WHO | Addressing Asias Fast Growing Diabetes Epidemic

WHO | Addressing Asias fast growing diabetes epidemic

Addressing Asias fast growing diabetes epidemic
Hampered by shortages of resources, specialized services and skilled health workers, India and other countries in south-east Asia are scrambling to respond to type 2 diabetes epidemics. Sophie Cousins reports.
Bulletin of the World Health Organization 2017;95:550-551. doi: http://dx.doi.org/10.2471/BLT.17.020817
A diabetes nutrition counselling session at Dr Mohans Diabetes Specialities Centre in Chennai.
During a visit to his native village outside the Indian city of Chennai, steel plant worker K Shankar (not his real name), 51, dropped in at Dr Mohans Diabetes Specialities Centre for a check-up, where he discovered his blood sugar was high, though not quite high enough to be type 2 diabetes.
They advised me to change my lifestyle to avoid diabetes, he says. Shankar used to eat a lot of white rice a large part of the diet of Indias 1.3 billion population but has since switched to smaller quantities of brown rice with lots of vegetables. He also goes for a walk twice a day.
Set up in 1991, the centre is part of a network of 32 private clinics offering care for some 400 000 diabetes patients across nine Indian states. The centre has also become a World Health Organization (WHO) collaborating centre.
Diabetes is a chronic disease that occurs when either the pancreas doesnt produce enough insulin (type 1) or when the body cant effectively use the insulin it produces (type 2).
An estimated 422 million adults were living with diabetes in 2014, according to WHOs Global report on diabetes 2016.
Between 1980 and 2014, the Continue reading

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LDLHow Low to Go In People With Diabetes?

For Professionals Research Updates Diabetes complications
LDLHow Low to Go In People With Diabetes?
Compelling data supports achieving a very low LDL-Cholesterol with combined statin-evolocumab therapy to reduce further risk of cardiovascular events, which presents important implications for people with diabetes.
With Robert Giugliano, MD, and Priyathama Vellanki, MD
Reducing LDL-cholesterol to less than 30 mg/dL with a combination of a statin and the PCSK9 inhibitor, evolocumab (Repatha), produced favorable clinical outcomes in patients at high risk for cardiovascular disease (CVD), including significant reductions in myocardial infarctions (MI) and stroke,1 according to findings presented at the American College of Cardiology annual scientific sessions, and simultaneously published in the New England Journal of Medicine. 2
Among the more than 27,000 patients enrolled in the FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) trial,2LDL-C was lowered 59%, but more telling was a 15% reduction in the 5-point composite of MI, stroke, hospitalization for angina, revascularization, and mortality.
CVD Risk Points to Need for Very Low LDL-Cholesterol
The study findings validated the lipid recommendation of the American Association of Clinical Endocrinologists (AACE),3 to treat patients who fell into the extreme risk category for CVD to achieve LDL levels of less than 55 mg/dl, published earlier this year in the AACE Lipids Guidelines Update.
In the FOURIER trial, evolocumab was typically given in combination with a b Continue reading

What's the Connection Between Sleep Apnea and Diabetes?

When You Should See a Doctor About Sleep Problems
Because sleep apnea can have such serious consequences, its a good idea to encourage your parents to see their doctor if you suspect they have it. If they sometimes appear to stop breathing during sleep or take long pauses between breaths and then gasp for air during sleep, they may have central sleep apnea.
A constant sense of tiredness, even after they sleep 7 hours or more
Loud snoring that wakes up other people in the home. Snoring isnt always a sign of sleep apnea, but the two are often related
Waking suddenly while feeling short of breath or choking
To diagnose a sleep problem , the doctor may ask your parent to keep a sleep diary to track their nighttime rest and nap patterns over a few weeks. The doctor will also ask if they have a family history of sleep apnea and whether their snore loudly or gasp and choke in their sleep.
If the physician thinks your parent may have sleep apnea, he or she will want to do a sleep study to monitor their brain activity, vital and other signs while they sleep. The study involves wearing sensors on their skin and it can be done at home with a portable machine or in a lab designed especially for sleep studies. The sleep study might record your parents sleep for a full night, or the doctor might order a split-night study. In this type of study, your dad or mom wears the sensors and sleeps for the first few hours. Then they use a CPAP machine for the remaining hours of sleep so the sensors can check for changes in their bodys response.
The most common treatment for sleep apnea is Continue reading

Skip the Coverage Gap: Maintaining Diabetes Care While Changing Insurance

Skip the Coverage Gap: Maintaining Diabetes Care While Changing Insurance
How to navigate changes in insurance with diabetes without losing access to care, whether getting a new job, turning 26, or moving to a new state
Changing health insurance plans can be daunting with diabetes. Tracking down various prescriptions, organizing paperwork, making phone calls to providers and device suppliers, and updating information at pharmacies is a headache for anyone. Whether youre changing jobs, moving to a new state, switching to Medicare, or turning 26, there are ways to avoid losing your health insurance at any point during the transition.
The sections below aim to guide you through the process of preparing to switch insurance, no matter what type of transition youre going through.
In this article (Click to jump to a particular section):
If you are changing jobs, start planning at least four weeks before you give your notice so that you are prepared to ask your current employer for the information you need.
If you are switching insurance because you are turning 26, start planning several months in advance.
2. You will need to devote some time to gather documentation, research and select new plans, and make phone calls. Depending on your specific situation, you may need to spend anywhere from five to twenty or more hours on this process.
3. Gather the following information and keep it in an accessible place:
Social Security Numbers for you and family members
Employer and income information (such as paystubs or W-2 forms)
Health insurance card for your current health ins Continue reading

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #59: Mechanisms of insulin signal transduction Part 3 of 8

Home / Resources / Clinical Gems / International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #59: Mechanisms of insulin signal transduction Part 3 of 8
International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #59: Mechanisms of insulin signal transduction Part 3 of 8
Following insulin binding and receptor autophosphorylation, the next committed step in signal transduction is tyrosine phosphorylation of intracellular proteins. To accomplish this, autophosphorylation of the subunit mediates noncovalent but stable interactions between the receptor and intracellular substrate proteins, and this positions these molecules for tyrosine phosphorylation by the activated insulin receptor kinase [26 28]. Several proteins are rapidly phosphorylated on tyrosine residues by ligand-bound insulin receptors, including six insulin receptor substrate proteins (IRS-1, IRS-2, IRS-3, IRS-4, IRS-5, IRS-6) [29 33], Src-homology-collagen proteins (SHC) [34] and, growth factor receptor bound-2 (Grb2) associated binder-1 (Gab-1) [35], signal-regulatory protein (SIRP) family members [36,37], the CAP/c-Cbl complex [38,39], an adapter protein with a PH and SH2 domain (APS) [40], signal transducer and activator of transcription 5B (STAT5B) [41], and proteins referred to as downstream of kinase (DOK 1-6) [33,42].
There is no known enzymatic activity associated with insulin receptor substrate molecules; however, their primary structure is noteworthy for multiple sites capable of interaction with other proteins. The receptor substrates are characterized by a representative architecture, par Continue reading