Diabetes Cure

The first definitive, large-scale clinical trial to investigate if a vitamin D supplement helps prevent or delay type 2 diabetes in adults who have prediabetes is underway.

The study, funded by the National Institutes of Health, is taking place at about 20 study sites across the United States, involving adults who are at high risk for developing type 2 diabetes.

The multiyear Vitamin D and Type 2 Diabetes (D2d) study will include about 2,500 people. The goal is to learn if vitamin D -- specifically D3 (cholecalciferol) -- will prevent or delay type 2 diabetes in adults aged 30 or older with prediabetes. People with prediabetes have blood glucose levels that are higher than normal but not high enough to be called diabetes.

“This study aims to definitively answer the question: Can vitamin D reduce the risk of developing type 2 diabetes?” said Myrlene Staten, M.D., D2d project officer at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of NIH. “Vitamin D use has risen sharply in the U.S. in the last 15 years, since it has been suggested as a remedy for a variety of conditions, including prevention of type 2 diabetes. But we need rigorous testing to determine if vitamin D will help prevent diabetes. That’s what D2d will do.”

“Past observational studies have suggested that higher levels of vitamin D may be beneficial in preventing type 2 diabetes,” said Anastassios G. Pittas, M.D., the study’s principal investigator at Tufts Medical Center, Boston, “but until this large, randomized and controlled clinical trial is complete, we won’t know if taking vitamin D supplements lowers the risk of diabetes.”

First of its kind

D2d is the first study to directly examine if a daily dose of 4,000 International Units (IUs) of vitamin D -- greater than a typical adult intake of 600-800 IUs a day, but within limits deemed appropriate for clinical research by the Institute of Medicine -- helps keep people with prediabetes from getting type 2 diabetes. Based on observations from earlier studies, researchers speculate that vitamin D could reduce the diabetes risk by 25%. The study will also examine if sex, age or race affect the potential of vitamin D to reduce diabetes risk.

“An estimated 79 million Americans have prediabetes, and nearly 26 million more have diabetes,” said NIDDK Director Griffin P. Rodgers, M.D. “With D2d, we seek evidence for an affordable and accessible way to help prevent or delay type 2 diabetes.”

Researchers are recruiting volunteers to take part in D2d. Half of the participants will receive vitamin D. The other half will receive a placebo -- a pill that has no drug effect. Participants will have check-ups for the study twice a year, and will receive regular health care through their own health care providers.

In the dark

The study will be double-blinded, so neither participants nor the study’s clinical staff will know who is receiving vitamin D and who is receiving placebo. The study will continue until enough people have developed type 2 diabetes to be able to make a scientifically valid comparison between diabetes development in the two groups, likely about four years.

There have been other NIH-funded studies of methods to delay or prevent type 2 diabetes, including the Diabetes Prevention Program, which showed that -- separately -- lifestyle changes to lose a modest amount of weight and the drug metformin are both effective in slowing development of type 2 diabetes in people with prediabetes. However, additional safe and effective preventative strategies are needed to stem the increasing numbers of people developing type 2 diabetes.

Type 2 diabetes, along with heart disease and cancer, seems to be a curse of civilization, increasing rapidly in many industrialized nations, with diagnosed cases increasing by 100 percent or more in 18 states between 1995 and 2010, according to a recent study by the Centers for Disease Control and Prevention (CDC). 

Both types of diabetes have a genetic component. What triggers the development of type 1 is not fully understood while type 2 diabetes is often associated at least partly with obesity and a sedentary lifestyle.

It's type 2 diabetes -- too much glucose in the bloodstream -- that has been increasing at such an alarming rate in recent years, marching along in tandem with the incidence of overweight and obesity and the increasingly sedentary lifestyle found in developed countries.

So, if that's the cause of diabetes, it should be easy to find a cure, right? Unfortunately, no. Someone once compared type 2 diabetes to a car wreck -- once it happens, the resulting injuries can treated but the only complete  cure is to avoid the accident in the first place.

Reducing weight through exercise and a healthy diet can often reduce the severity of type 2 diabetes and even enable some people to return to more normal glucose levels. In more severe cases, it is sometimes possible to nudge type 2 diabetes into remission through weight-loss surgery, a drastic step but one that is sometimes the most effective option for the morbidly obese.

However, it's important to note that a remission is not a cure. If the patient regains the weight, as many do, the diabetes is likely to return.

Potential type 1 cures

Researchers are developing and testing many potential cures for both types of diabetes, including stem cell therapy, which could theoretically be used to build new pancreatic cells that would generate and control insulin for those with type 1 diabetes.

But while stem cells may hold the key to treating many types of illness, there is still no proven method for implanting them in humans, so any cure involving stem cells is far from imminent.

Islet cell transplantation can improve the quality of life for patients with type 1 diabetes, by enabling the pancreas to produce and regulate insulin more effectively but while it may improve quality of life, it is not yet regarded as a cure.

Type 2

But while stem cells and islet cell transplants are seen as potential cures for type 1 diabetes, there is still no cure on the horizon for type 2 diabetes, which is why prevention is so important and why public health officials are so alarmed at the virulent spread of type 2 diabetes.

The Internet is full of ads and bogus news stories about "natural" and "secret" cures for diabetes -- the types of claims we hear about every chronic disease, often using phrases like "the diabetes cure they don't want you to know about."

Such claims can cause consumers to pursue phony treatments that may leave them worse off than when they started -- while also draining their bank accounts.

"I keep receiving bill for a book. I already paid for a book called 30 Day Diabetes Cure with a check that was cashed by Bottom Line Books," said Marjorie of Greenville, N.C., in a recent posting to ConsumerAffairs.

Even cookware manufacturers have been known to claim that using their pots and pans will somehow prevent or cure diabetes. Rena Ware International, Inc., agreed to pay more than $600,000 a few years ago to settle claims by the California attorney general that it "made fraudulent and unethical claims" that its high-priced cookware could cure diseases such as diabetes and heart disease.

A good rule of thumb is to immediately dismiss any claims -- about anything -- that supposedly reveal a "secret" known only to a handful of insiders. While the CIA may still have a few secrets up its sleeve, the truth is that very few things are secret in today's wide-open world of information, misinformation and disinformation.

Rest assured, if anyone develops a cure for diabetes, scientists, public health officials, the government, the press and the health insurance companies that now pay billions to treat diabetes will be quick to publicize it.

"Natural" cures

Consumers should also be cautious of claims made by nutrition supplement peddlers and those who say there are "natural" cures for diabetes and other diseases.

There is a natural prevention for type 2 diabetes -- maintaining a good diet, keeping weight to a healthy level and exercising regularly. While this may not be 100 percent effective, most experts agree it would prevent millions of new cases of type 2 diabetes.

Will adding a few magnesium and chromium supplements to your diet prevent or cure diabetes? Not likely.

While vitamin and mineral supplements may contribute to overall health, it's important to talk with your doctor before taking any supplement. Many can conflict with prescription medications or aggravate existing health conditions.

Misinformation

The Internet has arguably done a few good things for humanity but enabling  the spread of false and misleading health information is not one of them. There are many sources of sound information, including the American Diabetes Association website and sites operated by major medical centers, like the Mayo Clinic and the Johns Hopkins Diabetes Center.

However, it's important to remember that all health information pubished in books, on websites and elsewhere is general in nature. Only your doctor can apply general information to your particular situation.

It's worth noting that taking the steps recommended to prevent or treat diabetes -- a heathy diet, regular exercise, limited or no use of alcohol -- can also contribute to a reduced risk of heart disease, stroke, cancer and many other health problems.

Sitting in a chair reading fraudulent claims on the Internet isn't nearly as good as taking a brisk walk around the neighborhood.

Here's a statistic that may be surprising to some pet owners:

There has been a 32 percent rise in dogs being diagnosed with diabetes between the years of 2006 and 2010, according to a study released by Banfield Pet Hospital called the “State of Pet Health 2011 Report.”

The study shows that canine obesity was one of the leading factors in dogs developing Diabetes Mellitus, and it remained within the top five causes for the disease among young adult, mature adult and geriatric dogs.

The authors of the report advise owners to bring dogs to the vet twice a year as opposed to once, which will increase the chance of the illness being discovered in its beginning stages.

Also, pet owners should be engaging their dogs in the right amount of physical activity, while constantly managing their food intake, meal portions and other nutritional needs.

All of these methods combined will significantly lower the possibility of your dog developing diabetes or other dangerous illnesses, say experts.

Placing one hand on your dog's side is one quick way of checking to see if your dog is obese or not. If you're not able to feel your dog's ribs quickly and upon first touch, it's a good indication he or she may be overweight.

Other symptoms

There are also other symptoms that owners will notice when their dog is suffering from the disease.

“Polyuria, which means urination. Polydipsia, which is drinking more, is the first sign you see in dogs and weight loss,” said Dr. Sailendra Roy, a veterinarian at Ambassador Animal Hospital, located in Silver Spring, Md. in an interview with ConsumerAffairs.

“That's the characteristic or sign which prompts the owner to say 'hey something is going wrong here.' And then they bring the animals in, we do the blood work exactly the same way like humans. So that's the typical symptom. Once you get the blood work it tells you more if there are any other organs involved and things like that. But these are the primary symptoms," he said.

Experts also say if your dog is diagnosed with diabetes, but still able to hold down food and water without vomiting, they may be able to be treated as an outpatient and won't require an expensive and sometimes stressful hospital stay.

Of course this will be ultimately determined by the veterinarian during the initial diagnosis or within your pet's follow-up visits.

Insufficient insulin

Canine Diabetes is usually due to an insufficient amount of insulin being created in the dog's body, which is the Type 1 version of the disease, formerly known in humans as Juvenile Diabetes. In rare cases a dog may have enough natural insulin but the pancreas will process it in the wrong way, say experts. This can cause Type 2 diabetes, formerly known in humans as Adult Onset Diabetes.

Currently, there is no cure for the disease in animals, and although treatments vary, Dr. Roy says insulin has a far better success rate than other types of medicines, and really should be your first line of attack against dog diabetes.

“Once a dog is diagnosed, most dogs will be depending on insulin or medication,” he said. “In cats and dogs oral medication has questionable benefits.”

“So you start with insulin and there's a lot of foods out there which are designed as a prescription diet for diabetic patients,” he noted. “There are quite a few out there like Waltham. They have different kinds of diabetic diets that are normally recommended because home meds are kind of impossible [to properly treat the dog].”

The Banfield Hospital report also shows that geography may play a part in dogs being diagnosed with diabetes. In 2010, Rhode Island, Iowa, Idaho, Nevada, and Delaware had the highest rate of Diabetes Mellitus in dogs.

Although the reason why these states had a higher prevalence for Canine Diabetes wasn't revealed in the report, it could be due to the same reason diabetes numbers fluctuate between states among humans.

Awareness, lifestyle and overall culture have always impacted health and potential treatments in humans and their pets.

Chronic condition

Once a dog starts treatment, it's unlikely that the condition will reverse itself, and medication will be needed for the remaining years of the animal's life, Dr. Roy said.

“Once the insulin starts, spontaneous remission is non-existent,” he said. "Most dogs will be getting it for the rest of their lives. There are some reports that [show] sometimes dogs and cats get into remission, but it's so rare. I haven't seen that happen."

According to Michigan veterinarian Dr. Race Foster, who co-authored four books on pet health, certain dog breeds are more prone to getting diabetes than others.

Labrador and golden retrievers, German shepherds, Yorkshire terriers, the Keeshond, the beagle and poodles of various sizes all have a slightly greater chance of developing the disease, he says.

Although Dr. Roy agrees there are some key findings on the link between genetics and Canine Diabetes, there isn't enough large-scale research for veterinarians to make a full and absolute conclusion.

“In the same way that research has been done in humans you can see a familiar test result,” [in dogs] he says. “We ask the patient if their parents had diabetes. I don't think as far as my knowledge is concerned that there is any extensive research to find out whether there's an inherited gene that's possible for diabetes in animals.”

Experts also say that using a portable blood glucose meter for your dog as well as keeping an informational chart of the results is imperative once your dog is diagnosed, and it's also important not to change your pet's diet until you discuss it first with your veterinarian.

As America packs on the pounds and becomes more sedentary, the number of cases of diabetes grows. The disease, a malfunction of the body's ability to process blood sugar, is particularly prevalent among overweight seniors, according to health statistics.

Data from the 2011 National Diabetes Fact Sheet found a total of 25.8 million children and adults in the U.S. – 8.3% of the population – have diabetes. About seven million of those cases remain undiagnosed, making them even more dangerous. 

To understand diabetes and whether you have it, or are at risk, we need to start with the classifications of the disease – Type 1 and Type 2 diabetes.

In Type 1 diabetes, your body does not produce enough insulin. It needs insulin to break down carbohydrates and fat and regulate your metabolism. People with Type 1 are usually diagnosed as children or young adults and the disease is not preventable. It's also fairly rare, making up only 10% of the diabetes cases in the U.S.

Type 2, on the other hand, is preventable in most cases. In Type 2 diabetes, blood sugar levels are abnormally high, a condition known as hyperglycemia. If you are overweight or obese you have a higher risk of developing Type 2 diabetes, compared to those with a healthy body weight. Not surprisingly, doctors have seen a corresponding rise in Type 2 diabetes with the recent rise in obesity.

Symptoms

How do you know if you have diabetes? The symptoms for the two types vary slightly. According to the Mayo Clinic, those with pre-diabetes or Type 2 may not have any symptoms right away. On the other hand, if you have developed Type 1 diabetes, you'll experience symptoms almost immediately. Symptoms for both types include: 

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones, a byproduct of the breakdown of muscle and fat that happens when there's not enough insulin, in the urine
• Fatigue
• Blurred vision
• Slow-healing sores
• High blood pressure
• Frequent infections, such as gums or skin infections and vaginal or bladder infections

Seniors at risk

If you are a senior and have put on weight late in life, you may be especially vulnerable to Type 2 diabetes. Though the reasons are unclear, doctors suspect that the combination of adding body weight while decreasing physical activity in old age is a major catalyst. Men whose testosterone levels fall as they age may also be at higher risk, since some research suggests low testosterone levels are linked to insulin resistance.

People with diabetes, either Type 1 or Type 2, typically manage their disease with insulin, a nutritious diet and regular physical activity. Type 2 patients may be able to avoid insulin – at least in the beginning – by following a healthy lifestyle. However, Type 2 is a progressive disease that, over time, usually gets worse.

Toby Smithson, a nutritionist and author of the book “Diabetes Meal Planning and Nutrition for Dummies, says proper meal planning is a simple way patients can gain influence over the potentially harmful influence of food.

"People with diabetes want to stay healthy, but we are constantly surrounded by images of food, messages about food, and food itself,” Smithson said. “Your amazing brain can make the best food choices for your health if you give it the facts and some quiet time to come to a conclusion. But, wander aimlessly through the grocery or start down a buffet line with an empty plate and impulse wins every time. Planning ahead is the secret to healthy eating and diabetes health."

November is not only American Diabetes Month, it's also Pet Diabetes Month, intended to remind pet owners that their dogs and cats can develop diabetes just as humans can.

"Pet owners should be aware of the possible warning signs of pet diabetes and see their veterinarians for a definitive diagnosis," said Dr. Madeleine Stahl, a veterinarian speaking on behalf of Merck, which makes Vetsulin, an insuline product for dogs and cats. "Considering the fact that pet diabetes can be effectively managed, lack of owner awareness may be the biggest risk factor associated with this condition." 

Lethargy, excessive thirst and frequent urination are some of the most common signs of diabetes mellitus in dogs and cats. Pets may also exhibit increased hunger while losing weight, cloudy eyes (due to cataracts) in dogs and weakness of the back legs in cats.

Though any dog or cat can have diabetes, it is most commonly found in miniature schnauzers, German shepherds, golden retrievers and poodles. It strikes females more than males and it usually appears in a dog's middle years – age six to nine.

The causes of diabetes in dogs are similar to those in people. The islet cells in the pancreas slow down, failing to produce enough insulin. Without the proper amount of insulin, glucose can't pass into cells and produce energy for metabolism.

The result is high blood sugar as well as too much sugar in the urine.

Awareness campaign

To call attention to the problem, Merck Animal Health is launching a global awareness campaign during November. It has created three videos to help pet owners learn more about the condition and its signs. Those videos can be found at www.petdiabetesmonth.com along with a variety of pet owner educational materials.

Saying that having diabetes is "like having a part-time job," Google researchers are working on a "smart" contact lens that could sample the glucose level in tears as often as once every second.

That would relieve diabetics of the nagging task of measuring their blood glucose level, a process that involves pricking their finger several times per day.

The company's secretive Google[X] lab is using a wireless chip and miniature glucose sensor embedded between two layers of soft contact lens material to measure the glucose levels in tears.

Noting that diabetes affects one in every 19 people on the planet, Google researchers Brian Otis and Babak Parviz said they're hoping to make it easier for people with diabetes to keep their blood sugar levels under control.

LED lights

They're investigating the potential for the device to serve as an early warning for the wearer, by integrating tiny LED lights that could light up to indicate that glucose levels have crossed above or below certain thresholds.

"Many people ... say managing their diabetes is like having a part-time job. Glucose levels change frequently with normal activity like exercising or eating or even sweating," the two said in a blog posting. "Sudden spikes or precipitous drops are dangerous and not uncommon, requiring round-the-clock monitoring. Although some people wear glucose monitors with a glucose sensor embedded under their skin, all people with diabetes must still prick their finger and test drops of blood throughout the day. It’s disruptive, and it’s painful. And, as a result, many people with diabetes check their blood glucose less often than they should."

Uncontrolled blood sugar can lead to dangerous complications, including damages to the eyes, kidneys and heart. 

"We hope this could someday lead to a new way for people with diabetes to manage their disease," Otis and Parviz said, adding that they were in early discussions with the U.S. Food and Drug Administration (FDA).

"We’ve always said that we’d seek out projects that seem a bit speculative or strange, and at a time when the International Diabetes Federation (PDF) is declaring that the world is 'losing the battle' against diabetes, we thought this project was worth a shot," they said.

A British study finds that eating high levels of flavonoids found in berries, tea and chocolate could offer protection from type 2 diabetes. Findings published today in the Journal of Nutrition reveal that high intakes of these dietary compounds are associated with lower insulin resistance and better blood glucose regulation.

A study of almost 2,000 people by researchers at the University of East Anglia (UEA) and King's College London also found that these food groups lower inflammation which, when chronic, is associated with diabetes, obesity, cardiovascular disease, and cancer.

"Our research looked at the benefits of eating certain sub-groups of flavanoids," said Prof. Aedin Cassidy from UEA's Norwich Medical School led the research. "We focused on flavones, which are found in herbs and vegetables such as parsley, thyme, and celery, and anthocyanins, found in berries, red grapes, wine and other red or blue-coloured fruits and vegetables."

"This is one of the first large-scale human studies to look at how these powerful bioactive compounds might reduce the risk of diabetes," Cassidy said. "Laboratory studies have shown these types of foods might modulate blood glucose regulation – affecting the risk of type 2 diabetes. But until now little has been know about how habitual intakes might affect insulin resistance, blood glucose regulation and inflammation in humans."

2,000 women studied

Researchers studied almost 2,000 healthy women volunteers who had completed a food questionnaire designed to estimate total dietary flavonoid intake as well as intakes from six flavonoid subclasses. Blood samples were analyzed for evidence of both glucose regulation and inflammation. Insulin resistance, a hallmark of type 2 diabetes, was assessed using an equation that considered both fasting insulin and glucose levels.

"We found that those who consumed plenty of anthocyanins and flavones had lower insulin resistance. High insulin resistance is associated with Type 2 diabetes, so what we are seeing is that people who eat foods rich in these two compounds – such as berries, herbs, red grapes, wine– are less likely to develop the disease.

"We also found that those who ate the most anthocyanins were least likely to suffer chronic inflammation – which is associated with many of today's most pressing health concerns including diabetes, obesity, cardiovascular disease, and cancer.

"And those who consumed the most flavone compounds had improved levels of a protein (adiponectin) which helps regulate a number of metabolic processes including glucose levels.

"What we don't yet know is exactly how much of these compounds are necessary to potentially reduce the risk of type 2 diabetes," she added.

With the huge increase in obesity in the U.S., there has been a spike in cases of type 2 diabetes.

According to the American Diabetes Association, diabetes causes blood glucose, or sugar, levels to rise to abnormally high levels. The clinical term for it is hyperglycemia. Type 2 has now become the most common form of diabetes and its rise has been linked to the rise in obesity.

People with type 2 diabetes have something called insulin resistance. The pancreas works overtime to make extra insulin but eventually can't keep up. At that point, patients have to take insulin.

Type 1 diabetes, which normally occurs in youth, is not reversible. Under certain conditions, however, doctors say type 2 can be reversed – by reducing weight, increasing exercise and eating better.

Cleveland Clinic study

Now, doctors at the Cleveland Clinic say undergoing bariatric surgery has helped some obese patients reverse type 2 diabetes. In fact, a recent trial helped most of the participating patients to be free of insulin and many to be free of all diabetic medications three years after surgery.

"We see patients whose lives are ravaged by diabetes,” said Sangeeta Kashyap, M.D., one of the lead investigators and an endocrinologist at Cleveland Clinic's Endocrinology & Metabolism Institute.

Doctors say that, when examined at the three-year point, the procedure showed itself to be highly effective in reversing the effects of the disease.

90% no longer needed insulin

"More than 90% of the patients who underwent bariatric surgery were able to lose 25% of their body weight and control their diabetes without the use of insulin and multiple diabetes drugs," Kashyap said.

Besides being able to drop insulin treatments, patients in the study experienced improvements in their quality of life following the surgery, which reduces the size of the stomach. They no longer needed insulin and in many cases, their blood pressure and cholesterol readings improved without relying on medications.

At the end of the study, doctors say only 5% to 10% of patients still had to use insulin.

"The three-year data confirm that bariatric surgery maintains its superiority over medical therapy for the treatment of type 2 diabetes in severely obese patients," said lead investigator Philip Schauer, M.D. "Moreover, data show that bariatric surgery is as effective in treating type 2 diabetes in patients with mild obesity. That's why Cleveland Clinic health insurance plan now covers bariatric surgery for its members with mild obesity and uncontrolled diabetes."

Early risks

Bariatric surgery hasn't always enjoyed such a reputation. According to the American Society of Metabolic and Bariatric Surgery, the procedure was first used in the 1960s and complications were common.

Over the intervening years the procedure has evolved and been improved, though the procedure still has risk. The National Institutes of Health now recommends bariatric surgery for obese patients with a Body Mass Index (BMI) of at least 40.

Cases of diabetes and pre-diabetes in the United States have nearly doubled since 1988, with obesity apparently to blame, according to new research from the Johns Hopkins Bloomberg School of Public Health.

The burden of the disease has not hit all groups equally, with alarming increases in diabetes in blacks, Hispanics and the elderly.

According to new research reported in the April 15, 2014 issue of the Annals of Internal Medicine, diabetes increased from 6% to 10% in the past two decades and pre-diabetes also doubled in prevalence over the same period. Depending on the definition used, current estimates of the prevalence of pre-diabetes range from 12% to 30% in the population.

“There is a growing need to recognize this serious issue, especially since most cases of diabetes can be prevented through weight loss and other lifestyle changes,” said lead author, Elizabeth Selvin, PhD, MPH, an Associate Professor at the Johns Hopkins Bloomberg School of Public Health.

More cases being diagnosed

“The implications of the increase in pre-diabetes and diabetes are enormous but the good news is we are doing better with screening and diagnosis,” says Selvin.

While diabetes has increased dramatically in the population, the investigators found that the proportion of undiagnosed cases has decreased. Currently, only 11% of diabetes cases in the U.S. population are undiagnosed, suggesting major improvements in screening and diagnosis of diabetes during the last two decades.

However, major challenges still exist despite improvements in screening and treatment for diabetes. The investigators found a greater prevalence of pre-diabetes and diabetes, particularly undiagnosed diabetes, in ethnic minorities compared with whites. This disparity has increased over the past 20 years.

“The substantially greater prevalence of pre-diabetes and diabetes, and poor rates of glycemic control (even among persons with medication-treated diabetes) in ethnic minority populations is particularly concerning,” Selvin said. “Especially since blacks and Mexican Americans are also at a greater risk for complications of diabetes.”

Total diabetes in blacks was nearly double the prevalence in whites (15% vs. 9%). Mexican Americans also had a greater prevalence of diabetes than whites (12% vs. 9%).

43,000 cases studied

In 2010, approximately 21 million American adults aged 20 or older had confirmed diabetes (either diagnosed or undiagnosed). The investigators analyzed data from more than 43,000 participants collected over two decades in the National Health and Nutrition Examination Surveys (NHANES), hoping to update national trends in pre-diabetes, diabetes and its treatment based on data from the NHANES.

One novel aspect of this study was to “confirm” cases of undiagnosed diabetes in the population. The investigators used a lab test that measures glucose over the past three months to confirm all cases of undiagnosed diabetes in their study to give the most realistic estimate of the burden of the condition in the population.

The study was funded by the National Institutes of Health.

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.  

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.

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.

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.

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.

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.