The other thing that was nice was that it displays a bar graph after every reading allowing for you to see visually how your weeks highs and lows compared.

All in all I give this system a 7 out of 10 stars, based on the app and the lack of supported meters, and the fact that it is only currently offered for Android. I really do like that the system is stand alone and Bluetooth which gives it great functionality and room for future development. You can get yours from Amazon by clicking here, and downloading the app from the Google Play Store by clicking here.

UPDATE

11/7/13

After having used the app a bit more I have found that my last statement of Ditto not having uploaded all of my readings from the meter was not true.
The meter I was using only had readings from back in March of this year. It did not display in the app that any information had been downloaded, it just displayed that there was no data found. I have brought this to the attention of Biomedtrics, and they are looking into it.

I did find and have a chance to look at my graphs for the time period that I did have data for and found that like the picture above it was well detailed and accurate, and gave me a good visual on how my trends were. I am going to upgrade my original rating from a 7 to a 7.5 stars out of 10. Knowing now that all my data was downloaded makes it nicer (and would have probably saved me some hardships had I used a meter with more accurate testing dates than half a year ago) to work with. I still stand by the fact that the over all usefulness of the app and website could be more user friendly but for those techy people out there this shouldn’t be to big of an issue.

Also in my previous review I forgot to mention that there is a website that you can view your information on called www.mydittolife.com which from what I can see is an HTML version of the app, without the ability to really change much of the information on, but have been assured that the site is a work in progress. The Ditto is a great device and is worth using, I would recommend it to my more computer literate friends, over the ones who are struggling to come into the 21st century.

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Glooko is coming to Android and Google Play

So there is a product on the market called Glooko, which is a revolutionary new device that allows you to connect your Glucose meter to your iPhone and copy all of your test results over to your phone, thus allowing you to email them to your doctor.

 

Well back in 2011 – 2012 I was accepted to be a tester for this new product and wrote a series of articles about it. Since then they have made leaps and bounds with it. You see Glooko use to only be available to iPhone users.

However, I was again chosen to be a beta tester for their new Android App. I must say so far I'm a bit disappointed (so far) with the outcome of the Android version of Glooko. You see unlike the iPhone single sync cord version (left), the Android sync version (right) requires 2 parts. These parts are a square box that plugs into the earphone jack of your phone or mobile device and has a cord that plugs into that, then into your meter. The other thing about the Android version is that it is not powered by the phone or the tester. It requires a large button cell battery, and the unit must be manually turned on in order to begin the sync with your phone.

One thing that I did notice though, was the large database of supported glucose meters the new Android version has. When I tested the iPhone version back in 2011 they had very limited number of supported meters. They now have all the main name brands and a few off brand glucose meters supported. The other thing that I was pleased to see was that unlike the iPhone sync which needed a whole different attachment or meters that had IR (infrared) beaming abilities, it is now built into the Android version.

The other thing that has been improved is the app for both Android and iPhone. The new and improved app allows for better, smoother functioning, making it super simple for even the most tech challenged person to use.

All in all I give the Android Glooko reader 8 out of 10 stars. The only reason I’m scoring it at an 8 is because of the 2 piece system and the fact that it is battery operated and not self powered like its counterpart for the iPhone. Other than that, I am happy that they finally crossed over to the Android market. You can get your own Glooko setup for iPhone here. It is not fully available for Android consumers yet. But keep up to date with them via their Facebook Page, Website, or Twitter, so that you can be the first to know when the consumer version of Glooko for Android is released.

[UPDATE] 10/29/13

It seems as if I was a bit to harsh/hasty on the rating scale of 8 out of 10 stars. At first glance I was off put by the over all appearance of the sync cable being in 2 separate parts and being battery operated. However, it did not dawn on me that the unit having a built in IR might need the additional power that the phone would not be able to give and provide normal functioning battery life for the phone itself. And the fact that there are some meters on the market that are IR compatible that would be unnecessary to have a data cable that was constantly attached. So I am reevaluating it and giving it a 10 out of 10.

I am also pleased to know that your meter data is available across platforms. I was able to pull readings from my iPhone and see them on my Android. So this makes the device even more universal and friendly. That is why Im giving it 10 out of 10. I have also synced my other meters with the App with only a few finger swipes. Unlike other mobile Apps that boost their ‘ease’ of use features. With Glooko its 2 swipes and your new meter is ready to go.

Get your Glooko meter cable here http://www.amazon.com/gp/product/B00F9K7BWQ
Get Glooko for Android here https://play.google.com/store/apps/details?id=com.glooko.logbook
Get Glooko for iPhone here https://itunes.apple.com/us/app/glooko-logbook-diabetes-take/id471942748?mt=8

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ABOUT INSULIN

What is insulin?

Insulin is the internal secretion of the pancreas formed by groups of cells called the islets of Langerhans. It is the hormone needed to enable glucose to enter the cells and provide energy. Insulin is also important in keeping blood glucose levels within the acceptable limits.

Insulin is injected into the body by people with type 1 diabetes in whom the cells that produce insulin have been destroyed. This is the most common form of diabetes in children and young adults, and they depend on insulin for survival. Insulin may also be used by people with type 2 diabetes, where the body needs more insulin than it can produce.

How is insulin prepared?

Since the landmark discovery of insulin by Frederick Banting and Charles Best in 1922, huge steps have been made in research and development regarding its preparation. Early preparations of insulin were purified quite crudely from pancreas tissue extracted from animals - either pigs or cattle. Today, insulin is mostly made biosynthetically by recombinant DNA technology or 'genetic engineering'.

Animal insulin

Until the 1980s, all insulin was extracted from the pancreases of cattle and pigs. The sequence of amino acids (the building blocks that make up the protein) is slightly different in insulin's from the different species. Compared to human insulin, porcine (pork) insulin has one different amino acid and bovine (beef) insulin three different amino acids. These very slight differences do not affect the way in which the insulin works inside the human body. Pork insulin is structurally closer to human insulin than is beef insulin. These days, animal insulin's are made from highly purified pancreas extracts and are marketed as 'natural' insulin's.

Human insulin

Human insulin is not prepared from human pancreas tissue. Rather than being extracted from human pancreases, commercially available human insulin is manufactured through recombinant DNA technology, in which the gene for making human insulin is transferred into simple cells such as bacteria or baker’s yeast. The insulin made by those cells is identical to insulin made by the human pancreas. Unlike animal insulin's, recombinant DNA human insulin's can be made in unlimited supply, since they do not depend on the supply of bovine and porcine pancreases.
Analogue insulin
Analogues are altered molecular versions of a natural substance (in this case insulin). They have been used in many therapies where hormone treatment is needed. The natural hormone is changed slightly, by rearranging the position of amino acids within the molecule (rather like changing the position of beads on a necklace). The insulin molecule is modified so as to give it a more desirable activity profile, thereby making it more convenient to use. These molecularly engineered hormones more closely mimic normal insulin secretion than do traditional insulin's.

Types of Insulin
Manufactured insulin comes in several types that differ in the way in which they act inside the body. Each type differs in three ways:

• Onset: the length of time after injection that the insulin begins to work
• Peak: the length of time after injection that the insulin takes to reach its maximum effectiveness
• Duration: the length of time that the insulin remains effective

The four basic types of insulin and their respective onset, peak and duration are as follows:

• Rapid-acting: begins to work after 15 minutes, peaks in 30 to 90 minutes, and has a duration of three to four hours.
• Short-acting: begins to work in 30 to 60 minutes, peaks in two to three hours, and has a duration of three to six hours.
• Intermediate-acting: begins to work in 90 minutes to six hours, peaks in four to 14 hours, and has a duration of up to 24 hours.
• Long-acting: begins to work in six to 14 hours and remains effective for 24 to 36 hours.

Many people with diabetes use combinations of theses different types of insulin to better control and manage their condition.
Sources: Diabetes Insight (www.diabetes-insight.info); Diabetes UK (www.diabetes.org.uk); Juvenile Diabetes Research Foundation (www.jdrf.org) Insulin use in the world
Insulin is currently underutilized in developing countries as shown in the table.
Source: King H. Insulin: availability, affordability, and harmonization. WHO Drug 1998: 4: 219-223.
Some 65% of people with diabetes live in developing countries and account for only 30% of the world's total insulin usage each year. This is in sharp contrast to the industrialized world that has 35% of the world's diabetic population but account for about 70% of the world's total insulin usage each year.
This difference cannot be entirely due to the low incidence and prevalence of type 1 in the developing countries. Moreover, only a small percentage of people with type 2 diabetes in developing countries may require insulin for survival. The consequences are that in some parts of Africa many people with type 1 diabetes under the age of 15 can expect to live for just one year after diagnosis1.

 

ORIGINAL POST FROM http://www.idf.org/about-insulin-0

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Testicle Check

original content found at http://accidentalbear.com/health-check-a-rugby-teams-testicle-check-watch-video/

Im posting this because I believe this is important information for all men to know.
 

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Three Devastating Statistics of Diabetes Medical Malpractice

Guest Post by Jonathan Portner

It is often forgotten that the preventable consequences of diabetes are just that: preventable. While diabetes itself cannot be cured, the symptoms that are experienced can be managed effectively. The level of care that is given determines whether the patient will be able to carry out his life normally or burdened with crushing ailments. In medical malpractice cases, the standard of care is the ruler that is used to measure the care given to a medical malpractice victim. In cases of diabetes medical malpractice, the standard of care for measuring blood sugar is regular home blood testing.

For over 30 years, the American Diabetes Association has been rallying for better preventative care for diabetes patients. One of the most essential ways in which diabetics can manage their symptoms is through regularly tracking their blood sugar. In 1976, the ADA published this statement, emphasizing the critical need for regular blood monitoring: “[T]he weight of evidence strongly supports the concept that microvascular complications of diabetes are decreased by reduction of blood glucose concentrations. The goal of appropriate therapy should include a serious effort to achieve levels of blood glucose as close to those in the nondiabetic person as feasible.”

Although regular monitoring has been the standard of care since 1986, over a decade later in 1999, the CDC discovered that barely 40% of diabetics are testing their blood regularly. It was found that those patients who respected the toll that poor blood sugar control can take on their bodies were those who were the most adamant in their testing habits.

When blood sugar control is not monitored, the effects can be devastating:

1) As many as 24,000 new cases of adult-onset blindness occur each year as a result of diabetes.

2) Approximately 82,000 new lower-limb amputations occur each year, making diabetes the leading cause of non-traumatic amputation in the United States.

3) 44% of new cases of end-stage kidney disease each year is caused by diabetes.

When a patient declares that he was not informed of the importance of home blood sugar testing, doctors oftentimes claim that the doctor informed the patient of the issue, but the patient refused to heed to the advice. In these cases, experienced diabetes medical malpractice attorneys know that a strong line of questioning usually reveals that the doctor failed to document this alleged conversation, even when everything else of consequence to the patient is recorded. One must remember that it is the physician’s job to ensure that the patient is fully educated, and if the patient is not, it is important for the physician to make a referral to a diabetes education specialist.

 

For more information about medical malpractice, please visit: www.portnerandshure.com

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Mixed Results On Computer-based Support For Diabetes

Cell phones and computer programs give specific advice and support to people with diabetes, but do not do much to improve their health or quality of life, new research suggests.
The outcomes, published in The Cochrane Library, were based on an analysis of 16 previous studies that assessed a different type of interactive intervention. A few of the programs gave access to social networking and peer support groups from home - some were readily available to patients when they visited a clinic.
Despite the fact that mobile phone and computer management programs have small positive effects on blood sugar levels - these effects are short-lived.
Close to 347 million adults around the world live with diabetes and are at an elevated risk for complications like heart attack and stroke.

Some previous research has proven that giving chronically ill patients the skills to control their own disease can help them reduce their risk of complications.
Smart phones and computers give the opportunity to better self-care for diabetes through patient-specific education and support - in turn decreasing costs to health care systems.
The investigators in the current study analyzed data from 16 trials consisting of 3,578 people with type 2 diabetes who used cell phones and computers as part of controlling diabetes interventions ranging between one and twelve months.
Generally, these interventions had positive advantages, but they were limited. In regards to controlling blood sugar, there were small advantages, and even greater advantages for those whose self-care programs were monitored by cell phone.
The authors noted that the advantages decreased after six months. Additionally, there was no proof that these interventions helped improve depression, quality of life or weight in people who have type 2 diabetes.
Lead researcher, Kingshuk Pal of the Research Department of Primary Care and Population Health at UCL in London, said, "Our review shows that although popular, computer-based diabetes self-management interventions currently have limited evidence supporting their use. There are also few studies looking at cost-effectiveness or long-term impact on patient health."
The authors emphasized that some research of computer-based interventions helped to improve education and understanding of diabetes, however, this did not lead to behaviors that can better health, like diet changes and exercise.
Dr. Pal concluded:

"Effective self-management is a complex task that may require changes to many aspects of people's lives. Any intervention to help that process needs to support sustained behaviour change in different areas like eating habits, physical activity or taking medication regularly and provide emotional support. We did not see any convincing evidence for long-term change like this in the interventions we looked at."

Researchers Found Software Program Helpful for Type 2 Diabetes Patiens

Researchers form Maryland University School of medicine reported in Diabetes Care (September 2011 issue) that an interactive computer software program appeared effective in helping patients manage their type 2 diabetes using their cell phones.
Patients who used the application experienced a 1.9% drop in A1c levels over a period of one year.
Charlene C. Quinn, Ph.D., R.N., an assistant professor of epidemiology and public health at the University of Maryland School of Medicine and the principal investigator, said "The 1.9 percent decrease in A1c that we saw in this research is significant. Previous randomized clinical trials have suggested that just a 1 percent decrease in A1c will prevent complications of diabetes, including heart disease, stroke, blindness and kidney failure."

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High-Fat Foods May Be A Factor In Glucose Control

In a study of patients with type 1 diabetes, Joslin researchers found that dietary fat can affect glucose levels and insulin requirements. These findings, which appeared in the April edition of Diabetes Care, have major implications for the management of type 1 diabetes.
Research has shown that dietary fat and free fatty acids (FFAs) impair insulin sensitivity and increase glucose production. Most studies have focused on the role of fat in the development of type 2 diabetes. However, studies of people with type 1 diabetes have shown that higher-fat pizza meals cause hyperglycemia hours after being consumed.

In reviews of continuous glucose monitoring and food log data from adult patients with type 1 diabetes, Joslin clinicians observed that "several hours after eating high-fat meals, glucose levels went up," says study lead author Howard Wolpert, MD, Senior Physician in the Joslin Clinic Section on Adult Diabetes and the Director of the Insulin Pump Program at Joslin. "We wanted to determine the underlying cause of these unexplained fluctuations."
Seven participants (adults with type 1 diabetes with an average age of 55) successfully completed the study. They spent two days at Beth Israel Deaconess Medical Center eating carefully controlled meals and having their glucose and insulin levels monitored.
All breakfasts and lunches featured identical low-fat content. The two dinners had identical carbohydrate and protein content but one was low-fat and the other high-fat. For two 18-hour periods beginning before dinner, participants had their insulin automatically regulated by a closed-loop system and their glucose and plasma insulin levels tested at frequent intervals.
Study results showed that participants required more insulin after eating the high-fat dinner than the low-fat dinner (12.6 units compared to 9 units). In contrast, the two breakfast meals required similar insulin doses. Despite the increased insulin, participants had greater hyperglycemia after the high-fat dinner with insulin levels elevated five to ten hours after the meal. The average increase in insulin was 42 percent with significant individual differences.
"These findings highlight the limitations of basing mealtime insulin dosing for type 1 diabetes solely on carbohydrate intake," says Dr. Wolpert. "We need to consider fat as well as carbohydrates in insulin dosing calculations as well as in nutritional recommendations."
Dr. Wolpert and the research team are about to start a new study funded by the Juvenile Diabetes Research Foundation that aims to define optimal insulin dosages for higher-fat meals. Participants will eat controlled high-fat meals and receive increasingly higher doses of insulin until the optimum dose is determined. "We are looking to identify individual patient characteristics that influence how much additional insulin individuals with type 1 diabetes need to cover high-fat meals," he says. "As we learn more about how dietary fat affects insulin control, we will apply our findings to improve treatment recommendations and outcomes for patients with diabetes."
They are also planning an intervention study to assess whether reducing fat intake would optimize glucose control. In the coming months, Dr. Wolpert also anticipates developing new guidelines for clinicians and patients to enable them to determine whether high-fat foods are a factor in glucose control and make appropriate nutritional changes.

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Disrupting Our Internal Clocks May Lead To A Complete Absence Of 24-Hour Bodily Rhythms And An Immediate Gain In Body Weight

If you're pulling and all-nighter to finish a term paper, a new parent up all night with a fussy baby, or simply can't sleep like you once could, then you may be snoozing on good health. That's because new research published in The FASEB Journal used mice to show that proper sleep patterns are critical for healthy metabolic function, and even mild impairment in our circadian rhythms can lead to serious health consequences, including diabetes and obesity.

"We should acknowledge the unforeseen importance of our 24-hour rhythms for health," said Claudia Coomans, Ph.D., a researcher involved in the work from the Department of Molecular Cell Biology in the Laboratory of Neurophysiology at Leiden University Medical Center in Leiden, Netherlands. "To quote Seneca 'We should live according to nature (secundum naturam vivere).'"
To make this discovery, Coomans and colleagues exposed mice to constant light, which disturbed their normal internal clock function, and observed a gradual degradation of their bodies' internal clocks until it reached a level that normally occurs when aging. Eventually the mice lost their 24-hour rhythm in energy metabolism and insulin sensitivity, indicating that relatively mild impairment of clock function had severe metabolic consequences.
"The good news is that some of us can 'sleep it off' to avoid obesity and diabetes," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "The bad news is that we can all get the metabolic doldrums when our normal day/night cycle is disrupted."

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Visiting Your Doctor Following ER Care For Chest Pain Reduces Risk Of Heart Attack, Death

Seeing a doctor within a month of an emergency room visit for chest pain significantly reduced the risk of heart attack or death among high risk patients, according to research published the American Heart Association journal Circulation.
Chest pain is the most common reason people go to the emergency room in developed countries and accounts for more than 5 million ER visits each year in the United States.

The study is the first to demonstrate the importance of follow-up care for chest pain patients after leaving the ER, researchers said. High risk patients in this study were those with previously diagnosed heart disease or diabetes.
"Being discharged from the emergency department is reassuring for patients, but it is critical that they follow up with their doctor to reduce their risks of future heart attacks or premature death," said Dennis T. Ko, M.D., M.Sc., senior author and scientist at the Institute for Clinical Evaluative Sciences, Cardiologist at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. "Patients need to advocate for themselves and physicians need to be more diligent about arranging follow-up care."
Researchers analyzed data on 56,767 adults (average age 66, 53 percent men) in Ontario, Canada, who were diagnosed with chest pain in an emergency room between April 2004 and March 2010; had been previously diagnosed with heart disease or diabetes; and didn't require additional hospitalization or die within a month. They tracked data for a median 3.7 years and accounted for differences in key patient characteristics such as age, gender, health status and location.
Among the findings:

• Only 17 percent of high risk chest pain patients seen in the emergency room were evaluated by cardiologists within a month; 58 percent saw a primary care physicians alone, and 25 percent had no physician follow-up within a month.
• Patients who followed up with a cardiologist within 30 days were 21 percent less likely to have a heart attack or die within one year, compared with patients who failed to seek additional care within that time.
• Patients seen by a primary care physician were 7 percent less likely to have a heart attack or die compared to those patients who sought no follow up care.
• Patients treated by cardiologists received more testing, procedures and medication within 100 days of their ER discharge and had the best health outcomes.
• Patients seen by their cardiologist were 15 percent less likely to have a heart attack or die within the first year, compared to patients who received follow up care from their primary care physician.

Patients who didn't seek follow-up care within a month received the lowest rate of care and had the worst health outcomes - demonstrating the need to improve follow-up with high risk chest pain patients after they're discharged from the emergency room, Ko said.
The study notes that there are several reasons patients did not receive additional physician follow-up including: patients believing they didn't need additional care and the lack of a coordinated referral system from the emergency department to physicians who can provide follow-up care.
While there is no cost for seeing a physician at follow-up in the Canadian health care system, the barriers for follow up care could include expense in other countries.
"As physicians, we are often so focused on knowing which drug to prescribe or which test to order that we overlook the fact that many patients fail to get follow-up care to begin with," Ko said. "We need systems of care that better identify these patients who are at increased risk because getting that follow-up can significantly reduce their risks of heart attack or premature death."
Because the study focused on high risk patients, the results may not apply to all who have chest pain. Researchers recommend further study that will also investigate economic factors.

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Supplementation Of Alternative Fuels Could Protect The Brain During Hypoglycemia

Tight control of blood glucose levels is critical to mitigating the long-term complications of diabetes; however, the intensive insulin therapy required for this control is frequently accompanied by recurrent episodes of low blood sugar (hypoglycemia). Hypoglycemic episodes have been implicated in brain damage and cognitive impairment. Though the brain depends predominantly on glucose as an energy source, it can also use alternative fuels, such as lactate, to satisfy its energy requirements.

In this issue of the Journal of Clinical Investigation, Raimund Herzog and colleagues at Yale University used magnetic resonance spectroscopy (MRS) to measure the concentrations and enrichment of different energy substrates and their metabolites in a rat model of recurrent hypoglycemia. They found that recurrent hypoglycemia enhances neuronal uptake of lactate which allows the brain to retain normal neural activity during hypoglycemia. These observations suggest that lactate supports neuronal function and indicate that supplementation of alternative fuels could protect the brain during hypoglycemia.

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Household Income Affects Chronic Disease Control In Kids, Despite Free Health Care

Researchers at the University of Montreal have found that the glycated hemoglobin levels of children with type 1 diabetes followed at its affiliated Sainte-Justine Mother and Child University Hospital (CHU Sainte-Justine) is correlated linearly and negatively with household income. Glycated hemoglobin is the binding of sugar to blood molecules - over time, high blood sugar levels lead to high levels of glycated hemoglobin, which means that it can be used to assess

whether a patient properly controls his or her blood glucose level. "Our study highlights a marked disparity between the rich and the poor in an important health outcome for children with type 1 diabetes, despite free access to health care", explained Dr. Johnny Deladoëy, who led the study.
The researchers used statistics collected from 1,766 children who had been diagnosed with type 1 diabetes at CHU Sainte-Justine between 1980 and 2011. They estimated their household income by using the median for their postal code as reported by Statistics Canada and standardized their glycated hemoglobin levels (HbA1c) in order to undertake the study. "We know that there are a variety of socio-economic factors that affect metabolic control in diabetic children, but it is difficult to compare studies as researchers look at these factors in different ways", Deladoëy said. "However, median household income is a good proxy for these factors taken together". In addition, all studies on this subject have come from countries where users must pay to consult a health care professional whereas the present study is the first to look at this in the context of free health care. A study from Ontario, published simultaneously in another journal, reports similar findings.
Because there are so many factors influencing the treatment of this disease, the researchers were not surprised by their results. "These confirm our clinical impression that the most important factor correlated with the treatment of type 1 diabetes is household income", Deladoëy said. Importantly, the researchers found that the difference in glycated hemoglobin levels in kids from the poorest and the richest neighbourhoods corresponds to a doubling of the risk of damage to the eyes (diabetes is a leading cause of blindness in adulthood). "Type 1 diabetes is a chronic disease requiring multiple daily insulin injections and blood tests throughout the individual's life. Our study suggests that there should be greater support to children with type 1 diabetes who live in low income areas; this could include, for instance, increasing the number and length of visits from social workers", Deladoëy explained.

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Diabetes Trials Worldwide Are Not Addressing Key Issues In Affected Populations

Only one in ten are studying prevention while almost two thirds focus on drug therapy
An analysis of diabetes trials worldwide has found they are not addressing key issues relating to the condition with almost two thirds focusing on drug therapy while only one in ten addresses prevention or behavioural therapies. The research is published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), and is by Dr Jennifer Green, Duke University Medical Center, Durham, NC, USA, and colleagues.
There are an estimated 371 million people with diabetes in the world. By 2030, there will be some 550 million with diabetes based on current trends. As such, research addressing the whole spectrum of diabetes care and treatment is essential.

To examine whether current studies adequately address these needs, Green and colleagues analysed diabetes-related trials registered with ClinicalTrials.gov from 2007--2010.
The researchers found 2,484 interventional trials by selecting those with disease condition terms relevant to diabetes. Of these, 75% had a primarily therapeutic purpose while just 10% were preventive. Listed interventions were mostly drugs (63%) while few were behavioural (12%). Most of the studies were also small to medium sized, and were designed to enrol 500 or fewer participants (91%) or 100 or fewer (59%) participants, with mean/median times to completion of 1.8/1.4 years.
A very small proportion of trials targeted persons aged 18 years and under (4%). This may be appropriate given the number of children currently affected by diabetes; however, the estimated 3% annual increase in incidence of type 1 diabetes may warrant greater representation. Furthermore, the increase in type 2 diabetes among adolescents, particularly noticeable in wealthier nations, is of considerable concern, since as Dr Green notes "it is unclear whether findings obtained from trials of adults with diabetes are readily translatable to paediatric/adolescent populations".
And despite the fact that nearly 20% of adults worldwide aged 65 years and over have diabetes, less than 1% of trials specifically targeted this age group, while 31% actually excluded patients over 65 years and almost all excluded those over 75 years.
"Only a tiny proportion of the trials analysed--1.4%--listed primary outcomes including mortality or clinically significant cardiovascular complications," says Dr Green. "Furthermore, distribution of registered trials by country does not reliably correlate with diabetes prevalence."
The International Diabetes Federation list of the 10 locations most affected by diabetes includes six Middle Eastern countries in which diabetes prevalence among adults is approximately 20% (Kuwait, Lebanon, Qatar, Saudi Arabia, Bahrain and the United Arab Emirates). However, this analysis by Green and colleagues, suggests that this region is minimally involved in the registered diabetes-related trials. Comparison of trial activities in countries with the highest diabetes prevalence among adults revealed 1126 trials in the USA. China, India and Mexico participated in 101--250 trials each; however, the Russian Federation (12.6 million persons with diabetes) and Brazil (12.4 million) are involved in fewer than 100 registered trials despite these heavy disease burdens.
Dr Green also says: "Rates of complications including diabetic retinopathy, lower extremity amputation, and end-stage renal disease vary among ethnic groups. To achieve the greatest impact upon clinical care, trials should enrol patients representative of populations disproportionately affected by diabetes and its complications. A better understanding of responses to interventions among diverse individuals and groups may inform individualised treatments of greater effectiveness and tolerability."
She concludes: "The majority of diabetes-related trials include small numbers of participants, exclude those at extremes of age, are of short duration, involve drug therapy rather than preventive or non-drug interventions, and do not focus upon significant cardiovascular outcomes. Recently registered diabetes trials may not sufficiently address important diabetes care issues or involve affected populations...Although many trials will provide valuable information upon completion, our review suggests that the current portfolio does not adequately address disease prevention, management, or therapeutic safety. This information may be meaningful in the allocation of future research activities and resources."

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Diet As Effective As Surgery For Diabetes Patients

Patients with type 2 diabetes who follow the same strict diet required for those who undergo bariatric surgery are just as likely to see a reduction in blood glucose levels.
The finding came from a new study conducted by researchers at UT Southwestern Medical Center and was published in the journal Diabetes Care.
Dr. Ildiko Lingvay, assistant professor of internal medicine and first author of the research, said:

"For years, the question has been whether it is the bariatric surgery or a change in diet that causes the diabetes to improve so

rapidly after surgery. We found that the reduction of patients' caloric intake following bariatric surgery is what leads to the major improvements in diabetes, not the surgery itself."

Ten patients were involved in the report and were followed in a controlled, inpatient setting during two separate times.
At first, the participants were treated only with the standard diet that patients who receive bariatric surgery are required to follow. The experts measured blood glucose levels to determine the impact of the diet.
After many months passed, the subjects received the Roux-en-Y gastric bypass bariatric surgery and followed the same diet. Once again, the scientists observed the patients' blood glucose levels.
During each of these observations, which lasted for 10 days, the volunteers consumed less than 2,000 calories total each day - the customary diet for gastric bypass surgery patients.
Results showed that during the diet-only period, fasting blood glucose levels reduced 21% on average, and after combining the diet with the procedure, levels decreased 12%.
After a standard meal, patients' overall blood glucose levels dropped 15% in the diet-only period and 18% after combining diet with surgery.
This indicates that the very strict diet given to patients after bariatric surgery is accountable for the quick diabetes remission, which usually occurs within days of the operation, the authors said. Previous research found that 67% of bariatric surgery patients were in complete remission for type 2 diabetes after 12 months.
Dr. Lingvay explained:

"Unfortunately, such a restrictive diet is nearly impossible to adhere to long-term in the absence of bariatric surgery. We found that the success of bariatric surgery is mediated through its ability to control food intake, which in turn has a beneficial effect on diabetes."

Type 2 diabetes often develops as an outcome of obesity and occurs because the body cannot meet the increased need of insulin brought upon by obesity and insulin resistance. According to a report from March of this year, people at high risk of developing type 2 diabetes can reduce the risk by sitting less and moving around more frequently.
Over 20 million people in the U.S. are affected by type 2 diabetes, according to the American Diabetes Association.
A recent study found a key mechanism in the immune system that plays a part in the development of obesity-linked type 2 diabetes. The findings, which were published in Cell Metabolism, are a stepping stone for new treatment methods, according to the authors.
If diabetes is left untreated, the disease can lead to other conditions, such as:

• stroke
• heart disease
• nerve damage
• kidney damage

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Late-Life Depression Associated With Prevalent Mild Cognitive Impairment, Increased Risk of Dementia

Depression in a group of Medicare recipients ages 65 years and older appears to be associated with prevalent mild cognitive impairment and an increased risk of dementia, according to a report published Online First by Archives of Neurology, a JAMA Network publication.

Depressive symptoms occur in 3 percent to 63 percent of patients with mild cognitive impairment (MCI) and some studies have shown an increased dementia risk in individuals with a history of depression. The mechanisms behind the association between depression and cognitive decline have not been made clear and different mechanisms have been proposed, according to the study background.

Edo Richard, M.D., Ph.D., of the University of Amsterdam, the Netherlands, and colleagues evaluated the association of late-life depression with MCI and dementia in a group of 2,160 community-dwelling Medicare recipients.

"We found that depression was related to a higher risk of prevalent MCI and dementia, incident dementia, and progression from prevalent MCI to dementia, but not to incident MCI," the authors note.

Baseline depression was associated with prevalent MCI (odds ratio [OR], 1.4) and dementia (OR, 2.2), while baseline depression was associated with an increased risk of incident dementia (hazard ratio [HR], 1.7) but not with incident MCI (HR, 0.9). Patients with MCI and coexisting depression at baseline also had a higher risk of progression to dementia (HR, 2.0), especially vascular dementia (HR, 4.3), but not Alzheimer disease (HR, 1.9), according to the study results.

"Our finding that depression was associated cross sectionally with both MCI and dementia and longitudinally only with dementia suggests that depression develops with the transition from normal cognition to dementia," the authors conclude.

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Young people with diabetes dying due to lack of adequate healthcare

Originally posted on: http://www.diabetes.org.uk/About_us/News_Landing_Page/Young-people-with-diabetes-dying-due-to-lack-of-adequate-healthcare/

Young adults with Type 1 diabetes are much more likely to die than their peers because they are not getting the healthcare they need to manage their condition.

Young women with Type 1 diabetes are nine times more likely to die than their peers – and young men with Type 1 diabetes are four times more likely – and this is likely to be because many of them have not had the care needed to give them the best chance of a long and healthy life.

Blood glucose targets missed

The lack of good-quality healthcare is reflected in the fact that 85 per cent of children with Type 1 diabetes have poor blood glucose control, which puts them at significantly increased risk of devastating health complications later in life.

Just 15 per cent of children with the condition have HbA1c levels (the standard measurement for blood glucose) of under 7.5 per cent, compared to the 34 per cent of children achieving this in comparable countries such as Germany and Austria.

Type 1 essentials for children and young people

This is why we have published the Type 1 essentials for children and young people: a guide that sets out the 10 things that every child with Type 1 diabetes needs.

We are calling on NHS management to make sure the resources are in place so that children with Type 1 diabetes have access to this care, and for healthcare professionals to make sure their patients are getting good-quality care. Parents of children with Type 1 diabetes can use the checklist when discussing care with healthcare professionals, to ensure that their child is receiving the care that he or she should.

Guide to good care

Barbara Young, Chief Executive of Diabetes UK, said, "The fact that so many people with Type 1 diabetes are doing less well than they should is at least partly the consequence of the quality of healthcare for children with the condition.

"Our Type 1 essentials for children and young people sets out the care every child with Type 1 diabetes should be getting – but many children do not get this care.

No reason to lag behind

"There is no good reason why we should be lagging so far behind countries such as Germany in terms of management of the condition, but the stark truth is that the UK fails to deliver good-quality healthcare for children with Type 1 diabetes. Every child needs to get the 10 things that can make a real difference.

"By publishing our guide to what good care looks like, we hope the NHS will ensure that services are commissioned and organised to give every child with Type 1 diabetes the quality of healthcare they deserve. We want parents and healthcare professionals to understand what good care is so they can play their part in making sure it is delivered.

Making sure every child gets 10 out of 10

"Our children with Type 1 diabetes have been let down by poor healthcare for too long. By making sure every child gets 10 out of 10, we can give every child with the condition the best possible chance of a long and healthy life."

"No family should have to struggle to get good care"

Amelia Lily, popstar and children’s ambassador for Diabetes UK, said, "As someone who has Type 1 diabetes myself, I know that no family should have to struggle to get the good care their child deserves. But that’s what thousands of families with children with Type 1 diabetes have to do year in, year out.

"The best possible start in life"

"I’m supporting Diabetes UK’s campaign because I’m passionate about putting an end to poor care so that children and young people with Type 1 diabetes can achieve the best possible start in life.

"Good care for children is so important because it puts you on the road to helping you manage your condition for the rest of your life and helps reduce the risk of developing serious complications, or even dying before your time.

"Living with Type 1 diabetes is hard enough. It’s vital that good healthcare is in place so that can children with the condition can get on with enjoying their childhood."

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Up to Half of Gestational Diabetes Patients Will Develop Type 2 Diabetes, Study Finds

Women who were diagnosed with gestational diabetes during pregnancy face a significantly higher risk of developing Type 2 diabetes in the future, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

The prospective cohort study tracked 843 women who were diagnosed with gestational diabetes between 1996 and 2003 at Cheil General Hospital in Seoul, South Korea. About 12.5 percent of the women developed Type 2 diabetes within two months of delivering their babies. During the next decade, the number of women diagnosed with Type 2 diabetes continued to grow at a rate of 6.8 percent a year.

"The findings indicate as many as half of Asian women who had gestational diabetes will develop Type 2 diabetes within eight years of giving birth," said the study's lead author, Soo Heon Kwak, MD, of Seoul National University Hospital.

The study is among the largest of its kind to study Asian women who had gestational diabetes. Researchers followed 370 participants for more than a year after the birth of their children. Of the remaining women studied, 105 were diagnosed with type 2 diabetes within two months of giving birth and the remainder did not participate in long-term follow-up visits.

Researchers identified two distinct groups of women who were at risk -- those who developed Type 2 diabetes within two months of giving birth and those who took a year or more to progress to a Type 2 diabetes diagnosis. Although obesity was a major risk factor for both groups, researchers found genetic variations that could explain the timing of the disease's onset.

Women who rapidly developed Type 2 diabetes had a significant defect in insulin secretion. Among this population, researchers found a variation in the HHEX (hematopoietically expressed homeobox) gene that is associated with Type 2 diabetes.

Women who were slower to develop Type 2 diabetes were more likely to have a variation in the CDKAL1 gene, which also has been linked to Type 2 diabetes.

More research into genetic and environmental risk factors is needed to develop models that can better predict who will develop Type 2 diabetes, Kwak said. In the meantime, women who had gestational diabetes should undergo regular blood sugar testing.

"It is crucial for women who had gestational diabetes to have their blood sugar levels checked two months after giving birth and annually thereafter," Kwak said. "In addition to the problems undiagnosed Type 2 diabetes poses to the mother, leaving the disease untreated increases the risk of any future children developing congenital disorders."

Other researchers working on the study include: H. Jung, Y. Cho, S. Kim and K. Park of Seoul National University Hospital; S. Choi, S. Lim and H. Jang of Seoul National University Bundang Hospital; and N. Cho of Ajou University School of Medicine.

The article, "Clinical and Genetic Risk Factors for Type 2 Diabetes at Early or Late Post-partum after Gestational Diabetes Mellitus," appears in the April 2013 issue of JCEM.

Related articles

• Up To Half Of Gestational Diabetes Patients Will Go On To Develop Type 2 Diabetes (medicalnewstoday.com)
• Type 2 Diabetes Clinical Trial Now Enrolling at Achieve Clinical Research in Birmingham, Alabama; Accepting M/F Age 18+ with Type 2 Diabetes (prweb.com)
• mHealth program helping Mexican women with gestational diabetes info (voxxi.com)

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Tips to Minimize Occurrence of Stretch Marks During and After Pregnancy

Stretch marks during and after pregnancy are inevitable. It occurs as a result of the stretching of the skin up to its limits. As the skin tends to stretch to house the growing fetus, the collagen fibers tend to compensate to bring skin together. This is the reason why there are white streaks around the mother’s tummy. This does not only happen to mothers but to those who have suffered from a drastic change in weight. While this seems to be a big problem to a lot of people, there are actually things that one can do to be able to get rid of the scars it leaves.

One of the secrets in order to hasten the process of healing is hydration. Hydration is important in order to clean the body from toxins that may come interfering with the process of healing. Hydration is also important to keep the tissues intact and not dried out.

Moisturize skin. Moisturizers will help prevent itching and drying caused by the stretching of collagenous material. As the skin is moisturized, it will avoid inflicting harm on the skin brought by stretching. There are creams available in the market that can be bought with prescription or over the counter. But before this, one should consult on a physician in order to find the cream that will suit your needs. Consultation is important in order to get rid of the possible existence of allergies brought by some ingredients comprising the cream.

Diet does not always go out of style. Most of the health problems existing can be controlled with the use of proper diet. Controlling the effects of stretch marks is one. Vegetables and fruits for instance helps the body get the needed amount of nutrients to function. This is a proven fact but it goes with a bonus too. These foods tend to let you have softer and moisturized skin which is great news to combat the effects of drying brought by stretch marks. Once the skin is softer, marks may come limited.

If diet is one of the vital things to consider, exercise goes to follow. Exercise, just like proper diet has never grown out of the spotlight. It has always brought myriad of benefits in the aspect of health. It is also linked with the reduction stretch marks. As one goes with exercise, the skin is tightened and toned. Once this happens, the skin easily comes back to its original form which means reducing the visible marks. This is also beneficial to help the uterus come back to its non-pregnant state after the pregnancy. This does not stop only once you achieve the form you have always wanted. Exercising regularly will help you tone your muscles, strengthening it to resist the effects of tearing.

Load yourself with vitamins. Vitamins specifically A, E and C are perfect for the skin. These vitamins have anti-toxin properties which wash away the toxins brought by the foods, beverages and drugs taken in. Once these toxins are completely washed away, it will reveal healthy skin. Once you have got the skin that is healthy, it will be easy for it to resist the effects of stretch marks and that the effects will be minimized. Even the feeling of itchiness will be controlled as you have the best defenses to achieve such.

Proper diet coupled with exercise should be enough in order to minimize the effects of stretch marks. If you come to observe it, it will just boil down to the idea of living a healthy life. You can never really go wrong over living the healthy life as it tends to direct you to becoming an individual resistant to health problems.

For an expectant mother, there are a lot of things to do to be able to finally get rid of the effects of stretch marks. Yet, for those who have already acquired such, it is never the end. Consult your doctor to know what you can do to get rid of it. You might be prescribed with creams safe enough to use during the pregnancy. All you have got to do is to relay your worries. Having stretch marks during and after pregnancy may come to shake you but these are controllable. And don’t forget to follow special diet, read some helpful recipes.

Naturally, the body reacts to the sudden change in the size of a person. You may think of it as a problem but stretch marks are just the effect of the natural mechanism of the body to resist tearing of skin when it has reached the limit. This is actually an indication that your body is working its functions well enough. But since its appearance is bothersome, you would naturally get rid of it. Living the healthy life would help well enough to combat the not so good effects of this naturally occurring body process.

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