Beat it

Beat it

How the data revolution could transform the way people live with diabetes


By Ana Swanson

Diabetes is a data-intensive disease. For those living with diabetes, managing their condition involves never-ending calculations: How much insulin to take to keep blood sugar in a targeted range, how many grams of carbohydrate are in a sandwich, or how an average monthly blood sugar reading fluctuates with different levels of exercise.
But unlike the math problems in school textbooks, there is often no clear answer to these questions. Given the numerous and complex factors that affect blood sugar – including food, physical activity, and sleep patterns – it’s not always clear what exactly occurs between a good blood sugar reading and a bad one.
To many Americans, this is an important question. Nearly 30 million Americans had diabetes in 2014, according to CDC estimates, though more than a quarter of them were undiagnosed. Another 80 million Americans were classified as “pre-diabetic,” meaning they will likely develop diabetes in the next decade if they don’t change their lifestyles. (Around 5-10 percent of these cases are Type 1 diabetes, in which a person’s body doesn’t produce insulin, and a person must take insulin to survive. The rest are Type 2 diabetes, sometimes called adult onset diabetes, in which a person gradually loses the ability to produce sufficient quantities of insulin.)
Because it is so widespread, diabetes is incredibly expensive, costing the U.S. $176 billion in direct medical bills and $69 billion in indirect costs, including disability, work loss and premature death, in 2012.
Diabetes can’t be cured; it can only be treated. The goal is to keep blood sugar within a certain healthy range: If it dips too low, a person can faint or go into a diabetic coma. But too-high blood sugar results in wear and tear on the body that can lead to eye, nerve or kidney complications.
“It’s math all day long,” says Jeff Dachis, the founder of a new app for managing diabetes and a person living with Type 1 diabetes. “If I take too much insulin, I can die instantly, and if I take too little insulin over time, I’ll just die slowly. But if I stay in range, I can stay considerably healthy and unimpacted by diabetes.”
The widespread adoption of wearable health devices is diminishing some of this mathematical mystery. Many Americans are now using products like the Google Fit platform, the Apple HealthKit, or Fitbit to track their sleep, exercise and calories. And a coming wave of wearable technology and social media and mobile apps promises to transform how people live with and manage diabetes.
Diabetics had to painstakingly measure the sugar levels in their urine until the early 1980s, when the first glucose monitors were introduced for home use. ("My first One Touch meter was almost the size of a lunch box," writes internet user coravh, who was diagnosed with Type 1 diabetes in 1966.) Today, most people with diabetes test their blood sugar with glucose meters, then administer insulin through an injection or an insulin pump, a device that sits under the skin and provides a continuous or programmed dose of insulin.
Technology companies are developing more innovative devices to continuously test blood sugar and provide readings and alerts, even while someone is exercising or sleeping. Abbot, Dexcom and Medtronic have developed continuous glucose monitors, which constantly measure blood sugar levels through a small sensor that is inserted under the skin, providing a lot more insight into how a good reading turns into a bad one. The devices still have drawbacks: They are expensive and only partially covered by insurance, if they are covered at all. And the FDA still recommends checking the readings against a glucose meter.
The next big technological step is an "artificial pancreas," an implantable device which would monitor blood sugar as well as automatically deliver insulin. Researchers are developing small implants that can do both, eliminating the need for daily finger pricks and injections. Companies are also developing less invasive ways to measure blood sugar. For example, Google and Novartis AG are partnering to develop a contact lens that monitors glucose contained in tears and transmits the data through a tiny antenna. But these high-tech devices will be expensive, and may not be commercially available for years.
In the meantime, diabetics may be able to learn a lot more about their condition by organizing and sharing their data. Dachis, the co-founder of digital marketing firm Razorfish, helped develop a new diabetes app that launched in the Apple App Store on Tuesday. Called One Drop, the free app includes a digital glucometer, tracking features, social sharing and food logging. The app combines glucose, food, insulin and physical activity in a simple relational data display, and allows people with diabetes to share and learn from other people around them, says Dachis.
Dachis says the app is an example of the emerging practice of "data-driven self-care." With doctors, hospitals and pharmaceutical companies more focused on procedure-based sick care, he argues that data-driven self-care has an important role to play in keeping people well. "The health care industry has been one of the last to digitally transform, and more importantly it’s been one of the last to participate in the democratization of the tools of self-expression that the mobile phone has enabled for people," he says.

Dachis is emphatic that One Drop will never share personal, identifiable data with someone outside the community, for example for marketing purposes. But he is hopeful about the potential that the data, stripped of ways to identify individuals, holds for diabetes research. "With a large-enough population base, you’ll start to see wildly relevant correlations or causality between all different kinds of behavior," he said. "We can start to collect and analyze and correlate that to clinical trial study data or published research data and start to extract the insights for people who are struggling and trying to navigate from moment to moment."

Childhood trauma may raise risk of type 1 diabetes


BY LISA RAPAPORT
(Reuters Health) - Traumatic events during childhood may increase kids' risk of developing type 1 diabetes, a Swedish study suggests.
The researchers questioned more than 10,000 families and found that children who experienced an extremely stressful life event – like divorce, illness or death in the family – were about three times more likely to develop type 1 diabetes.
The link doesn't prove trauma causes diabetes, but it does raise the possibility that mental health care or stress reduction could play a role in prevention, researchers said.
"We know that there are connections between the brain and immune system, and it is not surprising that psychological trauma can influence the immune balance and contribute to abnormal reactions" including the development of type 1 diabetes, study coauthor Dr. Johnny Ludvigsson, a pediatrics researcher at Linkoping University in Sweden, said by email.
Type 1 diabetes is an autoimmune disease in which the pancreas stops making insulin, a hormone that helps cells use sugar for energy. When the immune system attacks and destroys insulin-producing cells in the pancreas, called beta cells, diabetes occurs.
Thousands of people worldwide are diagnosed with type 1 diabetes each year. Millions have the more common form of the disease, known as type 2, which is linked to obesity and advanced age and does not involve destruction of beta cells.
Ludvigsson and colleagues invited all families in southeast Sweden with babies born between October 1997 and September 1999 to complete questionnaires distributed during routine physicals and by mail.
The researchers found that a serious traumatic event during the first 14 years of life increased the risk of type 1 diabetes, even after taking into account the family history for any form of diabetes as well as other factors such as the child's age and the parents' education level and marital status.
For the children in the study, having a severe injury or illness, having a parent with a severe injury or illness, or having someone close to them die or become sick was associated with a higher risk for developing type 1 diabetes.
That link remained even after adjusting for children’s overweight or obesity.
While some previous research has tied type 2 diabetes to chronic or severe stress, the current study is among the first to suggest that these same factors may contribute to the development of type 1 diabetes, Dr. Frans Pouwer, a psychologist at Tilburg University in the Netherlands, said by email.
Pouwer, who wasn't involved in the study, noted that more research is needed to firmly establish this link for type 1 diabetes.
"Other studies have looked at the potential role between stressful events, exposure to stress and diabetes onset and they have not been conclusive," said Dr. David Marrero, president of health care and education at the American Diabetes Association and a diabetes researcher at the Indiana University School of Medicine.
Even so, parents can take steps to reduce stress in their children's lives and encourage kids to get plenty of exercise and eat healthy food, Marrero said. It may not prevent type 1 diabetes, but it can lower the risk of developing type 2. "If it's type 2 you can lose weight and increase physical activity and really reduce the risk if you have a genetic or family link," he said.
For type 1, where origins aren't as well understood, it's possible, but not proven, that trauma could increase the risk, Marrero said.
"I wouldn't say 'my kid is exposed to a stressful event and they are therefore definitely going to get diabetes,' but I would say the connection is worth exploring and there is no downside to trying to avoid exposing children to stressful or traumatic situations."


Fewer, larger meals may be better for diabetics




Type 2 diabetics may have less depression and less hunger if they opt for 3 large, rather than six smaller meals throughout the day, a new study suggests.

People with type 2 diabetes may have less depression and fewer hunger pains if they opt for a big breakfast and lunch rather than six smaller meals throughout the day, suggests a new study.

Two large meals
"Eating large breakfasts and lunches may be more beneficial than the usual snacking model," said Dr. Hana Kahleova, the study's lead author from the Institute for Clinical and Experimental Medicine in Prague.
"However, further larger-scale, long-term studies are needed before offering clear recommendations," she told Reuters Health in an email.
The analysis used data from a previous study that compared two restricted-calorie diets in 54 people with type 2 diabetes. Each study participant spent 12 weeks eating six small meals a day, and then another 12 weeks eating a large breakfast and lunch, with no dinner.
With both diets, people reported fewer depressive symptoms and better quality of life compared to how they felt at the beginning of the study, but the improvements in mood were significantly greater when they ate larger meals twice a day.
Disinhibition, which is the tendency to overeat in certain situations, improved more on the two-meal diet. People also reported feeling less hungry when they ate just twice a day, researchers reported in the European Journal of Clinical Nutrition.
Fuller and more satisfied
People who eat less frequently may feel fuller and more satisfied when they do eat, rather than feeling hungry all day long from eating small meals, said Kahleova, who added that people need to eat 30 to 40 grams of fibre per day to be successful.
"Eat a hearty breakfast: eat breakfast like a king, lunch as a prince and dinner as a pauper," she said. "If you feel hungry in the evening you can have a vegetable salad."
"I think it's fascinating research," said Margaret Powers of the International Diabetes Centre at Park Nicollet in Minneapolis in a telephone interview.
By looking at the effect of eating patterns on patients' depressive symptoms, the new research is starting to take into account the "big emotional component to eating", said Powers, who wasn't involved with the new study but is president-elect of healthcare and education for the American Diabetes Association.
The most important thing for people with type 2 diabetes is to have a plan in terms of when they eat and how they spread out their intake of carbohydrates throughout the day, Powers said, adding that the goal is to maintain steady blood sugar levels and a healthy weight.
"There's no one right way or wrong way, but I think this says that we do have to pay attention to this emotional side of eating," she said.
"If somebody's eating two large meals a day and they want to eat at other times and they can't and that's making them miserable, that's not the right plan."
Healthy balance
Powers said she wants to see her patients eat a healthy balance and variety of foods.
"One of the goals of nutrition therapy for diabetes is actually to maintain the enjoyment of food," she said.
"Our goal is to help a patient understand him- or herself, so they can help find the best self-management plan . . . Whatever the food plan is, it should be a lifelong eating pattern."



Study: High-fat dairy products reduces diabetes risk



Editorial Team Apr 05, 2015 at 12:58 pm

Diabetics have a basic problem – they are either unable to use insulin or inefficiently use it. They need to eat food which causes the sugar levels in the blood to be consistent and not spike suddenly. Consumption of high-fat dairy products is associated with reduced risk for Type-2 diabetes, says a study. The new findings are in line with previous studies that indicated a link between high consumption of dairy products and a reduced risk of Type-2 diabetes.
‘Those who ate the most high-fat dairy products had a 23 percent lower risk of developing Type-2 diabetes than those who ate the least. High meat consumption was linked to an increased risk of Type-2 diabetes regardless of the fat content of the meat,’ said researcher Ulrika Ericson from the Lund University in Sweden.
The researchers studied the eating habits of 27,000 individuals aged 45 to 74. The participants took part in the Malmo Diet and Cancer study in the early 1990s, in which they provided details of their eating habits. Twenty years on, over 10 percent, that is, 2,860 people, had developed Type-2 diabetes. Both meat and dairy products contain saturated fat, but certain saturated fatty acids are particularly common in dairy products. Here is a diet plan diabetics can use for better sugar control.
‘When we investigated the consumption of saturated fatty acids that are slightly more common in dairy products than in meat, we observed a link with a reduced risk of Type-2 diabetes. However, we have not ruled out the possibility that other components of dairy products such as yoghurt and cheese may have contributed to our results,’ Ericson explained. The researchers took into account many dietary and lifestyle factors.
‘However, there may be other factors that we have not been able to measure. Moreover, different food components can interact with each other. Our results suggest that we should not focus solely on fat, but rather consider what foods we eat. Many foodstuffs contain different components that are harmful or beneficial to health, and it is the overall balance that is important,’ Ericson said in a paper published in the American Journal of Clinical Nutrition.
Glycaemic index (GI) is an indicator of how high your blood sugar levels will rise when you eat something. When diabetics eat foods with high GI, it results in a sudden rise in their sugar levels. On the other hand, low GI foods are healthier as they are rich in vitamins, fibres, minerals, etc. They also provide energy slowly unlike high GI foods and keep one full for a longer time. This helps in losing weight and lowering the fat levels. Foods like fruits, veggies, beans, brown rice, oats, etc. are better-suited for diabetics. Also, follow these expert diet tips and exercise to manage diabetes.

Source: With inputs from IANS

Blueberry Tea Shows Promise As Treatment For Diabetes, Researchers Say


By Wendy Lemeric on April 13 2015 1:03 PM

An herbal tea, with blueberry as the main ingredient, has caught the attention of researchers for its potential as a treatment for diabetes. Scientists at Menzies Institute in Hobart are trying to study the ability of blueberry tea in reducing insulin dependence.
Gerard Spicer is a diabetic who has been fighting type 2 diabetes mellitus for 13 years and is heavily dependent on insulin. Recently, he began drinking an herbal tea with blueberry base and observed this to be helping with his condition. The tea is a mixture of blueberry leaves and fruit, spearmint leaves, raspberry and cinnamon. This has sparked the interest of researchers at the Menzies Institute.
Michelle Keske, senior research fellow at the institute is studying the potential of blueberry tea in helping reduce a diabetic’s dependence on insulin. According to Keske, type 2 diabetes is difficult to treat, but pre-clinical trials have shown positive results. "The tea has enabled that hormone, insulin, to improve glucose uptake into muscle and by doing that it lowers blood glucose levels and it does that by stimulating blood flow," said Keske.
Finding treatment that act on blood flow stimulation can be hard, but Keske is positive about the blueberry tea and its potential. Blueberry is rich in flavonoids and polyphenols that she thinks would help with the blood flow stimulation.
Diabetes is a rapidly growing chronic condition. In Tasmania where population is estimated at more than 500,000 people, one fifth of the inhabitants is suffering from or has higher risk for diabetes. It is estimated that by year 2025, around 3 million Australians will develop the disease with type 2 as its most common form and unfortunately, there is no cure to the disease.
It has been established that blueberry offers several health benefits, but can the same thing be said for blueberry tea? Human trials are set to be conducted this year.

To contact the writer, email: wendylemeric@gmail.com



Diabetics Benefit by Biggest Meal Early



A small study finds that diabetics who ate a big breakfast and small dinner had better glucose control than those who ate the opposite. Steve Mirsky reports

April 1, 2015 |By Steve Mirsky

People with type 2 diabetes have to keep a close watch on their blood glucose levels. Now a small study finds that having the day’s biggest meal at breakfast and smallest meal at dinner offers much better glucose control than having a small breakfast and big dinner—even when the total intake during the day was exactly the same: 1,500 calories. The study, by researchers from Israel’s Tel Aviv University, Sweden’s Lund University and other institutions, is in the journal Diabetologia. [Daniela Jakubowicz et al, High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial]
 Eighteen adult volunteers, 10 women and eight men all with type 2 diabetes, were assigned by a coin flip to either the big breakfast diet or the big dinner one. In the big dinner diet, participants spent a week having about a 200-calorie breakfast, a 600-calorie lunch and a 700-calorie dinner. The big breakfast diet was the reverse, with the 700-calorie meal in the morning, the 600-calorie lunch and a light, 200 calorie dinner.
 After two weeks, the groups switched meal plans, so that the big dinner folks became the big breakfast folks and vice versa. And overall, various measures of blood glucose and insulin levels were significantly better in those who had their big meal in the morning.
 The next steps are longer studies with more participants. But like a healthy breakfast, this research seems like a good start.
—Steve Mirsky