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On our radar: Diabetes

Friday July 18, 2014
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NYU study indicates issues with Latinas learning about diabetes risks

A study by researchers at NYU indicates about 5.5 million Latin-American women suffer from elevated fasting plasma glucose and nearly four million of those women were never told by a healthcare provider they were at risk for diabetes, pre-diabetes or were borderline for diabetes.

The study, “Latinas with Elevated Fasting Plasma Glucose: An Analysis Using NHANES 2009-2010 Data,” which was led by Shiela M. Strauss, PhD, associate professor, NYU College of Nursing, points to the urgent need for alternate sites of opportunity for diabetes screenings, according to a news release.

The study also points to the need for effective and culturally sensitive follow-up care and case management. The study appears in Hispanic Health Care International, Vol.12:1, March 2014.

“Almost one million of these four million Latinas had not seen a doctor or other healthcare provider in the past 12 months,” Strauss said in the release. “This is of particular concern as it eliminates a potential opportunity for them to learn about their diabetes risk and their elevated FPG before it causes serious avoidable harm.”

The study’s data were drawn and analyzed from the National Health and Nutrition Examination Survey 2009-2010. The researchers examined data from 1,467 women who were given physical examinations and participated in interviews that asked about their socioeconomic status and demographic and health-related issues.

The researchers looked at how many women reported never being told by a healthcare provider that they were at risk of diabetes, had pre-diabetes or were borderline for diabetes. They then analyzed data from Hispanic subgroups, because cultural differences may argue for the development of different diabetes-related health-preserving strategies.

Study co-author Sherry Deren, PhD, director, Center for Drug Use and HIV Research and senior research scientist, College of Nursing, said in the release that the findings indicate “the urgent need to incorporate diabetes screening and culturally competent care across a broader range of healthcare visits.”

Diabetes Forecast 2014 Consumer Guide features new products

Diabetes Forecast, the Healthy Living Magazine from the American Diabetes Association, released its annual Consumer Guide in January, according to a news release. The new guide features new tools and how they fit into a treatment plan.
Highlights from this guide about diabetes devices and products include seven in-development products poised to make waves in the diabetes world.

Blood glucose meters

Will help people with diabetes make an educated decision in choosing a meter. The article also explains the Food and Drug Administration’s accuracy standards for meters and requirements announced by the International Organization for Standardization, which narrows the range for acceptable blood glucose readings and increase accuracy.

Insulin pumps

Outlines the top factors to consider when buying a pump, including one with a new threshold suspend feature, which automatically shuts off insulin delivery for up to two hours when hypoglycemia is detected and the user is unable to respond to an alarm.

Favorite apps

Readers share favorite smartphone apps for logging blood glucose results, counting carbs, recording exercise and losing weight.

Ketone test strips

Products offering a quick and easy way to determine if a person is at risk for diabetic ketoacidosis.

Aids for insulin users

Products that can help insulin users with dexterity problems, vision impairment and needle anxiety as well as profiles of some of the entrepreneurs behind them.

Study finds big increases in diabetes cases among youth

In a study that included data from more than 3 million children and adolescents from diverse geographic regions of the U.S., researchers found the prevalence of both Type 1 and Type 2 diabetes increased significantly between 2001 and 2009.

Researchers with the Colorado School of Public Health, Aurora, Colo., the University of North Carolina, Chapel Hill, and the SEARCH for Diabetes in Youth Study, examined whether the overall prevalence of Type 1 and Type 2 diabetes among U.S. youth has changed in recent years, and whether it changed by sex, age and race/ethnicity.

The analysis included cases of physician-diagnosed Type 1 diabetes in youths ages 0 through 19 and Type 2 diabetes in youths ages 10 through 19 years in 2001 and 2009.

The study population came from five centers located in California, Colorado, Ohio, South Carolina and Washington, as well as data from selected American Indian reservations in Arizona and New Mexico.

The prevalence of Type 1 diabetes among a population of 3.3 million youths was 1.48 per 1,000 in 2001 and increased to 1.93 per 1,000 among 3.4 million in 2009. After statistical adjustment, the authors wrote, the increase was 21% over the eight-year period.

The greatest prevalence increase was observed in youths ages 15 through 19. Increases were observed in both sexes and in white, black, Hispanic and Asian Pacific Islander youth.

The overall prevalence of Type 2 diabetes for youth ages 10 to 19 increased by an estimated 30.5% between 2001 and 2009 (among a population of 1.7 million and 1.8 million youth, respectively).

Increases occurred in white, Hispanic and black youth, whereas no changes were found in Asian Pacific Islander and American Indian youth. A significant increase was seen in both sexes and all age groups.

“Further studies are required to determine the causes of these increases,” the researchers wrote.

The study is titled “Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009.”

Veterans Affairs researchers study Type 2 diabetes to help more vets avoid it

Department of Veterans Affairs researchers are hard at work on one of the most widespread medical problems among Americans who have served their country: Type 2 diabetes.

“Type 2 diabetes is at epidemic proportions among the veteran population,” Tim O’Leary, MD, PhD, chief research and development officer, said in a news release. “It affects nearly 20% of veterans who use the VA healthcare system, compared to 8.3% of the general population. This means that diabetes — and with it, the risk of heart disease, stroke, blindness, renal disease and amputation — affects more than one million veterans at any given time.”

Millions of people don’t even realize they have the disease, since it can start out so subtly, according to the release.

“This is of tremendous concern for us at VA, and why we’re doing research that not only helps veterans avoid developing diabetes in the first place, but also helps them avoid developing those several other conditions,” O’Leary said in the release.

The VA has an extensive diabetes research portfolio and is adding to it all the time, according to O’Leary. “Many of our researchers are studying weight management, since being overweight or obese are significant risk factors for developing diabetes and are also epidemic among the veteran population,” O’Leary said in the release. “Approximately three-quarters of veterans are overweight, and nearly 40% are obese.”

O’Leary said the VA has participated in a number of large clinical trials, such as the Diabetes Prevention Program, where it was shown that losing weight and increasing exercise can reduce the progression from pre-diabetes to Type 2 diabetes.

“This effort,” he said, “has contributed to VA’s national weight management program, called MOVE, and also has been used beyond VA to improve the health of all Americans.”

AJMC study: Among diabetics, more weight equals less optimal blood pressure, A1C levels

With 26 million Americans diagnosed with diabetes and the incidence of diabetes tracking obesity geographically, researchers at Kaiser Permanente Southern California set out to determine whether overweight and obese patients with diabetes were more or less likely to seek health screenings associated with diabetes once they knew they had the condition.

The large scale study, published online in January by The American Journal of Managed Care, found Kaiser patients with diabetes consumed more healthcare services by seeking more screenings, and the higher the patients’ weight, the less optimal their blood pressure and A1C levels, according to a news release.

The study examined 164,721 patients enrolled in KPSC from July 1, 2007, to June 30, 2008, and asked whether obese patients — those with a body mass index of greater than 30 — would be less likely to seek common screenings for blood pressure, low-density lipoprotein cholesterol and retinal examinations.

Previous studies had shown overweight patients may avoid screenings generally. The question was whether those with diabetes would seek care.

The Kaiser results published by AJMC found the diabetic patients not only sought care, but that the more obese patients sought the most care and had the most difficulty maintaining control of their blood pressure and A1C levels.

According to the authors, the findings highlight the need for interventions to improve glycemic and blood pressure control among overweight and obese patients with diabetes.

Study indicates morbidity higher in obese liver transplant recipients with diabetes

Researchers from New Zealand report that morbidity after liver transplant is highest among obese patients with diabetes, but these risk factors do not influence post-transplant survival, according to a news release.

According to the study published in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, body mass index is effective for assessing obesity in liver transplant patients.

Prior research shows that liver transplant recipients who develop post-transplant diabetes and metabolic syndrome are at increased risk of cardiovascular disease.

Metabolic syndrome is a combination of hypertension, high blood sugar and high cholesterol along with increased belly fat.

“There is much evidence on post-transplant obesity and metabolic syndrome,” Adam Bartlett, MD, lead author of the New Zealand study, said in the release. ”However, the impact of pre-transplant obesity, hypertension and coronary artery disease on post-transplant outcomes has received less attention and is the focus of our study.”

BMI and percentage of body fat were measured before liver transplants in 202 patients at a New Zealand center between 2000 and 2010. Analyses of pre-transplant risk factors such as obesity, diabetes and coronary artery disease were conducted.

Analyses indicated obesity was an independent risk factor for diabetes and post-transplant complications. Diabetes in conjunction with obesity was the strongest predictor of complications after transplant and longer hospital stays.

Metabolic risk factors did not affect 30-day, one-year or five-year survival for liver transplant recipients.

“Our study confirms that BMI is an appropriate measure of body fat and obesity alone should not prevent patients from receiving liver transplants,” Bartlett said in the release. “Identifying modifiable risk factors during the pre-transplant assessment allows for earlier interventions including weight control, diabetes management and coronary interventions such as stenting, all which may improve long-term outcomes following liver transplantation.”

USC scientists uncover genetic clue to Type 2 diabetes risk

Los Angeles-based University of Southern California Keck School of Medicine scientists are part of an international team of researchers in Mexico and the United States that uncovered a new genetic clue that contributes to an increased risk of developing Type 2 diabetes, according to the school’s website.

The team performed one of the largest genetic studies in Mexican and Mexican-American populations, discovering a risk gene for Type 2 diabetes that had gone undetected in previous efforts.

The study indicates people who carry the higher risk version of the gene are 25% more likely to have diabetes than those who do not, and people who inherited copies from both parents are 50% more likely to have diabetes, according to the website story.

The higher risk form of the gene has been found in up to half of people who have recent Native American ancestry, including Latin Americans. The variant is found in about 20% of East Asians and is rare in populations from Europe and Africa, the study shows.

“This is another clear example of why we need to be conducting genetic studies in diverse populations, as here we found a locus for Type 2 diabetes that has been missed in previous efforts, which may contribute to the greater burden of disease in Latinos,” Christopher Haiman, ScD, associate professor of preventive medicine, said in the website story. Haiman, along with Distinguished Professor Brian Henderson, MD, comprise the Keck School team working on the international study.

The elevated frequency of this risk gene in Latin Americans could account for as much as 20% of the populations’ increased prevalence of Type 2 diabetes — the origins of which are not well understood.

To see the full article, visit news.usc.edu and type diabetes into the search bar.

Study looks at providers tracking key health measures and outcomes of care

A study of a group of manufacturing workers published in the American Journal of Managed Care found better care can make a difference, and can even compensate for being sicker at the outset, according to a news release.

“Better care” was defined in the study as having a doctor who tracked three key health measures: glycated hemoglobin, lipids and microalbuminuria. The study tracked 1,797 employees with diabetes from Alcoa Aluminum, who were followed from 2003 to 2009.

Researchers compared long-term health results of those diabetics whose doctors tracked all three measures, compared with diabetics whose doctors did not.

The study looked at time to progression for four common complications from diabetes: coronary artery disease, stroke, heart failure and renal disease.

Those who did not have all three health measures tracked were more likely to have heart failure or renal disease, and those who had all three measured tracked from the beginning were less likely to have complications overall.

Only 15% of the diabetics in the group had all three measures checked at the beginning of the study period.

Researchers noted the difficulty in assessing how care plays out over time. Did those patients who had the most symptoms at the beginning seek better care, or take better care of themselves in other ways?

“It is noteworthy that in the primary test of the hypothesis, the baseline characteristics created an uneven playing field, with more ostensibly sick patients having a higher rate of better care; thus, the deck was stacked against those with better care having better outcomes, an effect that began to be visually apparent in the third observation year,” the researchers wrote.

Harvard University report calls for changes to curb state’s ‘epidemic’

Diabetes rates in North Carolina have nearly doubled in 20 years, reflecting a rapidly growing “epidemic” that costs billions of dollars in medical spending and a less efficient workforce, according to a new report from Harvard University.

Diabetes is the seventh-leading cause of death in the state, where the disease is far more prevalent than in the U.S. overall, according to a press release.

It’s the third-leading cause of death among Native Americans and fourth among African Americans.

Funded through a grant from the Bristol-Myers Squibb Foundation and released May 29 in Raleigh, the report from the Center for Health Law and Policy Innovation at Harvard Law School is the result of research and over 90 interviews with policymakers, government agencies and nonprofits involved in North Carolina’s response to diabetes.

“This growing threat to the health of North Carolinians is also a threat to the state’s economy,” according to the report. which indicates diabetes is on track to cost the state’s public and private sectors more than $17 billion a year in medical expenses and lost productivity by 2025. It recommends the state take collaborative, coordinated efforts to attack known risk factors for diabetes for the population overall, and improve the quality of care and access to it for all who have the disease.

The report calls for “multipronged changes to the state’s healthcare, nutrition and physical activity landscapes,” including better access to healthy food and education programs; better access to medical and lifestyle interventions; improvements in the built environment; and new legislation and diabetes-related task forces.

In the U.S., diabetes affects nearly 26 million children and adults, or 1 in 10 Americans, and is the main cause of death for more than 71,000 Americans a year, according to the American Diabetes Association.

To see what else is trending, visit www.Nurse.com/Diabetes.


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