The Gadget That Costs Less Than $5—And Can Help Prevent Type 2

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What inexpensive little gadget can help you prevent type 2?
Surprise—it’s a cloth tape measure.

We’re serious.

A1c levels, you thought? Or BMI (body mass index)? Yes, those are important, but the tape measure is a key tool for preventing type 2.

Here’s why.

A tape measure can help you track your waist circumference. And the waist circumference usually is a better indicator of visceral fat than the BMI.

If you lose weight, you don’t know if you’re losing fat mass or lean muscle mass. In many cases, the difference between the two, in terms of risk of type 2, is huge.

You can read about waist circumference measurements, BMI measurements, and A1c levels in Prediabetes: Beating the Odds of Getting Type 2 Diabetes. It’s the third ebook in our Diabetes Leading Edge Series.™

Simple Changes in Eating Patterns Help Control Diabetes Type 2

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Eating Carbs Last Could Help Patients Lower Their Blood Glucose Levels After a Meal

We’ve found two preliminary studies that suggest simple ways people with type 2 diabetes may be able to improve blood glucose control after a meal. We’ll discuss one of the studies below, the other in an upcoming post.

Background. It’s been known for quite a while that the type of carbohydrates patients with type 2 diabetes eat—not just the amount of carbohydrates—influences how high their blood glucose levels rise after a meal. Controlling that after-meal increase in blood glucose levels—known as postprandial hyperglycemia—is an important goal in diabetes. Spikes can make symptoms worse, and have been linked with an increased risk of cardiovascular disease.

A small study recently published online suggests that controlling the order in which patients eat carbs vs. other foods may help them reach their after-meal goals for blood glucose control.

The Study. 16 type 2 patients ate the same foods, but in a different order, for three days:

Investigators tested patients’ blood levels of glucose, insulin, and other factors just before the meal, then every 30 minutes, up to 180 minutes. Insulin of course helps control glucose levels, and there’s a theory—it hasn’t been proven—that eating proteins first stimulates insulin secretion.

Results. When carbohydrates were eaten last:

  • Blood glucose levels rose less than they did in the other test situations (carbohydrates eaten first, or all foods eaten together)
  • Blood glucose and insulin levels peaked at lower levels than in the other test situations, and the peaks lasted for a shorter time

Bottom line: This was a small study; larger trials are needed. But in the meantime, eating carbohydrates after proteins and vegetables seems a simple change for patients to make; and one that could perhaps improve blood glucose control after meals.

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References

Shukla AP, Iliescu RG, Thomas CE, Aronne LJ. Food order has a significant impact on postprandial glucose and insulin levels. Diabetes Care. 2015;38:e98-e99. doi: 10.2337/dc15-0429. http://care.diabetesjournals.org/content/38/7/e98.full.pdf+html.

Shukla AP, Andono J, Touhamy SH. Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in Type 2 Diabetes. BMJ Open Diabetes Research and Care. 2017;5:: doi: http://drc.bmj.com/content/5/1/e000440. https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-10-03-people-with-type-2-diabetes-should-save-carbs-for-last/

Sleep Apnea and Weight Control in Diabetes and Prediabetes

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Or,

How “Tom” Controlled His Sleep Apnea—and May Have Avoided Type 2

As a medical scientist, I believe in well-controlled, randomized clinical trials—yet I’m sharing with you a “study” involving a single subject. He’s someone I’ve known for a long time, and he’s given me excellent data. Although my friend—we’ll call him Tom—doesn’t have diabetes or prediabetes, I believe that many people who do, and are overweight, may have sleep apnea— and could benefit from his experience.

Tom’s wife had complained about his snoring for years, but when she noticed that he sometimes stopped breathing for prolonged periods and gasped for breath, she began worrying that he might have sleep apnea. When she finally moved to a separate bedroom to get a good night’s sleep, Tom decided it was time to have a sleep study.

The diagnosis: mixed sleep apnea, a combination of obstructive and central apnea. The treatment: a continuous positive airway pressure (CPAP) device, a mask Tom straps over his nose and mouth at bedtime. A small machine connected to the mask pumps air through the mask to keep his airway open while he sleeps. No more snoring or sleep apnea.

Tom’s Weight Data

Before the sleep study, Tom had been struggling with a weight problem. Despite working out at a health club three times a week, and avoiding overeating, he was gaining weight. He recorded his weight under identical conditions each time he was at the health club. His data are shown in the chart below.

Everything began to change once Tom began using the CPAP. His weight dropped steadily and dramatically, from a high of 162 to 135 pounds, according to his most recent report.

Hormones—Ghrelin and Leptin

Some sleep experts believe that lack of “good” sleep leads to higher levels of the hormone ghrelin, which spikes the appetite, and lower levels of the hormone leptin, associated with feelings of fullness. The action of these hormones could explain why some people, like Tom, who aren’t getting decent sleep—because of sleep apnea or other causes—gain weight.

But wait—the story isn’t that simple. According to an archive article in WebMD, a physician who specializes in treating sleep disorders has found that his overweight patients with sleep apnea don’t have the typical low leptin levels—in fact, their leptin levels are uncharacteristically high. And when apnea is treated, the leptin levels drop—but somehow that helps patients lose weight.

So, it’s possible that individual responses to leptin may vary. Clearly, more studies are needed.  

Sleep Apnea and Diabetes

For some time now, researchers have suspected a link between sleep apnea and diabetes. A report published online June 6, 2014 in the American Journal of Respiratory and Critical Care Medicine lends some strength to that theory. The study analyzed data from 8,678 nondiabetic adults who underwent a sleep study. During follow-up, patients with severe obstructive sleep apnea (OSA) had a 30% or higher increased risk of developing diabetes than patients without OSA. Mild and moderate OSA carried a 23% higher risk.

The research team controlled for obesity, using body mass index (BMI), but they cautioned that this was an observational study. It showed an association between sleep apnea and development of diabetes, but the researchers weren’t able to check into the cause of the association. http://www.atsjournals.org/doi/abs/10.1164/rccm.201312-2209OC#.VAtDusJdUoE

Another study, published in the New England Journal of Medicine, showed that the changes in hormone levels were still present after 1 year.

http://www.nejm.org/doi/full/10.1056/NEJMoa1105816#t=articleTop

A recent review article, published in Chest, explores in greater depth the association between obstructive sleep apnea and diabetes.

http://journal.chestnet.org/article/S0012-3692(17)30930-3/pdf.

Benefits of a CPAP

Bottom line: If you or your partner think you might have a sleep problem, talk with your doctor. If you’re one of the many people who’ve been diagnosed with sleep apnea, and have tried a CPAP, but couldn’t tolerate it, why not give it another try. Newer CPAPs are smaller, lighter, and more user-friendly. Some models come without straps and heavy head-gear, and many are battery operated.

http://journal.chestnet.org/article/S0012-3692(17)30930-3/pdf

Tom’s experience with weight loss won’t work for everyone, but controlling sleep apnea could make a huge difference in your diabetes control, and your life.

By the way, Tom’s wife has moved back into their bedroom.

Coming: A New Nutrition Facts Label

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On May 20, 2016, the Food and Drug Administration (FDA) finalized the new Nutrition Facts label for foods—but the FDA has extended the deadline since then, without establishing a new deadline.

The new second edition of our book, Blood Glucose Levels and Diabetes Control—the first book in our Diabetes Leading Edge Seriestm—contains a section on the new labeling. We’re posting the entire section here, as a blog. It’s a bit on the long side for a blog, but it will introduce you to our style, in case you haven’t read any of our books.

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The FDA requires food labeling for most prepared foods, but nutrition labeling for “conventional” foods—fruits, vegetables, and fish—is voluntary.

The labeling revisions reflect the latest information about the link between diet and both obesity and heart disease. They highlight calories and servings, and indicate the number of grams of sugar added to a food. Consumers will be able to use the new label to make better choices about what they eat and the food they feed their families.

And consumers do pay attention to the labels. The FDA’s 2014 Health and Diet Survey reveals that, when buying a food product, 50 percent of adults read the Nutrition Facts label “always” or “most of the time.” Another 27 percent read it “sometimes.”

Some food manufacturers already use the new label. Those whose annual food sales total less than $10 million were given until July 26, 2019 to comply; however, as noted above, FDA has now extended the deadline.

The new label has several key changes. It zeroes in on added sugars, reflects new thinking about fats, updates serving-size requirements, and adds some required nutrients.

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Added Sugars

Under the current draft, labels will give a percent daily value (%DV) for added sugars, but will continue to list grams of sugar. “It is difficult to meet nutrient needs while staying within calorie limits if you consume more than 10 percent of your total daily calories from added sugars,” the FDA said in a news release.

The Dietary Guidelines Advisory Committee commented in their report, “Strong evidence shows that higher consumption of added sugars, especially sugar-sweetened beverages, increases the risk of type 2 diabetes among adults and this relationship is not fully explained by body weight.”

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Dietary Fats

The new label will remove the listing for “Calories from Fat,” but leave the “Total Fat,” “Saturated Fat,” and “Trans Fat” categories. Research has shown that the type of fat consumed is more important than total fat.

If left unchanged, the new labeling will also:

  • Emphasize calories and number of servings
  • Specify serving sizes that reflect what people currently eat
  • Provide dual column labels that show “per package” and “per serving” calorie and nutrition information; this will apply to products that could be eaten in one or more sittings, such as a pint of ice cream
  • Label as one serving the calories and other nutrients in products usually consumed in one sitting, such as a 20-ounce soda
  • Include the gram amount (in addition to the %DV) of Vitamin D and potassium (Americans face an increased risk of chronic disease because they don’t always get enough of these nutrients)
  • No longer require listing Vitamins A and C (deficiencies are rare), but voluntary listing is accepted

Below is an illustration comparing the old and new labels for a hypothetical product. Note several changes: the listing for serving size, the emphasis on calories per serving, and the entry “Total Sugars 12g, which, as the label notes, includes 10g Added Sugars,” for a total contribution of 20% of Daily Value (20%DV).

 

FDA sums up the changes nicely in a visual, New Label / What’s Different:

 

Sugar–How Bad Is It?

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What’s responsible for the worldwide epidemic of type 2 diabetes? And a major cause of the metabolic syndrome, obesity, and other health problems?

Increasingly, evidence points to a rise in our sugar intake.

Not just sugar, but one component of sugar. What we call sugar (table sugar, extracted from sugarcane or sugar beets), is known chemically as sucrose. It’s composed of equal parts of two simple sugars—fructose and glucose—joined chemically.

Enzymes in the small intestine break sucrose apart. The blood carries glucose to the body cells, and fructose to the liver. The body cells use glucose, the sugar normally present in blood, as their energy source. But the liver converts fructose to uric acid and fats. Uric acid alters the metabolism, and can cause gout; fats increase insulin resistance.

The Rise in Diabetes

In ancient times, before the advent of sugar, type 2 diabetes was extremely rare. But a few centuries ago as people began to consume sugar in increasing amounts, the incidence of diabetes also began increasing. In the last 50 or so years, now that sugar has become widely popular, and sugar-sweetened beverages and other sweets are widely used, the world has come down with what amounts to an epidemic of diabetes. This epidemic corresponds to the widespread consumption of sugar-sweetened beverages, such as soft drinks, and to a lesser extent use of sugar in baked goods and other sweets.

What About HFCS?

High-fructose corn syrup (HFCS) contains roughly equal amounts of fructose and glucose. The two simple sugars are not joined chemically, as they are in table sugar. HFCS is used extensively in sugar-sweetened beverages and commercially prepared foods. But because it contains roughly as much fructose as table sugar does, HFCS affects our bodies in the same way as sucrose.

Bottom Line

The evidence is convincing enough that we need to cut back on sugar consumption—both sucrose and HFCS. And learn to drink water or unsweetened tea instead of sugar-sweetened beverages. (The small amount of fructose occurring naturally in fruits and in some vegetables isn’t a problem.)

It’s a small step. But making a small change now could mean a big difference health wise down the road.

Now Available on the Web: The Diabetes 2014 Report Card

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A new 16-page publication, The Diabetes 2014 Report Card, is available for free download at http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf.

Published every two years by the Centers for Disease Control and Prevention (CDC), the Report Card contains the latest data available on prediabetes and the most common types of diabetes, along with risk factors, screening steps, diabetes complications, specific measures to prevent diabetes complications, and other information.

Data arranged by state or area reveal an intriguing trend—a “Diabetes Belt”: 15 southeastern states where the prevalence of diagnosed diabetes is especially high. The states are led by Mississippi, where 11.7 percent of adults have been told by a health care provider that they have diabetes. Louisiana (11.5 percent) and Alabama and West Virginia (both 11.1 percent) are close behind.

A newsworthy section called Stories from the Field presents glimpses of people and organizations that are making a difference in the lives of people with diabetes. Profiled are diabetes leaders and projects, including a National Diabetes Prevention Program (DPP) Lifestyle Coach, a National DPP Participant, and a Gestational Diabetes Collaborative (GDC) that monitors and tracks cases of gestational diabetes and provides outreach and patient education.

The 2014 date in the publication’s title is somewhat misleading. The report was published in 2015, not 2014, and it doesn’t cover 2014 data, other than mentioning that in that year, diabetes was the seventh leading cause of death. (Compiling massive amounts of data generally takes data crunchers about three years.)

Water, Anyone?

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Accumulating evidence points the finger more and more at sugar-sweetened beverages—sodas—as a major factor in the widespread increase in type 2 diabetes.

A New Meta-Analysis

Combining data from 21 studies, a recent meta-analysis found that drinking just one 250 mL serving (about 8.3 ounces) daily of a sugar-sweetened beverage increased the risk of developing type 2 diabetes by 18 percent. The risk was independent of whether the person was also overweight or obese. In other words, drinking sodas may lead to both an increase in weight and type 2 diabetes, but the overweight and diabetes occur independently. Someone doesn’t have to become overweight or obese to develop type 2 diabetes.

(A Harvard University website, The Nutrition Source, estimates the sugar content of a larger [12-ounce] serving of some popular drinks as follows: colas, 10 teaspoons; orange, cranberry, and other fruit drinks: 11 to 15 teaspoons. [One teaspoon of sugar = 4.2 grams.])

Combined data from the meta-analysis, published in BMJ, also “showed a positive association” between artificially sweetened beverages and fruit juice, and newly diagnosed cases of type 2 diabetes, but in this case the quality of the evidence was limited.

The 21 studies included in the meta-analysis comprised 38,253 cases of type 2 diabetes. All studies were prospective, meaning that none of the participants had diabetes at the time of enrollment. Investigators assessed the key factors leading to diabetes onset by tracking participants’ dietary habits during 10,126,754 person-years of follow-up.

Implications of the Study

The public health implications are strong: over 10 years, current consumption of sugar-sweetened beverages causes an estimated two million excess cases of type 2 diabetes in the U.S., at a cost of about $9,800 per patient.

Bottom Line

“Although causality has not been established and precision needs to be improved,” the authors note the potential efficacy of reducing consumption of sugar-sweetened drinks to prevent type 2 diabetes. But they consider neither artificially sweetened drinks nor fruit juice to be suitable alternatives.

Water, anyone?

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Source

Imamura F, O’Connor L, Ye Z. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015; July 21. 351:h3576. doi: 10.1136/bmj.h3576.

Reference

Harvard T.H. Chan School of Public Health. Calories, grams of sugar, and teaspoons of sugar in 12 ounces of each beverage. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/30/2012/10/how-sweet-is-it-bw.pdf.

 

29.1 Million . . . and Counting

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Alarming new estimates: The number of people in the U.S. with diabetes jumped from an estimated 26 million in 2010 to more than 29 million—9.3% of the population—in 2012, according to the Centers for Disease Control and Prevention (CDC). Another 86 million adults—more than one in three—have prediabetes, according to the CDC, and thus are at an increased risk of developing type 2 diabetes.

Diabetes hasn’t been diagnosed in 27.8% of those who actually have the disease, which means that these people are not getting the care they need to help prevent the complications associated with diabetes.

Estimated diabetes costs in the U.S. in 2012 were as follows:

• Direct medical costs: $176 billion
• Indirect costs: $69 billion (disability, work loss, premature death)
• Total costs: $245 billion

Average medical costs among people with diagnosed diabetes were 2.3 times higher than among those without diabetes.

The 2012 data are the most recent available because of the time required to gather and analyze data from many millions of people.

Source: http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.

65+ Years = at Special Risk for Diabetes

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The incidence of diabetes and prediabetes continues to rise in the U.S., and it’s hitting the older population particularly hard. More than one in four of those aged 65 or above have diabetes, and more than half have prediabetes, thus are at increased risk of developing diabetes and other health problems.

Many cases of diabetes in the over-65 population are undiagnosed, which means that many people are not getting the care and medical advice they need to help prevent serious health consequences. Moreover, once doctors have diagnosed diabetes, existing health problems in these patients make management especially difficult.

Avoiding episodes of hypoglycemia (low blood glucose levels), hypotension (low blood pressure), and drug interactions—given that many patients are taking other prescription drugs—make adjusting medications and dosages especially difficult.

Why are diabetes and prediabetes so common among older people?

Key risk factors for both conditions include overweight or obesity, and lack of physical activity. Both factors become more common as people age.

And why are many cases undiagnosed? The well-known symptoms of diabetes, such as frequent urination, excessive thirst, and feeling tired or lethargic, are not always obvious in older people. If noticed, they may be dismissed as just a part of the aging process.

Statistics in this blog are from http://templatelab.com/national-diabetes-report-2014/

Gestational Diabetes: Odds Now as High as 1 in 10

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As many as one in every 10 pregnant women in the U.S. may develop gestational diabetes, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC).

The increased incidence of gestational diabetes parallels the rise in the incidence of type 2 diabetes—and both conditions follow the steady rise in obesity in the U.S. population.

Gestational diabetes occurs when pregnant women who have never had diabetes develop the high blood glucose levels characteristic of the disease.The news release cites a possible contributing factor: hormones from the placenta may block the action of the mother’s insulin, and she may need up to three times as much insulin to control her blood glucose levels.

Babies and Mothers Face Increased Risks

Babies born to women who have gestational diabetes are more likely to be abnormally large, and may require delivery by cesarean section. The babies are also more likely to develop prediabetes later in life.

Mothers with gestational diabetes face an increased risk of complications during pregnancy and delivery, and have more than a seven-fold increased risk of developing type 2 diabetes five to 10 years after giving birth, according to the CDC news release.

Data in the study were based on information on questionnaires filled out by the mothers, and by information on birth certificates. The authors note that almost half the cases of gestational diabetes “could potentially be prevented if we reduced the risk of overweight and obesity to that of normal-weight women.”

The report was published June 19 2014 in Preventing Chronic Disease, a peer-reviewed journal: http://www.cdc.gov/pcd/issues/2014/13_0415.htm.

 

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