Death rates among people with diabetes have declined substantially in recent years, according to a survey conducted by researchers at the Centers for Disease Control and Prevention and the National Institutes of Health.
Since 1997 the C.D.C. has done five surveys of people with and without diabetes, each sampling about 107,000 adults. Compared with the 1997-98 figures, 2006 death rates from cardiovascular disease had declined 40 percent and all-cause mortality had declined 23 percent among people with diabetes, even after the researchers controlled for age and other health factors. Death rates also declined among those who did not have diabetes, but the decline was not as steep.
The study, in the June issue of Diabetes Care, attributes the progress to advances in medical care and self-management.
But every silver lining has a cloud.
“The good thing is that people with diabetes are living longer,” said one of the authors, Sharon Saydah, a senior research scientist with the C.D.C. “But people with diabetes are at risk for a number of complications — cardiovascular disease, lower leg amputations, kidney disease, eye problems, dementia and other kinds of disability. Preventing all of these complications means that we will have greater health care expenses for people living with diabetes.”
The benefits of eating a solid breakfast are hard to dispute.
People who skip that all-important first meal of the day, studies show, suffer setbacks in mood, memory and energy levels. They are also more likely to gain weight, in part because of excess eating later in the day. Research on the habits of people taking part in the National Weight Control Registry, a long-running study of successful dieters, for example, shows that about 80 percent eat breakfast daily.
But emerging research suggests another advantage to consistently eating breakfast: a reduced risk of Type 2 diabetes.
In a study published in the current issue of The American Journal of Clinical Nutrition, researchers followed 29,000 men for 16 years, tracking their diets, exercise, disease rates and other markers of health. About 2,000 of the men developed Type 2 diabetes over the course of the study.
Those who regularly skipped breakfast had a 21 percent higher risk of developing diabetes than those who did not. The heightened risk remained even after the researchers accounted for body mass index and the quality of the subjects’ breakfasts.
Other studies have also found a link between skipping breakfast and greater risk of Type 2 diabetes. While it is not clear why the relationship exists, some scientists suspect that a morning meal helps stabilize blood sugar through the day.
Some studies show that consuming a larger proportion of your calories later in the day, especially carbohydrates, has a detrimental impact on blood sugar and insulin levels.
THE BOTTOM LINE
Regularly skipping breakfast may raise the risk of Type 2 diabetes.
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Many people may only associate diabetes with vision loss, kidney disease, and limb amputations, but it also increases the risk for heart disease and stroke. From 1996 to 2006, however, the risk of dying from heart disease and stroke decreased by 40% among people with diabetes.
People with diabetes do die earlier than people without diabetes, but this gap appears to be getting smaller.
"This is good news," says researcher Edward W. Gregg, PhD. He is the acting director of the division for heart disease and stroke prevention at the CDC in Atlanta. "We are seeing a reduction in death rates in people with diabetes, and this is largely due to prevention efforts."
Specifically, he cites reductions in blood pressure levels, low density lipoprotein (LDL) or "bad" cholesterol, decreases in smoking, and improved blood sugar control among people with diabetes. "We think it is a gradual improvement of multiple risk factors."
This should be a source of empowerment and motivation for people with diabetes. "We can make a big difference," he says. "People can cut their risk of developing cardiovascular disease in half if they are able to manage their risk factors."
The new study analyzed data on 250,000 adults from 1997 to 2004.
The findings appear in Diabetes Care.
People With Diabetes Living Longer
John Buse, MD, says the future is looking brighter for many people with diabetes. He is the chief of the division of endocrinology at the University of North Carolina, Chapel Hill.
Buse says the new study confirms and expands upon previous reports suggesting a decline in death rates among people with diabetes. "This study demonstrates the trend robustly," he says in an email. "It is clear that the prognosis for people with diabetes is improving."
Others in the field are also excited about the new findings. "This is tremendous, really great news," says Carol J. Levy, MD, CDE. She is an associate professor of endocrinology at the Mount Sinai School of Medicine in New York City. "I am thrilled to see that what we are doing is making a difference."
In addition to better control of blood pressure, cholesterol, and other risks, she says earlier diagnosis of diabetes and many of the new treatments also play a role in the decreasing death rates among people with diabetes.
Abraham Thomas, MD, MPH, is the division head of endocrinology and at diabetes at Henry Ford Hospital in Detroit, Mich. He says the new findings mirror what he is seeing in his practice. "You can control your blood pressure, cholesterol, and glucose, and this can really have a big impact on survival and quality of life," he says. "If you can take care of these things, you can cut down on [your] chance of dying and of developing all these other bad complications."
Gout and Diabetes
Once termed “the kings’ disease,” gout used to be a problem primarily for wealthy people and royalty who lounged around drinking wine and eating rich food. But today, an estimated 68% of American adults are either overweight or obese. As a result, gout and type 2 diabetes -- two diseases that can result from an unhealthy lifestyle -- are sharply on the rise.
Gout is an arthritic condition caused by having an excess buildup of uric acid. It causes sudden, extreme attacks of pain, swelling, and redness. Gouty arthritis most often strikes the big toe, but it also can show up in the feet, ankles, knees, hands, and wrists.
Type 2 diabetes, a disease characterized by high levels of sugar in the blood, also can result from eating too much and moving too little.
Gout and type 2 diabetes often co-exist in people with common physical characteristics and conditions, the most prominent being obesity.
“A lot of the risk factors for type 2 diabetes are the same for gout,” says Michele Meltzer, MD, an assistant professor of medicine at Thomas Jefferson Hospital in Philadelphia who specializes in gout. By changing these risk factors, you can help prevent or fight both diseases.
Here’s what you can do:
• Lose weight. “We are digging our graves with our forks in this country,” says John D. Reveille, MD, director of the division of rheumatology at UT Health Medical School in Houston. To prevent gout, type 2 diabetes, and a host of other health problems, he says you should keep a close eye on your body mass index (BMI) and waist circumference. According to the National Institutes of Health, waist size becomes very important when a person’s body mass index (BMI) is between 25 and 34.9. A BMI over 25 is considered overweight, and a BMI greater than 30 is considered obese. Keep your waist size below 35 inches if you are a woman and 40 inches if you are a man.
• Exercise regularly. Regular exercise will help control weight and lower high blood pressure, both of which will lower your uric acid level and therefore lessen your chance of developing gout. “Plus, it’s well documented that exercise improves the glucose intolerance associated with type 2 diabetes,” Reveille says. He recommends 30 minutes of moderate activity, at least five days a week. If you're having an acute gout attack or have damaged joints from weight issues, some activities may be difficult. Talk to your health care provider about the best exercise plan for you.
• Skip the alcohol. A landmark study done by researchers at Massachusetts General Hospital examined the connection between drinking beer and gout. They found that people who drank two to four beers per week were 25% more likely to develop gout. And those who averaged at least two beers a day had a 200% higher risk. “Beer and hard liquor appear to cause a rise in uric acid levels,” Meltzer says. The same doesn't appear to be true with wine, however. Binge drinking is also a very strong risk factor for gout. “Plus, people who eliminate their two beers a day drop weight very quickly, which lowers risk of type 2 diabetes. So you get a two-for-one by cutting out the beer,” she says.
• Avoid sugar-sweetened beverages. Early research suggests that beverages sweetened with sugar or high-fructose corn syrup, such as regular soft drinks, may increase the chances of developing gout. Even orange juice may increase gout. Eliminating sugary beverages is also a great way to cut calories from your diet, shed a few pounds, and improve your diabetes.
• Go on a gout diet. A gout diet aims to control uric acid production by reducing intake of foods high in purines. High-purine foods create increased levels of uric acid in the body. Some of the worst high-purine foods are liver and other organ meats, as well as anchovies. Other foods to avoid include lobster, shrimp, scallops, herring, mackerel, beef, pork, and lamb. Don't worry about cutting out purines completely. Just eat these foods in moderation: No more than one serving daily.
• Eat more dairy.Some studies have shown that drinking skim or low-fat milk or eating low-fat dairy products can help reduce risk of gout, Meltzer says. There is evidence that eating low-fat dairy helps lower risk of type 2 diabetes as well. Aim for 16 to 24 fluid ounces of dairy per day.
TUESDAY, May 8 (HealthDay News) -- Eating too quickly may raise your risk of diabetes, a small, preliminary study suggests.