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

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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

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

Diabetes Tech on the Horizon Part 3 - What to Expect for CGM in 2018

Diabetes Tech on the Horizon Part 3 - What to Expect for CGM in 2018
Learn more about new and upcoming glucose monitoring products whats available now and what could be coming soon
Diabetes technology moves fast, so to help you keep track, weve rounded up some of the latest offerings and things coming soon related to CGM. (See here for updates about diabetes apps and software, and here for insulin delivery updates.) Below, youll find products that have recently become available or are expected to launch in the next year or so based on the most recent timing updates weve heard. This article is not fully comprehensive and timelines often change but this list covers many of the most notable CGM products. A more detailed description of each product follows the table of contents below.
Abbott FreeStyle Libre (real time) Just launched in US pharmacies (CVS, Walgreens, Walmart, Kroger, Rite Aid) with a prescription
Dexcoms G6 sensor with push-button applicator and 30% thinner transmitter currently under FDA review, US launch expected in 2018 (possibly with no fingerstick calibration)
Launched in US pharmacies in late November 2017
Whats New? Following FDA approval in September , Abbotts long-awaited, no-fingersticks-needed FreeStyle Libre real-time CGM has launched in US pharmacies: Walgreens, CVS, Walmart, Kroger, and Rite Aid. Currently, there is no US reimbursement for FreeStyle Libre, though the cash pay price is less expensive than other CGM systems. We called our local Walgreens and CVS and learned that each 10-day sensor costs approximately $43-$53 ($129-$159 Continue reading

The Danger and Disruption of Type 2 Diabetes

Ill admit it Im still recovering. You see, Im a Dodgers fan. I wasnt even going to mention that little factoid after their heartbreaking loss in the World Series (I attended Game 2, so at least I can cross that off the bucket list). But I got inspired when I watched an interview with Brandon Morrow , a Dodgers relief pitcher who became only the second player in MLB history to pitch in all seven games of a World Series. Before the series began, he was asked how he manages his (type 1) diabetes as an athlete competing at the highest level.
Weve been doing a lot of work around diabetes at Science 37, and trying to understand the experiences of those who live with it. Having that in the back of my mind, and then seeing Morrow discuss how he manages his diabetes, reminded me of someone I knew an aunt who had diabetes. Only she didnt know she had it. As a result, my family knows firsthand the perils of leaving it untreated.
As Sophia Petrillo used to say, picture it, March 2001. I was a high school senior in Los Angeles juggling a crazy schedule extracurricular activities, advanced placement classes, editor-in-chief duties for the yearbook, you name it. I was looking forward to the end of the month, when I got to take a break from school craziness for a few days to visit the Bay Area for my cousin Kassandres wedding. I come from a big family my mother had seven siblings, and I grew up seeing my cousins pretty often. Kassandre is the oldest of them, meaning that the new generation was preparing to take those big life steps. It was an exciting time, but that wasnt all that Continue reading