Should Patients With Type 2 Diabetes Take Aspirin To Prevent Stroke And Coronary Events?

Should Patients with Type 2 Diabetes Take Aspirin to Prevent Stroke and Coronary Events?

Should Patients with Type 2 Diabetes Take Aspirin to Prevent Stroke and Coronary Events?

What is the role of aspirin in primary prevention — preventing the first cardiovascular event in our patients? This has been an area of changing recommendations leading to considerable uncertainty among practitioners.
Aspirin is an effective antiplatelet agent that acts by inhibiting cyclooxygenase-1 (COX-1) which leads to reduced levels of thromboxane A2, a potent promoter of platelet aggregation. It is therefore widely used in high-risk individuals to prevent myocardial infarction and stroke. It may also reduce the risk of colorectal cancer. However, aspirin use is not without risks — the reduced platelet action increases the risk of gastrointestinal bleeding and hemorrhagic strokes. When aspirin is used for secondary prevention — to reduce the risk of recurrent myocardial infarction or ischemic stroke in patients with established cardiovascular disease — the risk of a recurrent cardiovascular event is so high that the benefits of aspirin greatly outweigh the risks.
But what about aspirin in primary prevention? Many patients who present with myocardial infarction or ischemic stroke have no previous history of cardiovascular disease but may have been at high risk for such disease due to risk factors such as type 2 diabetes.
NEJM Knowledge+ Internal Medicine Board Review includes the following question on this very topic; we have heard from many learners that they are uncertain about the current recommendations.
The Case & Question
A 44-year-old man with hypertension, hyperlipidemia, obesity, type 2 diabetes, and paroxysmal atrial fibrillation presents for a new-pat Continue reading

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Skin patch shows promise for pain-free diabetes testing

Skin patch shows promise for pain-free diabetes testing

An experimental device might one day literally take the pain out of managing diabetes, Korean researchers say.
The new invention uses a patch to monitor blood sugar levels via sweat, and delivers the diabetes drug metformin through the skin with microneedles.
"Diabetics are reluctant to monitor their blood glucose levels because of the painful blood-gathering process," said study author Hyunjae Lee, from Seoul National University in the Republic of Korea. "We highly focused on a noninvasive monitoring and therapy system for diabetics."
The findings were published online March 21 in the journal Nature Nanotechnology. The study team was led by Dae-Hyeong Kim, at Seoul National University. Funding for the study was provided by the Institute for Basic Science in the Republic of Korea.
Currently, people with diabetes have two options for monitoring blood sugar (glucose) levels, said Richard Guy, who wrote an accompanying editorial in the journal. He's a professor of pharmaceutical sciences at the University of Bath in the United Kingdom.
One option is a blood glucose meter that requires a finger stick to draw out a drop of blood for testing. The other option is continuous glucose monitoring, which requires that a sensor be placed underneath the skin and worn constantly. Both of these options are invasive and can be painful.
Previously, a less invasive product called GlucoWatch pulled fluid through the skin to the device to measure blood sugar levels. However, that device was never commercially successful and was taken off the market, Guy said.
The Korean research team used a sub Continue reading

Understanding Diabetes

Understanding Diabetes

What is it?
Diabetes Mellitus is a medical condition caused by an inability to use sugars due to the body producing ineffective insulin, an ineffective amount or complete lack of insulin in the body. The effects can be life threatening.
Normal Physiology
Every cell in the human body needs sugars (as well as oxygen) as their source of energy. The digestive system breaks down complex carbohydrates (long-chain molecules which are too large pass into cells) such as cellulose into simple (small-chain) carbohydrates such as glucose.
Glucose enters the blood stream where it is transported around the body to provide energy to cells, however, insulin is needed to combine with the glucose to enable it to pass into - and be utilised by - the cell.
Insulin is a hormone produced by endocrine glands on the pancreas; in a healthy person the body is able to regulate the amount of insulin produced, proportionate to the amount of glucose in the blood.
Providing the cells have metabolised enough glucose, insulin also acts on the liver to stimulate enzymes which convert excess glucose to glycogen - a long-chain carbohydrate which can be stored for later use.
Given that all cells use glucose as energy, and all cells are constantly using this energy, blood glucose levels will always fall once the cells (and liver) have been 'topped up'.
When blood glucose levels begin to fall, the endochrine glands on the pancreas release another hormone, glucagon, which acts as the counter to insulin and breaks the stored glycogen back into glucose which can then be metabolised by cells.
These automatic respons Continue reading

7 Best Ways to Beat Diabetes

7 Best Ways to Beat Diabetes

En español l The bad news first: More than 29 million Americans suffer from diabetes — a startling 10 percent jump in just two years — and an additional 86 million of us are at high risk for developing this chronic, debilitating disease, according to the U.S. Centers for Disease Control and Prevention.
Your risk for diabetes goes up as you get older and put on weight. The promising news: Research shows that a few basic lifestyle changes can prevent and, in some cases, reverse the disease, says George King, M.D., director of research at the Joslin Diabetes Center at Harvard Medical School and author of the forthcoming book The Diabetes Reset: Avoid It. Control It. Even Reverse It. A Doctor's Scientific Program. "Many people are not aware that you can improve your body's response to insulin and 'reset' your natural ability to metabolize the glucose in your blood," King says.
Here's what you need to do.
1. Cut the fat, up the fiber
The ideal diabetes prevention diet should consist of 15 percent fat, 15 percent protein and 70 percent carbohydrates, with the majority of those carbs coming from fruits, vegetables and whole grains, King says. "High fiber is the key, because fiber makes you feel full quicker and helps you absorb calories slower," King says. "That puts less stress on your beta cells" — the cells in your pancreas that make insulin.
2. Don't rely on supplements
New research finds that whole foods — think mainly fruits and vegetables — contain molecules that help activate the nutrients your body needs for weight and blood sugar control. "That's why food work Continue reading

Jason Wyrick: Cured Type-2 Diabetes and Obesity

Jason Wyrick: Cured Type-2 Diabetes and Obesity

Cured Type-2 Diabetes – No Cost
When I was in my teens, I was a thin kid, in good health, and very active. I am still amazed that, ten years later, I found myself in a hospital in Austin, Texas, well over a hundred pounds overweight, being treated for an infection, and being told I was diabetic. I was more than scared when I found out, I was ashamed. I was under 30, diabetic, and looking at the prospect of having to take medication for the rest of my life. More than ashamed, I was desperate. I know how I caught the disease. Diabetes was in my family for at least two generations before me and now it looked like it had hit a third. My maternal grandmother was diabetic, both of my parents are diabetic, and my middle brother had many of the symptoms of the disease. I’m fairly certain I had it at least two years before I was diagnosed with it. I was overweight, unnaturally tired, prone to energy spikes and sudden crashes, my intellect was slowing down, and my eyesight was going terribly. That, perhaps, was the most visible (pun intended) symptom, having gone from 20/15 vision down to at least 20/30. Since a number of my family members wore glasses, I just thought I was now going down the same road. I never associated these health issues with diabetes because I simply didn’t know any better. The highest blood sugar I can remember was 290 mg/dl. In hindsight, it may have been a good thing that I was in the hospital being treated for an infection (another symptom of diabetes) because, had I not been diagnosed with it then, the damage to my body would have been far worse.
Fami Continue reading

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