Diabetes Cure

There's a lot of talk about the high cost of health care, but do you know which conditions contribute most to health care spending?

If you said diabetes, you're right -- a new study finds diabetes costs $101 billion annually in diagnosis and treatment and is growing 36 times faster than the cost of heart disease, the leading cause of death and the second most-expensive condition. 

"While it is well known that the US spends more than any other nation on health care, very little is known about what diseases drive that spending." said Dr. Joseph Dieleman, lead author of a paper published in JAMA and Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively."

In fact, the study found that just 20 conditions make up more than half of all spending on health care in the United States.

While diabetes and heart disease primarily affected consumers 65 and over, lower back and neck pain, the third-most-expensive condition, primarily strikes adults of working age.

These three top spending categories, along with hypertension and injuries from falls, comprise 18% of all personal health spending and totaled $437 billion in 2013.

This study distinguishes between spending on public health programs from personal health spending, including both individual out-of-pocket costs and spending by private and government insurance programs. It covers 155 conditions.

$2.4 trillion

In addition to the $2.1 trillion spent on the 155 conditions examined in the study, Dr. Dieleman estimates that approximately $300 billion in costs, such as those of over-the-counter medications and privately funded home health care, remain unaccounted for, indicating total personal health care costs in the US reached $2.4 trillion in 2013.

Other expensive conditions among the top 20 include musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome, and rheumatoid arthritis; well-care associated with dental visits; and pregnancy and postpartum care.

Other key findings include:

• Women ages 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 40% was expended on cardiovascular diseases, Alzheimer's disease, and falls.
• Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a spouse at home to provide care.
• Less than 10% of personal health care spending is on nursing care facilities, and less than 5% of spending is on emergency department care. The conditions leading to the most spending in nursing care facilities are Alzheimer's and stroke, while the condition leading to the most spending in emergency departments is falls.
• Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, totaled an estimated $77.9 billion in 2013, less than 3% of total health spending.

Top 10 diseases

The top 10 most costly health expenses in 2013 were:

1. Diabetes - $101.4 billion

2. Ischemic heart disease - $88.1 billion

3. Low back and neck pain - $87.6 billion

4. Hypertension - $83.9 billion

5. Injuries from falls - $76.3 billion

6. Depressive disorders - $71.1 billion

7. Oral-related problems - $66.4 billion

8. Vision and hearing problems - $59 billion

9. Skin-related problems, such as cellulitis and acne - $55.7 billion

10. Pregnancy and postpartum care - $55.6 billion

Oftentimes, scientists and medical experts need to look at the most minute details in order to understand the human body and the diseases that affect it. And since technology in the field is advancing all the time, they are able to do it to a greater degree.

In that vein, new research on how the body produces insulin may allow future therapies to evolve that better treat diabetes. Dr. Markus Grompe, who is best known for his work with stem cells, has found that there are at least four subtypes of insulin-producing beta cells in humans. It is the first study of its kind that has identified multiple types of such cells, and the information could mean a lot.

“Further understanding of cell characteristics could be the key to uncovering new treatment options, as well as the reason why some people are diabetic and others are not,” explained Grompe.

Identifying new cell types

Diabetes currently affects over 29 million people in the U.S. alone, and it occurs when a person’s insulin-producing beta cells are disrupted or cease to function. Without these cells doing their job, a person loses their ability to regulate their blood sugar levels, which can result in extreme fatigue, weight loss, vision ailments, pain in the extremities, and nerve damage, to name a few.

Up until this point, the medical community had thought that only one type of beta cell existed, but Grompe and his colleagues were able to isolate beta cells and classify three additional types.

Additionally, they found that there are hundreds of genes that differently express cell types, which leads to varying production of insulin in the body. The differences between these genes and cells could explain the differences between the types of diabetes and why certain people are susceptible to them.

“Some of the cells are better at releasing insulin than others, whereas others may regenerate quicker. Therefore, it is possible that people with different percentages of the subtypes are more prone to diabetes,” Grompe explains.

The next step for the researchers will be to attempt to understand how different cell subtypes are created so that they can create an approach for medical treatment. The full study has been published in the journal Nature Communications. 

Over 29 million people in the U.S. have diabetes, and over eight million who have it are undiagnosed, according to a 2014 statistical analysis. Although the disease affects so many, it has been hard for scientists and researchers to nail down a cure. This is due, in part, to the fact that the disease can take different forms, and there are still some things that researchers do not know about them.

However, a recent study conducted at the University of Pennsylvania has shed some light on type 2 diabetes. Researchers at the Perelman School of Medicine believe that they have finally found the cause of insulin resistance, which is characteristic of this particular type of the disease.

Excess fat

Many people attribute insulin resistance to fluctuating sugar levels in the body, but researchers say that it also has to do with the amount of fat in the body. In particular, too much fat inside of skeletal muscle is one main cause of insulin resistance.

With this in mind, scientists went about trying to find out how excess fat could be removed from skeletal muscle. If this fat could be removed, they reasoned, then it would also be possible to prevent insulin resistance from occurring. But in order to do that, there were some questions that had to be answered first.

“This research sought to answer a few large questions. . . How does fat get into skeletal muscle? And how is the elevation of certain amino acids in people with diabetes related to insulin resistance?” asked Dr. Zoltan Arany, senior author of the study. “We have appreciated for over ten years that diabetes is accompanied by elevations in the blood of branched-chain amino acids, which humans can only obtain in their diet. However, we didn’t understand how this could cause insulin resistance and diabetes. How is elevated blood sugar related to these amino acids?”

New way to treat diabetes

In order to answer these questions, Dr. Arany and his team began examining amino acids and what happened when they broke down. They found that when these compounds broke down, a byproduct called 3-HIB was created. After being secreted by muscle cells, 3-HIB activated certain cells which resulted in more fat being stored in skeletal muscle tissue.

Researchers observed this phenomenon in mice and saw that when it happened it led to insulin resistance. By blocking 3-HIB from synthesizing, researchers were able to keep excess fat from going to the skeletal muscle and insulin resistance was no longer a problem.

Dr. Arany is quick to note that 3-HIB byproducts are also plentiful in humans who have type-2 diabetes, so although there will need to be more research to prove that there is a link, he is confident that one may be discovered in the future.

“The discovery of this novel pathway – the way the body breaks down these amino acids that drives more fat into the muscles – opens new avenues for future research on insulin resistance, and introduces a conceptually entirely new way to target treatment for diabetes,” he said.

The full study has been published in Nature Medicine. 

Smartphones may soon be able to add one more entry to their rolodex of skills: the ability to act as a tool to measure blood glucose levels for those suffering from Type 1 diabetes.

After 20 years of research, University of Virginia School of Medicine researchers are in the final testing phases of a system that can automatically measure and monitor blood sugar levels. Early testing produced promising results. Now, researchers say actual patient testing is going well, and the system is circling the landing towards completion.

The app—called “InControl”—can control everything people with diabetes need, eliminating the need for finger pricks and manual insulin injections. This ease of the system could prove to be a game-changer in the lives of 1.25 million people who suffer from the disease.

Effortlessly manages levels

The so-called “artificial pancreas” has been in the works since 2006, says lead researcher Boris Kovatchev, director of the Centre for Diabetes Technology in the US. 

Kovatchev’s own father suffered from diabetes, so he saw firsthand the need for an easier way to live with the disease. “We show that it is not only possible, but it can run on a smartphone,” says Kovatchev.

Every five minutes, the system will report blood glucose level results to the app on a nearby android smartphone. It will analyze the data, and if necessary, adjust insulin levels on a small, wearable insulin pump.

Wirelessly controls pump

The app works by controlling an insulin pump: a device which is already used by approximately 350,000 diabetes sufferers in the US. The pump works by delivering user-adjusted doses of insulin to the bloodstream through a very fine needle; it can be worn discreetly under an article of clothing or hooked to a belt.

The wireless monitor, which talks to the pump, is as tiny as a flash drive and can be worn anywhere on the body. Together, the two devices create a digital treatment ecosystem of sorts that can handle the burden of the disease.

"It runs on a five-minute cycle and takes information from these devices and calculates the next best option for the patient pretty much any point in time,” said Chad Rogers, the CEO of TypeZero Technologies, which has licensed and refined the technology.

Final phases of testing 

The ultimate goal is to make managing Type 1 diabetes automatic and effortless.

“If it is working, you do not know that it is there,” says Francis Doyle III, dean of Harvard’s Paulson School of Engineering and Applied Sciences, who is collaborating with Kovatchev on the system

UVA researchers have brought the system to nine locations across the U.S. and Europe to try it on 240 patients. Researchers hope to have the trials complete and the system perfected in four years.

In the last decade there has been an explosion in the number of type 2 diabetes cases, coinciding with a massive rise in obesity.

The disease is a long-term condition caused by too much glucose, a type of sugar, in the blood.

Now, researchers at Newcastle University in the UK say they have found a simple way to reverse it; lose weight.

After a small trial, the scientists have concluded that reducing the amount of fat around the pancreas in type 2 diabetes patients returns organ functions to normal. They say this shows that the excess fat in the diabetic pancreas is specific to type 2 diabetes and important in preventing insulin from being made.

When that excess fat is removed, insulin secretion increases to normal levels. In other words, they were diabetes free.

Previous research

This isn't the first study to suggest weight loss might reverse type 2 diabetes. Last year, researchers at the Cleveland Clinic found that bariatric surgery – reducing the size of the stomach so the patient loses weight – appeared to be effective in reversing diabetes.

Meanwhile, like most chronic diseases, type 2 diabetes is treated with drugs, including the newly approved Jardiance.

Roy Taylor, a professor at Newcastle University, says losing weight simply helps patients with type 2 diabetes drain excess fat out of the pancreas, and that allows function to return to normal.

One gram of pancreas fat

“So if you ask how much weight you need to lose to make your diabetes go away, the answer is one gram. But that gram needs to be fat from the pancreas,” Taylor said. “At present the only way we have to achieve this is by calorie restriction by any means – whether by diet or an operation.”

In the trial, type 2 diabetes patients saw the fat levels in their pancreas decrease by as much as 1.2% over eight weeks. With an average pancreas for a person with Type 2 diabetes having a volume of 50 ml, this is the equivalent of around 0.6 grams of fat.

The patients who had never had diabetes experienced no change in the level of fat in their pancreas. That told the scientists that the increase in fat in the pancreas is specific to people who develop type 2 diabetes.

The fat in the pancreas may, in fact, be a trigger for the disease, and individuals vary in how much fat they can tolerate in the pancreas before type 2 diabetes develops.

What to do

Taylor says the research may transform the thinking about type 2 diabetes and its treatment.

Keep in mind, this is a report of research findings. It should not be used by patients to make unilateral decisions about their care or to start or stop prescribed medications.

If you have concerns about type 2 diabetes treatments, you should discuss them with your doctor, mentioning this study. 

Diabetes comes in a variety of different forms. The most common form of the disease, type 2 diabetes, results from cells in the body not using insulin as well as they should. Type 1 diabetes (T1D), however, is much rarer, and results when the body simply can’t produce its own insulin at all. People who have this condition must take part in insulin therapy and other treatments in order to live a full and healthy life.

Scientists from Uppsala University have investigated the disease thoroughly, and believe that a certain protein found in the body could potentially provide a cure.

The protein in question is called interleukin-35 (IL-35), and it is made of immune cells. Dr. Kailash Singh, who is a PhD student at Uppsala University, began studying this immune cell when she was examining T1D in rat models. In her research, she found that immune regulatory T-cells in the models were producing pro-inflammatory destructive proteins instead of IL-35, which is an anti-inflammatory protein.

This reversal is the exact opposite of what should be happening in a normal body, and Singh believes that it may be something that is prompted by T1D.

“This suggests that the good guys (the anti-inflammatory proteins) have gone bad in early development of Type 1 diabetes and therefore our immune cells destroy the beta cell,” she said.

Crucial protein

As a result of this destructive process, Singh found that the levels of IL-35 that should have been present in the models were much lower than they should be. These low levels indicate that the protein may play a crucial role in stopping T1D.

The research team that Singh was a part of, which was led by Professor Stellan Sandler, set out to find if IL-35 could suppress or reverse T1D, even if the disease was already established. The team utilized mice who had been injected with a chemical that induced symptoms of T1D. After the symptoms had been established for two days, the researchers injected them with IL-35 to see if their blood glucose levels normalized.

Their findings show that the blood glucose levels in the mouse models stabilized after they were given the injections. In addition to this finding, the researchers were also able to test IL-35 injections against a specific model of T1D, called non-obese diabetic mouse (NOD). Even after the IL-35 treatments were stopped, diabetic symptoms did not return in any of the subjects.

Unique insights 

"To the best of our knowledge, we are the first to show that IL-35 can reverse established Type 1 diabetes in two different mouse models and that the concentration of the particular cytokine is lower in Type 1 diabetes patients than in healthy individuals. Also, we are providing an insight into a novel mechanism: how immune regulatory T cells change their fate under autoimmune conditions", said Singh.

The full study has been published in Scientific Reports. 

Many recent advances in treating diabetes have focused on making the disease more manageable by allowing those affected to measure their glucose levels more quickly and with less pain. Now researchers have developed a new way of doing just that for those suffering from Type 1 diabetes.

They have proposed implanting an “artificial pancreas” into people that can measure their blood sugar levels and automatically release insulin when it is needed.

Type 1 diabetes affects well over one million people living in the United States today, many of which are teenagers or children. The disease results from the immune system destroying pancreatic cells which are responsible for insulin production. In order to make up for this, patients take insulin injections every day to keep their glucose levels normal.

The current method of injecting insulin is less than optimal, since it relies on the user to constantly keep track of their blood sugar levels and the amount of insulin they are taking. This is particularly hard for people who are very young or very old, since they may not be able to keep track of all of the pertinent information.

Even after injecting the insulin, there is still a significant amount of time that needs to pass before it can affect a person’s system. This can be dangerous in cases where the desired effects are needed sooner rather than later. In order to fix this problem, Francis J. Doyle III and his team researched ways in which monitoring and delivering insulin injections would not be so laborious.

Faster reactions

Doyle and his team designed an algorithm that keeps track of blood sugar levels in the human body and calculates how much insulin is needed to counteract imbalances. The formula is designed to work with implanted devices, like the artificial pancreas.  

If proven viable, the artificial pancreas would be able to react to insulin needs much faster than someone with Type 1 diabetes ever could. Because it is constantly monitoring the body, it can deliver the correct dosage as soon as a person needed it. The algorithm is even designed to take food intake and sleep periods into account when making its determinations.

Early tests of the artificial pancreas have proven positive. It maintained blood sugar levels within a target range almost 80 percent of the time. The researchers will strive to improve upon that number as time goes on. They hope to begin testing the device in animals in the near future. 

Researchers from the University of North Carolina and NC State have developed a small insulin patch that may help the 387 million people who suffer from diabetes. If successful, the patch could replace painful insulin injections and better regulate blood sugar levels in the human body.

The developing patch is a thin square that is no bigger than a penny. It is covered with over one hundred “microneedles” that each hold a small store of insulin and a sensor that detects glucose. When you apply the patch to your skin, the sensors in the needles will detect if your blood sugar levels are too high. If they are, then the needles release their insulin stores to regulate your glucose levels.

“We have designed a patch for diabetes that works fast, is easy to use, and is made from nontoxic, biocompatible materials,” said Zhen Gu, who is co-senior author of the study. “The whole system can be personalized to account for a diabetic’s weight and sensitivity to insulin, so we could make the smart patch even smarter.”

Impractical and imprecise

The current standard for those with diabetes is to prick their fingers to test their glucose levels, and take an insulin shot if they need to. This can be a dangerous practice, though. John Buse, who is another co-senior author of the study, calls it impractical and imprecise.

“Injecting the wrong amount of medication can lead to significant complications like blindness and limb amputations, or even more disastrous consequences such as diabetic comas and death,” he said.

Researchers have already begun testing their patches on mice to see if they could control their blood sugar levels. One set of mice was given a standard insulin injection; their blood sugar levels dropped to normal levels, but rose back up to hyperglycemic range quickly. Another set of mice was given the new smart patch; their blood sugar levels were brought under control within 30 minutes and stayed that way for several hours.

These tests reflect positively on the smart patch’s ability to regulate blood sugar levels in people. Mice are less sensitive to insulin, so the stabilizing effects of the patch could last even longer when given to humans. Researchers hope that the patch could last up to a few days before needing to be changed. This would save a lot of time for diabetics who need to constantly be on top of their blood sugar regulation.

“The hard part of diabetes care is not the insulin shots, or the blood sugar checks, or the diet, but the fact that you have to do them all several times a day, every day, for the rest of your life,” said Buse. “If we can get these patches to work in people, it will be a game changer.

The full study has been published in Proceedings of the National Academy of Sciences.

Despite advances in modern medicine, there are still many diseases that stubbornly persist. Cancer, heart disease and diabetes are being worked on tirelessly by researchers and scientists every day.

So if there were a medicine that could help with these illnesses, wouldn’t you want to know about it? Unfortunately, it seems that many medical professionals are keeping us in the dark, or may be in the dark themselves.  

A study from UCLA shows that only a small fraction of practicing doctors are prescribing metformin, which has been proven to help prevent the onset of diabetes. It indicates that only 3.7% of U.S. adults with pre-diabetes were recommended to take the drug in a recent three-year period.

While many people struggle with fully formed diabetes, pre-diabetes is often understated. It is found in people who have higher-than-normal blood sugar levels, yet do not reach the threshold for diabetes. It is projected that one third of adults in the U.S. currently meet the requirements for pre-diabetes. Dr. Tannaz Moin, who is the study’s lead author and a professor of medicine at UCLA, says metformin can help those at risk.

“Diabetes is prevalent, but pre-diabetes is even more prevalent and we have evidence-based therapies like metformin that are very safe and that work," Moin said.

Different organizations have recognized the benefits of metformin in recent years. The American Diabetes Association added metformin to its guidelines for diabetes prevention in 2008. The organization specifically mentions that the drug should be used by those who have high blood sugar levels, even if they are not yet in the diabetes range.

Despite all of this support, only small fractions of patients are advised to take the drug. Of these, there were specific people that were more likely to get a prescription. In particular, women, the obese, and those suffering from multiple chronic diseases were preferred.

Various theories

Researchers are not completely certain why the drug is not being recommended, but they do have theories. One of these is that medical professionals are reluctant to “medicalize” pre-diabetes. Even patients may be hesitant to admit that they could be in danger. This lack of acceptance could very well be the reason that the FDA has not approved the drug for treatment of pre-diabetes.

While the study is telling, there are some shortcomings that need to be followed up on in the future. For example, the researchers focused only on adults who had commercial insurance. This excludes those who are uninsured or older. Being able to verify if patients could take the drug could also adjust the findings significantly.  

Additional research could very well lead to drastic improvements in health, says Dr. Sam Ho, a co-author of the study: "Identifying more effective ways to help people avoid diabetes is essential to individuals' lives and to society as a whole, which is why it was important to us to support this research," he says.

As Americans have become increasingly overweight and obese, there has been an explosion in the cases of type 2 diabetes. Unlike type 1 diabetes, type 2 is largely tied to lifestyle risk factors.

In 2014 the Centers for Disease Control and Prevention (CDC) estimated 29.1 million people – 9.3% of the U.S. population – had diabetes, a chronic condition that affects the way your body metabolizes sugar, or glucose.

Type 2 was once most common in adults – typically older adults – but the Mayo Clinic reports that it has increasingly begun to affect large numbers of children. The disease is managed through insulin drugs, as well as by eating well, exercising and maintaining a healthy weight.

In addition to the growing number of diabetes cases, the American Diabetes Association (ADA) estimates another 86 million American adults probably have prediabetes, meaning their blood sugar levels are higher than normal. More disturbing, the group says about 8 million Americans may have the disease and not know it.

Risk factors

How do you know if you or your child is at risk of developing type 2 diabetes? Being obese and living a sedentary lifestyle are 2 significant risk factors.

The ADA has developed a Diabetes Risk Test, an online app that allows users to measure their risks of developing the disease. The quiz asks users to answer short questions about weight, age, family history and other potential risk factors for diabetes.

The results are compiled into a numerical score that indicate either a low or high risk for developing type 2 diabetes. If the results suggest a high risk, the ADA urges you to speak with a health care provider to learn more about ways to either reduce the risk or delay the onset of the disease.

“Awareness is crucial in the effort to stop Diabetes,” said David Marrero, an executive at ADA. “We’re asking the public to take It. Share it. Step out. Take one minute to take the risk test today, share it with your loved ones and get started getting active by getting involved in your local Step Out event. The Diabetes Risk Test can be the first step in knowing your risk and helping us get closer to our vision of a life free of diabetes and all of its burdens.”

Primary risk factors

Doctors say you are most at risk of developing type 2 diabetes if you are overweight, sedentary, over the age of 45 and have a family history of diabetes. African Americans, Hispanics/Latinos, Native Americans, Asian Americans and Pacific Islanders are at an increased risk, as are women who have had gestational diabetes or had babies weighing more than nine pounds at birth.

Symptoms

How do you know if you have the disease? Symptoms can include blurred vision, excessive thirst and frequent urination. The problem is, these symptoms may not show up at the onset of the disease.

ADA is trying to close what it sees as a diagnosis gap, getting treatment to patients earlier in the disease and heading off dangerous complicaitons, like heart disease, blindness, kidney disease, stroke, amputation and even death.

The group cites studies showing type 2 diabetes can be prevented or delayed by losing just 7% of body weight, regular physical activity and healthy eating.

Patients diagnosed with diabetes are usually treated with insulin, a natural substance in the body that regulates how sugar is broken down and processed.

For decades insulin has been a life saver and allowed diabetics to live a healthier, more active life.

But for diabetics who lack prescription drug benefits, insulin prescriptions are costly, running anywhere from $120 to $400 a month. While many expensive drugs have less-expensive generic alternatives, insulin does not – at least not in the U.S.

Normally, pharmaceutical companies obtain a patent for a drug, allowing them exclusive right to sell it under a name brand. Eventually the patent expires, and other drug companies may then produce it and sell it for less in its generic form.

But that hasn't happened with insulin, even though it was introduced more than 90 years ago.

Evergreening

Writing in the New England Journal of Medicine, Johns Hopkins researchers Jeremy Greene and Kevin Riggs say insulin is an example of what's called “evergreening.” The drug company holding the patent keeps making small improvements to the drug and each time it does it renews the patent.

These regular tweaks result in more effective medication for people with diabetes but has had the effect of blocking entry of a generic insulin drug to the market.

True, generic drug makers could produce the older versions of the drugs, but the authors say they don't because they have less incentive. As a result, they say many patients who should be taking insulin don't because they can't afford it.

While there are generic drugs for just about everything else, Greene and Riggs say a generic insulin would be highly beneficial.

Limits of competition

“We see generic drugs as a rare success story, providing better quality at a cheaper price,” said Greene, who is an associate professor of the history of medicine at the Johns Hopkins University School of Medicine and a practicing internist. “And we see the progression from patented drug to generic drug as almost automatic. But the history of insulin highlights the limits of generic competition as a framework for protecting the public health.”

There have been many notable improvements to insulin over the years. In the 1930s and 1940s, insulin treatments became longer-acting, so that most patients only had to take a single dose each day.

In the 1970s and 1980s, manufacturers improved the purity of cow and pig extracted insulin. Since then, several companies have developed synthetic forms.

The authors say the patents on the first synthetic insulin expired last year, but these newer forms are harder to copy so these unpatented versions will go through a lengthy Food and Drug Administration (FDA) approval process and will cost more to make.

Riggs and Greene say there may ultimately be some generic versions of these insulin drugs but they probably won't be a lot cheaper than the name brands.

It's often said that maintaining your health will result in spending less money on doctor's visits, tests and prescription medicine.

It would make sense that is true, but can anyone really back it up? Researchers at Wake Forest Baptist Medical Center say they can.

In a study, they found that overweight people who have diabetes can save, on average, $500 per year by shedding pounds through proper diet and exercise.

"Lifestyle interventions promoting weight loss and physical activity are recommended for overweight and obese people with type 2 diabetes to improve their health," said Mark A. Espeland, lead author of the study. "This is the first study to show that weight loss can also save money for these individuals by reducing their health care needs and costs."

In the study, subjects with type 2 diabetes, a condition largely the result of obesity and other lifestyle factors, were put on an intensive lifestyle intervention program, supplemented with diabetes support and education. Others in the study maintained their normal lifestyle and managed their diabetes solely through medication.

Results

The researchers say at the end of the study, those who lost weight and adopted a healthier lifestyle had 11% fewer hospitalizations. Those who were admitted to hospitals were discharged 15% earlier. They also had to purchase fewer medications.

The researchers were able to put a dollar amount on those differences. The group that lost weight saved an average $5,280 over 10 years – or $528 per year.

Espeland said the people who lost weight and increased physical activity improved their overall health because they had better control of their diabetes, blood pressure, sleep quality, physical function and symptoms of depression. The cost savings appeared to be consistent regardless of age, initial weight, gender or ethnicity.

"Type 2 diabetes is a chronic disease that is affecting more and more adults, increasing their health care needs and costs," Espeland said. "This study shows that by losing weight and being physically active, individuals can reduce these costs."

Boost for corporate wellness programs

The findings may provide additional support for corporate wellness programs, that provide incentives for employees to get regular exercise and adopt a healthy lifestyle. According to Kiplinger, more than 40% of large employers surveyed by the National Business Group currently offer their employees some kind of incentive for participating in a wellness programs.

The average incentive is just under $400. The corporations hope to recoup the cost of those incentives through lower health insurance premiums, as well as increased worker productivity and fewer sick days.

According to Kiplinger, some employers may add $75 to an employee's health savings account if they participate in an exercise program.

The U.S. military is grappling with the effects poor lifestyle choices have on health, not just in dealing with rising health care costs but in filling out its ranks.

According to Army Magazine, about 1 in 4 possible recruits is eligible to enlist. Some of the other 75% might be ineligible, have weight or medical issues that keep them out of uniform.

It quotes Army officials as say the declining pool of recruits is a problem, so the urgency for better health and lifestyle choices is no longer simply a national health issue, nor just an economic one -- it's a matter of national security.  

Princeton University researchers have developed a way to use a laser to measure people's blood sugar, and, with more work to shrink the laser system to a portable size, the technique could allow diabetics to check their condition without pricking themselves to draw blood.

"We are working hard to turn engineering solutions into useful tools for people to use in their daily lives," said Claire Gmachl, the project's senior researcher. "With this work we hope to improve the lives of many diabetes sufferers who depend on frequent blood glucose monitoring."

In an article published June 23 in the journal Biomedical Optics Express, the researchers describe how they measured blood sugar by directing their specialized laser at a person's palm. The laser passes through the skin cells, without causing damage, and is partially absorbed by the sugar molecules in the patient's body. The researchers use the amount of absorption to measure the level of blood sugar.

Sabbir Liakat, the paper's lead author, said the team was pleasantly surprised at the accuracy of the method. Glucose monitors are required to produce a blood-sugar reading within 20% of the patient's actual level; even an early version of the system met that standard. The current version is 84% accurate, Liakat said.

"It works now but we are still trying to improve it," said Liakat, a graduate student in electrical engineering.

Jardiance (empagliflozin) tablets have been given the green light to be used to improve glycemic control in adults with type 2 diabetes.

Approximately 26 million people are affected by type 2 diabetes, which accounts for more than 90% of diabetes cases diagnosed in the U.S. Over time, high blood sugar levels can increase the risk for serious complications, including heart disease, blindness, and nerve and kidney damage.

"Jardiance provides an additional treatment option for the care of patients with type 2 diabetes," said Curtis J. Rosebraugh, M.D., M.P.H., director of the Office of Drug Evaluation II in the Food and Drug Administration’s Center for Drug Evaluation and Research. “It can be used alone or added to existing treatment regimens (diet and exercise ) to control blood sugar levels in the overall management of diabetes.”

Safe and effective

Jardiance is a sodium glucose co-transporter 2 (SGLT2) inhibitor. It works by blocking the reabsorption of glucose (blood sugar) by the kidney, increasing glucose excretion, and lowering blood glucose levels in diabetics who have elevated blood glucose levels.

The drug’s safety and effectiveness were evaluated in seven clinical trials with 4,480 patients with type 2 diabetes receiving Jardiance. The pivotal trials showed that Jardiance improved hemoglobin A1c levels (a measure of blood sugar control) compared to placebo.

Jardiance has been studied as a stand-alone therapy and in combination with other type 2 diabetes therapies including metformin, sulfonylureas, pioglitazone, and insulin. It should not be used: to treat people with type 1 diabetes; in those who have increased ketones in their blood or urine (diabetic ketoacidosis); and in those with severe renal impairment, end stage renal disease, or in patients on dialysis.

Further study required

The FDA is requiring four postmarketing studies for Jardiance:

• Completion of a continuing cardiovascular outcomes trial.
• A pediatric pharmacokinetic/pharmacodynamic study.
• A pediatric safety and efficacy study. As part of the safety and efficacy study, the effect on bone health and development will be evaluated.
• A nonclinical (animal) juvenile toxicity study with a particular focus on renal development, bone development, and growth.

Warnings

Jardiance can cause dehydration, leading to a drop in blood pressure (hypotension) that can result in dizziness and/or fainting and a decline in renal function. The elderly, patients with impaired renal function, and patients on diuretics to treat other conditions appeared to be more susceptible to this risk.

The most common side effects of Jardiance are urinary tract infections and female genital infections.

Jardiance is distributed by Boehringer Ingelheim Pharmaceuticals of Ridgefield, Conn.