#AADE17: An Uncertain Future For Diabetes Education

#AADE17: An Uncertain Future for Diabetes Education

What will diabetes education look like in 5-10 years? Or moving into 2030 for that matter?
One thing that became clear at the recent annual meeting of the American Association of Diabetes Educators (AADE) in Indianapolis is that there's some serious concern about this profession, which has been at a crossroads for at least a decade now, and we've wondered in the past if the organization was "lost at sea" in adapting to current trends.
To keep up with the changing times, some wonder now if we've reached a point where CDEs (Certified Diabetes Educators) might need to drop that official title in favor of something with more of a coaching bent, like "diabetes care coordinators," facilitators, managers, or possibly even "Diabetes Champions" (!)
Whatever the term, a big theme at the AADE conference was the fact that these healthcare team members have some of the highest potential to help PWDs (people with diabetes) by recognizing what's working and what isn't, and identifying other health or social issues that may be lurking beneath the surface. Yet CDEs are struggling to redefine their roles in a changing healthcare landscape, and are battling economic realities that prevent many patients from accessing them, or even knowing about the services they provide.
Ten years ago, the big crisis in diabetes education that people were talking about most was the shrinking pool of people going into the profession. But today's crossroads are more about the onslaught of new technology, and uncertainties around insurance coverage and overall access to these professionals who can really help PW Continue reading

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A Tale of a Diabetes Pizza Study

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When pizza meets diabetes in a medical research.
You may have a certain image that comes to mind when you think of a clinical trial. But did you know that a study can involve eating pizza?
There are certain foods that I have to eat with aspray and pray mentality where I can only hope for the best. All too often though, the best is rarely realized. When I was approached by the Joslin Institute for Transformational Technology Program, which is new group headed by Dr. Howard Wolpert in Boston, and they asked me to be a subject in a pizza study, I signed up right awa Continue reading

Why Are We Waiting To Treat Diabetes Until A1c Reaches 6.5%?

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Why Are We Waiting To Treat Diabetes Until A1c Reaches 6.5%?
Getting type 2 diabetes at an early age increases risk for all diabetes complications, including death.
Going back years, the diagnosis of diabetes was a fasting plasma glucose (FPG) of 180 mg/dl. Today, its an FPG of 126 mg/dl or greater, or an A1C of 6.5% or greater. But should the diagnostic standard move even further, to 100 mg/dl, a lower A1C, and treatment for diabetes start much earlier?
To examine the association between early onset of type 2 diabetes mellitus (DM) and clinical behavioral risk factors for later complications of diabetes, 5,115 people with type 2 were enrolled in a cross-sectional study. Risk factors at time of diagnosis among those diagnosed at 45 years (early onset) with diagnosis age 46 to 55, 56 to 65 (average onset = reference), 66 to 75, and >75 years (late onset) were recorded.
According to the analysis, being diagnosed with type 2 diabetes at a young age comes with more serious complications and higher rates of death than being diagnosed later in life.
We know that it takes many years to develop complications in diabetes and having type 2 at a younger age equates to a higher lifetime risk of complications given the projected length of exposure to high glucose and other risk factors. This includes higher death rates, which rose to six times higher when subjects were in early middle age.
Those diagnosed between ages 15 and 30 had more severe nerve damage and signs of early kidney di Continue reading

Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence

Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
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Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
Renata Micha, Georgios Michas, and Dariush Mozaffarian
Growing evidence suggests that effects of red meat consumption on coronary heart disease (CHD) and type 2 diabetes could vary depending on processing. We reviewed the evidence for effects of unprocessed (fresh/frozen) red and processed (using sodium/other preservatives) meat consumption on CHD and diabetes. In meta-analyses of prospective cohorts, higher risk of CHD is seen with processed meat consumption (RR per 50 g: 1.42, 95 %CI = 1.071.89), but a smaller increase or no risk is seen with unprocessed meat consumption. Differences in sodium content (~400 % higher in processed meat) appear to account for about two-thirds of this risk difference. In similar analyses, both unprocessed red and processed meat consumption are associated with incident diabetes, with higher risk per g of processed (RR per 50 g: 1.51, 95 %CI = 1.251.83) v Continue reading

Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world's leading diabetes organizations

Type 2 diabetes mellitus (DM) and obesity are chronic diseases that often coexist. Combined, they account for tremendous morbidity and mortality. Approximately 85% of all patients with type 2 DM have a body mass index (BMI) categorizing them as overweight (BMI 25.0–29.9 kg/m) or obese (BMI > 30.0 kg/m) (Figure 1). Obesity is strongly associated with diabetes and is a major cause of insulin resistance that leads to the cascade of hyperglycemia, glucotoxicity, and beta-cell failure, which ultimately leads to the development of microvascular (neuropathy, nephropathy, retinopathy) and macrovascular (myocardial infarction, stroke) complications. Treatment guidelines emphasize that both diabetes and obesity should be treated to optimize long-term outcomes. Metabolic surgery is the only diabetes treatment proven to result in long-term remission in 23% to 60% of patients depending upon preoperative duration of diabetes and disease severity. This review presents the evidence supporting use of metabolic surgery as a primary treatment for type 2 DM, potential mechanisms for its effects, associated complications, and recommendations for its use in expanded patient populations.
First-line therapy with lifestyle management and second-line therapy with medications, including oral agents and insulin, are the mainstays of type 2 DM therapy. Although these approaches have reduced hyperglycemia and cardiovascular mortality, many patients have poor glycemic control and develop severe diabetes-related complications. A study using data from the National Health and Nutrition Examination Survey Continue reading