Diabetes Cure

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.

Adults with type 2 diabetes have a new treatment option.

The Food and Drug Administration has approved canagliflozin tablets, which are marketed as Invokana, to improve glycemic control. The pills are to be used in conjunction with diet and exercise.

Approval of the drug came after it was evaluated in nine clinical trials involving over 10,285 type 2 diabetes patients.

There are some side effects associated with the medication, including vaginal yeast infection, urinary tract infection and a sudden fall in blood pressure when standing up.

Learn more about Inkovana and its uses here.

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.

Can you stop type 2 diabetes with a single shot? Salk scientists, writing up their latest findings in the journal Nature, say that you can and that they have.

The result could be a whole new generation of drugs that could safely and effectively stem the rising type 2 diabetes epidemic.

The magic bullet in this case is the protein FGF1. The Salk experiments discovered that a single injection could restore blood sugar levels to the safe range for several days.

More than just managing the disease

More significant, perhaps, the experiments showed that sustained treatment doesn't just act as a controlling mechanism but actually reduces insulin insensitivity, the underlying cause of the disease.

Type 2 diabetes is different from type 1, in that type 1's cause is mostly genetic while type 2 is largely caused by obesity and an unhealthy lifestyle. Not surprisingly, type 2 is now the more common form of the disease.

When you have diabetes your body causes blood glucose, or sugar levels to rise higher than normal. It's a condition known as hyperglycemia.

When you have type 2 diabetes your body does not use insulin properly, a condition known as insulin resistance. The pancreas tries to compensate for it but over time it isn't able to keep up and can't make enough insulin to keep your blood glucose at normal levels.

No cure – yet

According to the Mayo Clinic there is currently no known cure for type 2 diabetes but the disease can be managed through diet and exercise and maintaining a healthy weight. Medication and insulin therapy helps where lifestyle changes fall short.

No one is using the word “cure” just yet but the Salk scientists say the results of the FGF1 experiments may be a big step in that direction. So far they have found no side effects that might reduce the effectiveness of the treatment or prevent some patients from receiving it.

“Controlling glucose is a dominant problem in our society,” said Ronald Evans, director of Salk's Gene Expression Laboratory and corresponding author of the paper. “And FGF1 offers a new method to control glucose in a powerful and unexpected way.”

The diabetes drugs currently approved for use attempt to boost insulin levels and reverse insulin resistance by altering the expression levels of genes to lower glucose levels in the blood. But the researchers say drugs that increase the body’s insulin production can also cause glucose levels to fall too low and lead to life-threatening hypoglycemia, as well as other side effects.

Pleasant surprise

As many breakthroughs are, this one was something of a surprise. The experiment used obese mice as stand-ins for obese, diabetic humans.

Evans’ team injected doses of FGF1 into the obese mice with diabetes to see how it affected metabolism. Researchers said they were stunned by what happened: they found that with a single dose, blood sugar levels quickly dropped to normal levels in all the diabetic mice.

“Many previous studies that injected FGF1 showed no effect on healthy mice,” said Michael Downes, a senior staff scientist and co-corresponding author of the new work. “However, when we injected it into a diabetic mouse, we saw a dramatic improvement in glucose.”

More research is ahead before an FGF1 drug is submitted for FDA approval, but the scientists hope to move next to human trials. Evans says there are still many questions from the study that need to be answered. But, he says, “the avenues for investigating FGF1 in diabetes and metabolism are now wide open.”

Diabetes is, unfortunately, a relatively common disease in dogs, just as it is in humans. In both species, obesity and a sedentary lifestyle can be contributing factors, although dogs are more likely to develop Type 1 diabetes -- the kind that is caused by inadequate production of insulin by the pancreas rather than by lifestyle factors.

Thus, heredity gets most of the blame in dogs, as the disease occurs more widely in some breeds than in others and in some families within breeds. It can also result from repeated bouts of pancreatitis, inflammation of the pancreas. 

Pet owners sometimes blame their pet's food for diabetes, pancreatitis and other conditions.

"I have been feeding my 4 Chihuahuas Science Diet for 8 years. They are 10 and 11 years old and all 3 have diabetes and one has kidney problems from the dog food," said Cathy of Van Bureau, Ark., in a ConsumerAffairs posting. Medical authorities aren't likely to agree with Cathy, however.

"It is usually unclear why one pet develops diabetes and another does not. It is likely that many factors are involved and that most of them were beyond your immediate control," says Ron Hines, DVM, PhD, a widely-quoted Texas veterinarian.

Proper diet

Whatever the cause of your pet's diabetes, just as in humans, keeping it under control involves eating a proper diet -- one prescribed by the veterinarian who is caring for your pet -- as well as seeing to other lifestyle factors that can have a big influence on how well your dog manages its diabetes.

It's important to remember that Type 1 diabetes cannot be cured but it can be managed with daily injections of glucose and careful monitoring of blood sugar levels. Just like humans, dogs with Type 1 diabetes don't manufacture enough of the insulin that's needed to transfer glucose from the bloodstream into the cells, where it's needed to maintain life.

Thus, a dog whose diabetes is not properly managed can quickly develop too much sugar, or glucose, in the bloodstream while, at the same time, its muscle and nerve cells are starving because of inadequate glucose. This can lead to serious complications, including death, so it's not to be taken lightly, which brings us back to careful monitoring of blood sugar levels.

"There is absolutely no question in my mind that the best way to monitor pets with diabetes to aid in regulating insulin levels is for the veterinary client to learn to monitor blood sugar at home using a blood glucose meter," said Dr Mike Richards, DVM, in a posting on VetInfo.com. "If your vet is one of those who discourages clients from attempting home glucose monitoring I personally think that you ought to change vets, at least for the pet with diabetes, unless there is a really compelling reason to stay."

Simple answer

What kind of food is best for a diabetic dog? The simple answer is, the kind your veterinarian prescribes. In general, these will be high-fiber foods that are low in simple sugars. This helps prevent fluctuations in blood sugar levels throughout the day.

There are many prescription dog foods and chances are, your vet will prescribe one or more. Whether your dog will eat it is, of course, another matter.

If your dog refuses to eat the food your vet prescribes, you may have better luck with over-the-counter foods that are intended for overweight dogs. Again, check with your vet.

Dogs that refuse to eat prescribed foods may need additional insulin injections.

Lifestyle changes

Most dogs are creatures of habit. Left to their own devices, they tend to do the same thing at the same time day in and day out. Fortunately, this is exactly what your veterinarian is likely to prescribe for your dog -- a consistent schedule that combines feeding, insulin injection, exercise and the lounging about that is the specialty of most dogs.

If your dog is a female, it's important to have her spayed, as the pregnancy and reproduction routine causes wild fluctuations in hormones, just as it does in humans. This is bad news for diabetes management.

Also, since diabetes is regarded as primarily hereditary in dogs, spaying diabetic dogs helps to hold down the number of affected animals. 

As in humans, diabetes is a serious disease that cannot be taken lightly. If your dog is not treated properly, it will not have long to live. So take action promptly and follow your veterinarian's instructions. 

A study of two "lifestyle intervention" diabetes prevention programs finds the programs resulted in weight loss, as well as improvements in waist circumference and fasting plasma glucose level for overweight or obese adults compared with usual care over a 15-month period.

“Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact,” said the authors of the report of a randomized trial published Online First by Archives of Internal Medicine, a JAMA Network publication.

With an estimated 69 percent of U.S. adults overweight or obese, diabetes prevention is a top public health and previous studies have found that lifestyle modifications that focus on modest weight loss (5 percent to 10 percent) and moderate-intensity physical activity are associated with a reduced incidence of type 2 diabetes.

But, the study authors said, there has been a failure to incorporate weight management into clinical practice, according to the study background.

Jun Ma, M.D., Ph.D., of the Palo Alto Medical Foundation Research Institute, Palo Alto, Calif., and colleagues evaluated two adapted diabetes prevention program (DPP) lifestyle interventions among overweight or obese adults who were recruited from one primary care clinic and had pre-diabetes, metabolic syndrome, or both.

The Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE) was a primary-care based randomized trial designed to evaluate the effectiveness of the adapted DPP lifestyle interventions.

Three groups

Participants were assigned to one of three groups: a coach-led group intervention, a self-directed DVD intervention or usual care. The behavioral weight loss program was delivered during a 3-month intervention phase by a lifestyle coach or home-based DVD and then was followed by a 12-month maintenance phase, according to the study.

The participants (47 percent of whom were women) had an average age of nearly 53 years at baseline and an average body mass index (BMI) of 32. At month 15, the average change in BMI from baseline was -2.2 in the coach-led group,-1.6 in the self-directed group and -0.9 in the usual care group.

The percentage of participants who reached the 7 percent DPP-based weight-loss goal were 37 percent and 35.9 percent in the coach-led and self-directed groups, respectively, compared with 14.4 percent in the usual care group. Compared with the usual care group, improvements reached “statistical significance” for waist circumference and fasting plasma glucose levels in both interventions, according to the study results.

“The E-LITE trial makes a unique contribution to this growing literature in that its interventions integrate standardized, packaged DPP translational programs (delivered in groups or by DVD) with existing health IT [information technology],” the authors conclude. “Although these intervention components and delivery channels are not new, their integration into structured interventions for use in primary care is novel.”

Diabetes is becoming a more common disease in the U.S. but one that remains little understood by those most at risk.

An estimated 26 million U.S. children and adults have either diabetes 1 or 2 and another 79 million have what is known as “prediabetes,” meaning they are at risk of developing type 2 diabetes.

Type 1 diabetes is a condition in which the body does not produce insulin. It usually develops in children or young adults and is nowhere near as common as type 2, comprising only 10% of all U.S. diabetes cases. Type 1 is primarily genetic, meaning it's not related to lifestyle.

Type 2 diabetes usually develops from lifestyle factors, such as poor diet and excessive weight. It's similar to type 1 in that insulin levels are out of control. The result is excessive levels of blood sugar.

Managing type 2 diabetes

Some people may be able to control type 2 diabetes symptoms by losing weight, eating a healthy diet, exercising, and monitoring their blood glucose levels. But it's usually a progressive disease and the patient will probably have to take insulin to treat it.

Because of America's obesity epidemic, type 2 diabetes is growing at an alarming rate. A late 2012 study by the U.S. Centers for Disease Control and Prevention found 18 U.S. states saw diabetes cases increase more than 100% from 1995 to 2010.

The report, appearing in CDC's Morbidity and Mortality Weekly Report, found that states with the largest increases are Oklahoma (226 percent), Kentucky (158 percent), Georgia (145 percent), Alabama (140 percent), and Washington (135 percent).

"Regionally, we saw the largest increase in diagnosed diabetes prevalence in the South, followed by the West, Midwest, and Northeast," said Linda Geiss, a statistician with CDC's Division of Diabetes Translation and lead author of the report. "These data also reinforce findings from previous studies, which indicate that the prevalence of diagnosed diabetes is highest in the southern and Appalachian states."

Extremely serious

Undiagnosed, diabetes is extremely serious. Those with the disease can lose limbs and their eyesight and they can die from its complications.

How do you know if you have it? Being obese or overweight is a major risk factor. Having a lot of visceral fat, also known as central obesity or belly fat, is a risk multiplier, causing the body to release chemicals that can play havoc with the body's cardiovascular and metabolic systems.

The risk also increases as a person ages, though experts aren't sure why.

According to the National Institutes of Health (NIH), symptoms of diabetes include blurry vision, excessive thirst, fatigue, hunger, frequent urination and unexplained weight loss.

Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms.

Symptoms of type 1 diabetes develop over a shorter period of time. People may be very sick by the time they are diagnosed.

Diagnostic tests

A urine test may reveal elevated blood sugar levels but by itself does not diagnose diabetes. Measuring blood sugar levels after fasting is a much more reliable method.

According to NIH, diabetes is diagnosed if the fasting blood glucose level is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

Once diagnosed, a patient will need to measure their blood sugar daily using a glucose meter.

“Many patients will need to test 6-8 times per day, but some will need to test more, depending upon their activity level, how often they eat and what other types of activities their day may include,” said Carol Wysham, MD, section head for the Rockwood Center for Diabetes and Endocrinology. “It is not reasonable or practical to set a specific number for all people with diabetes who are on intensive insulin regimens, as no two people’s lives are the same. Even for the same individual, no two days are exactly alike. A person may need to test six times one day and 10 the next.”

Possible new treatment

While diabetes is normally treated with insulin, University of Michigan (U-M) researchers have found that amlexanox, an off-patent drug currently prescribed for the treatment of asthma and other uses, also reverses obesity, diabetes and fatty liver in mice.

“One of the reasons that diets are so ineffective in producing weight loss for some people is that their bodies adjust to the reduced calories by also reducing their metabolism, so that they are ‘defending’ their body weight,” said researcher Alan Saltiel. “Amlexanox seems to tweak the metabolic response to excessive calorie storage in mice.”

Saltiel is teaming up with clinical-trial specialists at U-M to test whether amlexanox will be useful for treating obesity and diabetes in humans.

There's been real progress over the past couple of decades in the way people with diabetes are handling the disease.

According to a study conducted and funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), more people are meeting recommended goals in the three key markers of diabetes control.

The report, published in Diabetes Care, shows that -- from 1988 to 2010 -- the number of people with diabetes able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2 percent to about 19 percent. Each measure also showed substantial improvement, with over half of people meeting each individual goal in 2010.

The markers

The measures are A1C -- which assesses blood sugar (glucose) over the previous three months -- blood pressure and cholesterol. They are often called the ABCs of diabetes. When these measures fall outside healthy ranges, people are more likely to be burdened by complications of diabetes, including heart disease, stroke, kidney disease, blindness and amputation.

Despite improvement, the results show continued need for better diabetes control. In particular, young people and some minority groups were below average in meeting the goals.

To gauge diabetes management, researchers analyzed data from the National Health and Nutrition Examination Surveys from 1988-1994 and 1999-2010. “The most impressive finding was the significant improvement in diabetes management over time across all groups,” said Catherine Cowie, Ph.D., the study’s senior author and director of the Diabetes Epidemiology Program at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which conducted and funded the study. “However, we see a lot of room for improvement, for everyone, but particularly for younger people and some minority groups.”

Steady progress

According to 2007-2010 data on Americans with diabetes:

• 53 percent met A1C goals, compared with 43 percent in 1988-1994 data
• 51 percent met blood pressure goals, compared with 33 percent in 1988-1994 data
• 56 percent met cholesterol goals, compared with 10 percent in 1988-1994 data

Improved cholesterol control was likely due to the increase in the use of statins, a type of cholesterol-lowering drug, from about four percent of people with diabetes during 1988-1994 to 51 percent during 2007-2010.

Falling short

Glucose control was worse in Mexican-Americans and in younger adults. Only 44 percent met A1C goals, versus 53 percent of whites and blacks in 2007-2010 data. People between 20-49 years old were less likely to meet A1C goals than older people.

“It is particularly disturbing that good control was seen less frequently in young people,” said Judith Fradkin, M.D., director of the NIDDK Division of Diabetes, Endocrinology, and Metabolic Diseases. “Research has shown that good diabetes control early in the course of disease has long-lasting benefits reducing the risk of complications. For people with long life expectancy after diagnosis of diabetes, it’s especially important to focus on meeting diabetes management goals as early as possible, because with that longer life comes a greater chance of developing complications if they do not control their diabetes.”

“Not only do Mexican-Americans and non-Hispanic blacks have higher rates of diabetes, members of these groups who develop diabetes also have poorer health outcomes,” said the paper’s first author, Sarah Stark Casagrande, Ph.D., an epidemiologist from Social & Scientific Systems Inc., Silver Spring, Md., whose work is supported by NIDDK. “While diabetes control has improved in these populations, some disparities remain, demonstrating the need for improved management of the disease to prevent its devastating complications.”

Setting goals

Goals for A1C, blood pressure and cholesterol must be individualized for people with diabetes, as effects of diabetes can differ depending on a person’s age, type of diabetes, diabetes medications, complications from diabetes and other factors.

For A1C, a goal for many people is below seven percent. It is particularly important for people with long life expectancies to control A1C to protect against eye, nerve and kidney disease in the future. Goals can be less stringent for people with limited life expectancy, since complications develop over time. For blood pressure, the goal for most people is 130/80. Moderate- or high-dose statin therapy is recommended for people over 40 with diabetes, with a goal of keeping the low-density lipoprotein (LDL) -- sometimes called bad cholesterol -- less than 100 milligrams per deciliter. Control of blood pressure and cholesterol are particularly important for lowering cardiovascular risk.

People at risk

About 26 million Americans have diabetes, and another 79 million have prediabetes, a condition that places them at increased risk for developing type 2 diabetes and heart disease. Between 1988 and 2012, the prevalence of diagnosed diabetes has more than doubled, from nearly four percent of the U.S. population to nearly nine percent, according to data from the CDC.

To help people improve their health, the National Diabetes Education Program (NDEP), an initiative of the NIH and the CDC, is working to assist people in making positive, lasting changes to improve their health. NDEP’s Make A Plan tool can help make these changes become part of a daily routine to support people in reaching their health goals. The NIDDK's National Diabetes Information Clearinghouse creates and promotes research-based health information and campaigns for the public. Among many publications, the A1C Test and Diabetes explains how this important test can help with diagnosis and management of diabetes.

Diabetes is a disease that increasingly strikes Americans. As it turns out, our dogs also suffer from it in increasing numbers.

It's called diabetes mellitus, or sugar diabetes. Though any dog can have it, 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.

Symptoms

How do you know your dog is suffering from diabetes? The symptoms are similar to a human's. The glucose in the urine causes them to urinate frequently. Because they are passing so much fluid, they get dehydrated and drink lots of water. Later, they may become lethargic, stop eating and be prone to vomiting.

Often these symptoms are cited by pet owners who blame a particular brand of dog food for their pet's condition. In some cases, these symptoms might have nothing to do with the dog food but the onset of diabetes. Only your vet can tell for sure.

The good news is diabetes in dogs is treatable, just as it is in humans. Many veterinarians prescribe daily insulin injections, along with a strict diet. Your vet will decide how much insulin your dog needs. It's hard to predict and will vary, depending on the level of damage to the pancreas.

Typically, you are your pet will start the treatment at home. After a week or so of proper diet and daily insulin injection, the vet will want to see the dog again to run some blood tests. The goal is to see when glucose levels rise and fall.

How to give an injection

Below is a brief video that demonstrates the way to give your dog an insulin shot.

Left untreated, diabetes will affect all the dog's organs. It will result in enlarged livers and hearts and the dog can become easily infected. Sometimes a dog with advanced diabetes will have major problems with its central nervous system.

Avoid obesity

Just as with humans, avoiding obesity makes it easier to treat diabetes. If the dog is obese, it can reduce its responsiveness to insulin. So when your dog is diagnosed with diabetes, it's important to make sure he or she is at a proper weight.

If your dog is overweight, institute a high-carbohydrate, high-fiber diet. Try to avoid foods that are high in sugar – they include most soft-moist food and doggie treats.

According to the Whole Dog Journal, dogs with diabetes have survival rates similar to those without the disease, as long as they get proper treatment and good care. The greatest risk is early in the treatment and a diabetic dog is more likely to die of complications, like kidney disease, than diabetes itself.

What to do

Take note and act quickly if your dog exhibits symptoms of diabetes. Some may be subtle at first, but uncharacteristic indoor “accidents” may be a sign that your pet is suffering.

Tell your vet exactly what symptoms you have observed. If diabetes is the diagnosis, learn the proper technique for administering insulin shots and commit yourself to it.

Ask your vet to recommend a healthy dog food and make sure your pet gets plenty of exercise.

Eating more red meat over time is associated with an increased risk of type-2 diabetes in a follow-up of three studies of about 149,000 U.S. men and women, according to a report published Online First byJAMA Internal Medicine, a JAMA Network publication.

“Our results confirm the robustness of the association between red meat and type-2 diabetes and add further evidence that limiting red meat consumption over time confers benefits for diabetes prevention,” the researchers concluded.

But a commentary accompanying the study noted that the emphasis might be better placed on limiting saturated fat.

“A recommendation to consume less red meat may help to reduce the epidemic of type-2 diabetes. However, the overwhelming preponderance of molecular, cellular, clinical and epidemiological evidence suggests that public health messages should be directed toward the consumption of high-quality protein that is low in total and saturated fat," said William J. Evans, Ph.D., of GlaxoSmithKline and Duke University, Durham, N.C.

"These public health recommendations should include cuts of red meat that are also low in fat, along with fish, poultry and low-fat dairy products. It is not the type of protein (or meat) that is the problem: it is the type of fat,” Evans concludes.

Previous studies

Red meat consumption has been consistently related to an increased risk of type-2 diabetes, but previous studies measured red meat consumption at a baseline with limited follow-up information. However, a person’s eating behavior changes over time and measurement of consumption at a single point in time does not capture the variability of intake during follow-up, the authors note in the study background.

An Pan, Ph.D., of the National University of Singapore, and colleagues analyzed data from three Harvard group studies and followed up 26,357 men in the Health Professionals Follow-up Study; 48,709 women in the Nurses’ Health Study; and 74,077 women in the Nurses’ Health Study II. Diets were assessed using food frequency questionnaires.

During more than 1.9 million person-years of follow-up, researchers documented 7,540 incident cases of type-2 diabetes. 

The results indicate that compared with a group with no change in red meat intake, increasing red meat intake of more than 0.50 servings per day was associated with a 48 percent elevated risk in the subsequent four-year period.

Reducing red meat consumption by more than 0.50 servings per day from baseline to the first four years of follow-up was associated with a 14 percent lower risk during the subsequent entire follow-up.

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. 

As the number of people diagnosed with diabetes continues to grow, so does the number of illegally sold products promising to prevent, treat, and even cure diabetes.

That's prompted the Food and Drug Administration (FDA) to warn consumers against using such products. The agency cites a number of problems with these products: they may contain harmful ingredients or may be otherwise unsafe, or may improperly be marketed as over-the-counter (OTC) products when they should be marketed as prescription products; they carry an additional risk if they cause consumers to delay or discontinue effective treatments for diabetes. Without proper disease management, people with diabetes are at a greater risk for developing serious health complications.

"People with chronic or incurable diseases may feel desperate and become easy prey,” said Gary Coody, R.Ph., national health fraud coordinator for FDA. “Bogus products for diabetes are particularly troubling because there are effective options available to help manage this serious disease rather than exposing patients to unproven and risky products. Failure to follow well-established treatment plans can lead to, among other things, amputations, kidney disease, blindness and death."

Warning letters issued

In July 2013, FDA issued letters warning 15 companies about selling products for diabetes in violation of federal law. These products are sold as dietary supplements; alternative medicines, such as ayurvedics; prescription drugs and over-the-counter drugs, including homeopathic products: Examples of claims made by these illegally marketed products include:

• "Lower your blood sugar naturally."
• "Lowers A1C levels significantly."
• "You'll lower your chances of having eye disease, kidney disease, nerve damage and heart disease!"
• "It can replace medicine in the treatment of diabetes."
• "For Relief of Diabetic Foot Pain."

Some of the companies also promote unapproved products for other serious diseases, including cancer, sexually transmitted diseases and macular degeneration.

FDA tested products marketed as "all natural" treatments for diabetes and discovered some of them contained one or more active ingredients found in prescription drugs to treat type 2 diabetes.

Undeclared ingredients can cause serious harm. If consumers and their health care professionals are unaware of the actual ingredients in the products they are taking, these products may interact in dangerous ways with other medications. One possible complication: Patients may end up taking a larger combined dose of the diabetic drugs than they intended, and that may cause a significant unsafe drop in blood sugar levels, a condition known as hypoglycemia.

Online pharmacies

FDA also looked at sales of prescription drugs from fraudulent online pharmacies. Signs that indicate an online pharmacy is legitimate include: requiring that patients have a valid prescription; providing a physical address in the U.S.; being licensed by a state pharmacy board; and having a state-licensed pharmacist to answer questions.

Some fraudulent online pharmacies illegally sell drugs that are not approved in the United States, or sell prescription drug products without meeting necessary requirements.

One website that is subject to a warning letter shipped a prescription diabetes drug without requiring a prescription, and even included an unsolicited free sample of a prescription drug for erectile dysfunction. Moreover, the prescription diabetes drug was dispensed without the medication guide and other precautions required by FDA to ensure the drug is used safely and appropriately.

Although some of these websites may offer for sale what appear to be FDA-approved prescription drugs, FDA cannot confirm that the manufacture or the handling of these drugs follows U.S. regulations or that the drugs are safe and effective for their intended uses. Also, there is a risk the drugs may be counterfeit, contaminated, expired or otherwise unsafe.

A major problem

There are 26 million people in the U.S. with diabetes, including about 7 million who are undiagnosed, according to the Centers for Disease Control and Prevention. www.cdc.gov Millions more have pre-diabetes, meaning they have higher than normal blood sugar levels and can reduce their risks of developing diabetes through healthy lifestyle changes, including diet and exercise.

"Products that promise an easy fix might be alluring, but consumers are gambling with their health. In general, diabetes is a chronic disease, but it is manageable and people can lower their risk for developing complications by following treatments prescribed by health care professionals, carefully monitoring blood sugar levels, and sticking to an appropriate diet and exercise program," said Coody.