Landmark New Study: Weight Loss Alone Can Reverse Diabetes

A new landmark study in The Lancet reports that weight-loss can reverse diabetes. The British study found that type 2 diabetes, a chronic condition affecting more than 422 million people worldwide, can go into remission simply through weight loss — and no medication[1].
Weight loss is an important treatment for diabetes
When patients receive a type 2 diabetes diagnosis, doctors usually prescribe medication to control blood sugar levels. In this study, researchers divided 300 participants into two groups. Half went off their medication and used a weight loss program to manage the disease. The other half stuck with their usual diabetes treatment and medication. Those on the weight-loss program lost an average of 30 pounds over the course of three to five months using a liquid diet, along with a period of food reintroduction and cognitive-behavioral therapy. Compared to just 4% in the control group, 46% of the people in the diet group went into remission with their diabetes. All participants had been diagnosed with type 2 diabetes within six years of the study.
This study shows just how important it is to incorporate weight loss and diet into a treatment plan as soon as a person is diagnosed with diabetes. Dietary changes that include weight loss can help people take control of their disease, avoid serious complications like heart disease and neuropathy, and possibly even reverse the disease.
Why diet works better than medication in treating diabetes
Normally, insulin, the hormone that processes sugar, keeps blood sugar levels in check — by sending sugar to cells for energ Continue reading

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Why the ketogenic diet may help fight diabetes, cancer

A diet extremely high in fat may not seem like the best way to lose fat. But there’s a growing body of research showing that the high-fat, low-carbohydrate ketogenic diet is not only good for weight loss, but also may help in preventing disease.
The ketogenic diet, or keto, relies on using your fat as fuel, instead of glucose from carbohydrates or protein. Simply put, the daily ketogenic diet consists of 75 percent fat, 20 percent of protein, and a teeny allotment of carbohydrates, about 5 percent. This balance of macronutrients is intended to put your body in a state of ketosis, which suppresses the release of insulin and blood glucose levels. The benefits of ketosis to your health are improvements in biomarkers like blood glucose, reduction of blood pressure and decreased appetite due to fullness linked to consumption of fats.
You might think this sounds a lot like the Atkins diet — it’s not. The main difference lies in the protein content of the diet. Atkins tends to be very high in protein, while ketogenic is moderate.
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It's not the easiest plan to follow, but the theory of ketosis as a possible prevention against disease is gaining attention from cancer specialists. Tumor immunologist Dr. Patrick Hwu, one of the leading cancer specialists in the U.S., has followed the keto diet for four years, although he prefers to call it the fat-burning metabolism diet, or fat-burning diet. More research is needed to prove its benefits, but Hwu, the head of cancer medicine at MD Anderson in Houston, believes in it after seeing improvements in his own health.
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Coding Diabetes Mellitus with Associated Conditions

Overseen by AHIMA’s coding experts for the Journal of AHIMA website, the Code Cracker blog takes a look at challenging areas and documentation opportunities for coding and reimbursement. Check in each month for a new discussion.
There has been some confusion among coding professionals regarding interpretation of the coding guideline of “with.” An area that contains many instances of using this guideline in ICD-10-CM is coding Diabetes Mellitus with associated conditions. There are 53 instances of “with” subterm conditions listed under the main term Diabetes.
The ICD-10-CM Official Guidelines for Coding and Reporting states the following at Section I.A.15:
The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.
The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.
There was a recent clarification regarding this guideline published in the first quarter 2016 issue of AHA Coding Clinic on page 11. According to this clarification, the subterm “with” in the Index should be interrupted as a link between diabetes and any of those conditions indented under the word “with.”
Following this guidance as we look to the main term Diabetes in the ICD-10-CM Codebook Index, any of the conditions under the subterm “with” such as gangrene, neuropathy, or amyotrophy (see below for the full list) can be coded without the physician stating that these conditions are linked. The c Continue reading

A Diabetes Monitor That Spares the Fingers

For the past year and a half I’ve been buying a medical device from Italy that has improved my life immeasurably. It wasn’t easy: I roped in a good friend who had moved to Milan to buy the device and ship it to me because it wasn’t yet available in the States. And it was expensive: over $1,600 a year.
But my black-market purchase helps me manage my Type 1 diabetes without the need to draw blood from my callused fingers 10-plus times a day to track my glucose level, a ritual that had been an unpleasant part of my life for decades.
The FreeStyle Libre, made by Abbott, is a flash glucose sensor that allows people with diabetes to view our blood sugar every minute of the day without a single finger prick. While there are similar devices on the market — called continuous glucose monitors, or CGMs — the Libre is the least invasive one I’ve seen. It takes readings from a sensor under the skin but doesn’t require finger sticks for calibration, and is about the size of a quarter and as thick as two. And it’s helping me keep my diabetes under better control.
There have been some challenges: The Milanese UPS store wanted a letter detailing exactly what was in the box. My credit card’s fraud department called (“Yes, the charge for $365 from Milan is mine”).
So I was thrilled to learn that the Food and Drug Administration recently approved the sale of the Libre in the United States, a decision that may help some of the 29 million Americans with diabetes.
The Libre I buy from Italy has a self-adhesive, waterproof white sensor that sticks to my arm for 14 days. It to Continue reading

Native Americans with Diabetes

Native Americans (American Indians and Alaska Natives) have a greater chance of having diabetes than any other US racial group. Diabetes is the leading cause of kidney failure, a costly condition that requires dialysis or kidney transplant for survival. Kidney failure can be delayed or prevented by controlling blood pressure and blood sugar and by taking medicines that protect the kidneys. Good diabetes care includes regular kidney testing and education about kidney disease and treatment. Kidney failure from diabetes among Native Americans was the highest of any race. However, this has declined the fastest since the Indian Health Service (IHS) began using population health and team-based approaches to diabetes and kidney care, a potential model for other populations.
Health care systems can:
Use population health approaches to diabetes care. Assess long-term outcomes and address disparities. Promote wellness of the entire community and connect people to local resources, including healthy food, transportation, housing, and mental health care.
Develop a coordinated team approach to diabetes care. Team based-care should include patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.
Integrate kidney disease prevention and education into routine diabetes care. Screen people with diabetes for kidney disease and make sure that kidney disease is routinely addressed as part of diabetes care.
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