Sodium-Glucose Co-Transporter-2 Inhibitors: An Update On The Evidence For Treatment Of Type 2 Diabetes

Sodium-Glucose Co-Transporter-2 Inhibitors: An Update on the Evidence for Treatment of Type 2 Diabetes

Introduction
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a class of antihyperglycemic agents that can be used to improve glycemic control in the treatment of type 2 diabetes (T2D). SGLT-2 inhibitors block SGLT-2–mediated reabsorption of glucose into circulation. By this mechanism, plasma glucose levels are reduced and glucose is excreted in the urine. Not only do SGLT-2 inhibitors have glucose-lowering effects, but their efficacy in nonglycemic clinical parameters, such as lowering blood pressure and helping in weight loss, may be beneficial for patients with T2D.1
Within the family of sodium-dependent glucose transporters, sodium-glucose co-transporter-1 (SGLT-1) and SGLT-2 transporters are key regulators of glucose reabsorption filtered by the kidney, with expression on 2 regions of the renal proximal convoluted tubule. The majority of glucose reabsorption (90%) is attributed to SGLT-2 within the S1 segment, and the SGLT-1 receptor aids in glucose reabsorption downstream from SGLT-2 in the S3 segment.2 In patients with T2D, an increased filtered load of glucose increases its reabsorption through the SGLT-2 transporters of the kidney. Instead of excreting excess filtered glucose in urine, increased reabsorption causes elevated plasma glucose, thereby leading to the hyperglycemic state.
The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) currently recommend that an SGLT-2 inhibitor may be used as first-line therapy in the management of T2D for patients with glycated hemoglobin (A1C) <7.5%, although stronger Continue reading

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Why Is Meat a Risk Factor for Diabetes?

Bill, I think a lot of McDougall’s program as well. The thing I like about Barnard’s book is that he had recipes that featured low glycemic index plant foods that help to keep blood sugar under control while the diet helps your muscles do a little house cleaning and get the fat out. My understanding is only under high levels of circulating FFA do those fats get stash fat in the muscles, so given an opportunity the fat out of the muscles when the circulating levels of FFA drop. That means the effectiveness of the diet isn’t predicated on losing a bunch of weight, which is good since you say that you are already lean.
The trouble is that the source of the free fatty acids is mainly from saturated fat, the very type of fat that is highest in most low-carb diets. So instead of fixing the root cause of diabetes, a low-carb diet that is high in saturated fat may in fact *be* the root cause of diabetes. Thus the recommended diabetic diet might in fact be the cause for why once developed diabetes only progresses and never reverses or stays the same! It is like treating somebody for a toxic effects of a low level poison by putting them on a diet containing the poison.
Also non-estrified fatty acids (NEFA) that come from saturated fat also reduced insulin output from the pancreas.
So the same high saturated fat diet that is causing insulin resistance looks to be also reducing the body’s ability produce more insulin to compensate.
The good news is that without the suppressive effect of saturated fat, you body might be able to produce more insulin than you think it can. And eve Continue reading

Type 2 diabetes warning: Too much red meat and poultry can increase risk

Dinner time favourites such as beef and lamb are high in iron, a mineral associated with triggering the debilitating disease.
But even chicken thighs and drumsticks can be bad for you, say experts.
The darker the meat, the greater the risk, with scientists finding a direct link between consumption and Type 2 diabetes.
Almost 12 million Britons are thought to be at risk of developing the condition, which is linked to lifestyle factors such as poor diet.
Analysis of more than 60,000 people shows those eating the most red meat increase their risk by 23 per cent while for those who eat a lot of dark poultry meat the risk increases by 15 per cent.
Experts suggest cutting out dark meat and replacing it with chicken breast, fish, shellfish and vegetables.
Dietitian Pav Kalsi, clinical adviser to charity Diabetes UK, said: “We know eating more red and processed meats is associated with a higher risk of Type 2 diabetes.
“Simple changes to diet include eating less processed and red meat and instead getting protein from plant sources such as pulses, beans and lentils and from lean poultry and oily fish.
“Eating more fruit and vegetables and whole grains, as well as cutting down on the amount of sugar, salt and fat in your diet can help too.”
The new study, one of the biggest of its kind, looked at the diets of 63,257 people aged between 45 and 74 who took part in the Singapore Chinese Health Study between 1993 and 1998.
Scientists from Duke-NUS Medical School in Singapore then followed the group over the next 11 years, identifying 5,207 new cases of Type 2 diabetes.
They say t Continue reading

Balancing Type 2 Diabetes and Compulsive Eating

By Robin Fein Wright, L.C.S.W.
To people with type 2 diabetes who also struggle with compulsive eating– please know you are not alone. According to the Walden Eating Disorders Treatment Program, “Studies estimate that 12% of patients with Type 2 Diabetes also suffer from BED (Binge Eating Disorder).” Given that 9.3% of the population has diabetes, this is a dual diagnosis that affects millions of people in the U.S.
What is Compulsive Eating?
Compulsive eating is considered an emotionally triggered behavior, usually a response to an uncomfortable feeling, not to physical hunger. Here are definitions of emotional eating from WebMD:
-Something stressful happens to you and you immediately want to eat
-An overwhelmingly urge to eat comes over you (physical hunger usually builds more slowly)
-You strongly desire one particular food like chocolate or ice cream rather than a variety of foods
This kind of eating makes many people feel like they have no control over what they eat. There is guilt and shame over the quantities of food consumed. Many compulsive eaters prefer to eat alone because it’s more of a solitary act than a social one. People who eat compulsively often don’t pay close attention to the act of eating and can eat almost automatically because it is emotionally driven. It is hard to read hunger signals to know when to stop eating because the behavior is not driven by physical hunger.
Another factor in developing compulsive eating is body dissatisfaction. Compulsive eating is part of a behavioral cycle that begins with an effort to be restrictive in order to l Continue reading

Does Eating Red Meat Increase the Risk of Diabetes?

No matter how often I write articles defending the place of red meat in a healthy diet, there are always people who get bent out of shape whenever a new study is published with a different twist on the same old “red meat is killing us” story.
Although I can’t say addressing these (often ridiculous) studies is the most exciting undertaking, I wanted to write about this one because it’s a prime example of the limitations of observational evidence, and what happens when you control for even the most simple confounding variables.
Does red meat really increase your risk of diabetes? Read this to find out!
The study in question is titled “Associations between red meat intake and biomarkers of inflammation and glucose metabolism in women,” and was conducted by Walter Willet and a group of other Harvard researchers. (1) Using data from the Nurse’s Health cohort, they identified a positive relationship between red meat intake and higher levels of plasma C-reactive protein (CRP), ferritin, fasting insulin, and Hb A1c, after adjusting for demographic, medical and lifestyle factors. CRP (and sometimes ferritin) are markers for inflammation, and elevated fasting insulin and hemoglobin A1c indicate impaired glucose metabolism.
Limitations of Observational Evidence
Right off the bat, there’s a glaring weakness in this study that has been largely glossed over by many media reports: all but one of these associations disappeared after adjusting for BMI. As the study authors mention, excess body fat is the biggest risk factor for type 2 diabetes, so it shouldn’t come as a su Continue reading