Lifestyle changes may be the best way to delay diabetes

Lifestyle changes are the best way to stave off development of Type 2 diabetes, according to a 10-year followup of an innovative trial to prevent the disease in high-risk groups. The results are important because diabetes is a rapidly spreading epidemic in the United States. About 24 million Americans -- 1 in every 9 -- have diabetes, the vast majority of them Type 2, which develops during adulthood. An additional 57 million people have blood glucose levels that are higher than normal but that are not yet in the diabetic range, and it is this group that could benefit the most from interventions.

The original Diabetes Prevention Program trial involved 3,234 overweight or obese men and women, most of them from ethnic groups with an above-normal risk for diabetes. They were divided into three groups: one received intensive training on altering their lifestyle, the second received the diabetes medication metformin, and the third received a placebo. The lifestyle intervention involved reducing the amount of fat in their diet, exercising daily and losing 5% to 7% of their body weight. On average, those in this group exercised about 30 minutes per day and lost about 15 pounds, although they subsequently regained 10 pounds. Those in the metformin group lost 5 pounds, and those in the placebo group lost less than 2.

The study was halted prematurely in 2001 when it became clear that lifestyle intervention was most effective. Those in the lifestyle arm of the trial reduced their risk of diabetes by 58% compared with the placebo group, and those in the metformin group reduced risk by 31%.

The original group was offered the chance to participate in followup studies and 1,766 did, roughly a third from each of the trial arms. All were given training in lifestyle changes.

The study team, led by Dr. David M. Nathan of Massachusetts General Hospital, reported on the 10-year results this week in the journal Lancet. In the 10 years, participants in the original lifestyle-change group delayed the onset of diabetes by an average of four years compared with the placebo group, and those in the metformin group delayed it by an average of two years. "The benefits of intensive lifestyle changes were especially pronounced in the elderly," Nathan said. "People age 60 and older lowered their rate of developing diabetes in the next 10 years by about half."

About 5% to 6% of those in the lifestyle intervention group developed diabetes every year during the initial trial, a rate that remained constant over the follow-up period. About 8% of those in the metformin group and 11% of those in the placebo group developed diabetes each year during the original trial. Over the rest of the period, however -- apparently because of the added lifestyle training -- the latter two groups reduced their annual rate to the same range as those in the original lifestyle group.

In an editorial accompanying the report, Dr. Anoop Misra of Fortis Hospitals in New Delhi wrote that, "Prevention of diabetes is a long and winding road. There seems to be no shortcut, and a persistent and prolonged lifestyle intervention seems to be the most effective mode to travel on it."

Red Grape Compound Showing Promise Against Diabetes

Heart specialists may advise you to drink a glass or two of red wine to keep your heart healthy but emerging research may be shedding a new light on the same theory involving diabetes health. Next time you are planning a road trip, ski trip, or just a quiet dinner at home, you may want to reach for the red grapes and put a bushel (or bottle) in your cart to ward off the danger of diabetes. Type 2 diabetes is the most common form of the disease affecting 90 to 95 percent of the diabetic population, and is the type that occurs later in life, and differs from type 1 which is usually called juvenile diabetes because the majority of people get it during childhood. Whereas type 1 is caused by a disorder that crushes the insulin-producing cells, type 2 usually develops later in life because the body is still creating insulin, but there are not enough cells or the body is using more insulin hormones than it can create. Researchers at the University of Texas Southwestern Medical Center in Dallas are using the compound resveratrol—found in red grapes—to find out if it can stave off type 2 diabetes in humans. While the research has primarily been done on mice, author Roberto Coppari has hope because the findings have shown his team how the compound affects the brain. Coppari, an assistant professor of internal medicine at the University of Texas, says that once the brain has been labeled a "major player" in the fight against diabetes, drug companies will then work on a solution to “focus on a drug that will penetrate the brain.” Resveratrol is a compound found not only in red grapes and, consequently, red wine but also in pomegranates and other similar foods. When given to mice—even ones with a high-fat diet—resveratrol has been found to increase the life span of the tiny rodents by copying the practice of restricting the amount of food the mice eat. Coppari continues that weight loss and longer life can almost always be attributed to eating less which is information that is not new, “You can take the spider, fish, and almost every animal in the planet, and give 70 percent of what the animal would normally eat, and you'll see beneficial effects," he also acknowledges how hard it is to stick to a restricted diet, "Of course, calorie restriction is very difficult to impose on people. You will feel hungry all the time.” Once these mice were injected into the brain with resveratrol, the scientists followed a placebo group and a group of diabetic or limited-diet mice to track their progress. The team looked at the effects against diabetes solely because they were led to believe from previous studies that resveratrol can fend off the disease. After an observation period of at least five weeks, the mice that were on high-fat diets showed that healthy insulin levels came back in half of the group due to triggers of what the team at University of Texas thinks are brain proteins called sirtuins also called Silent Information Regulator Two (Sir2) proteins, which are thought to influence aging and stress resistance. Some of the other mice had elevated insulin levels which was conclusive depending on their diets. Even if the foundation for a solution is here, research is not yet closer to a plausible way to administer resveratrol to humans because injection into the brain is not an option. Coppari also rejects the idea that wine can solve your pre-diabetic problems as there is not enough of the compound in each serving, unfortunately. The study will be published in the December edition of the journal Endocrinology and is supported by the American Heart Association, National Institutes of Health, and the American Diabetes Association. Even though it seems that buying a bunch of grapes at the supermarket could keep the diabetes bug away, for now research will have to catch up, but in the meantime eating grapes can never be bad for you.

Walk to raise money for juvenile diabetes, honor child's memory

Students, teachers and community members will walk Friday to raise funds for juvenile diabetes research and to honor the memory of a lost classmate.

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Breanne Tidmore was 8 years old when she died from undiagnosed Type 1 diabetes in 2005.
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SPECIAL TO THE TIMES

Breanne Tidmore was 8 years old when she died from undiagnosed Type 1 diabetes in 2005.

Friday would have been Breanne’s13th birthday. Members of the Gadsden community will mark the date with a walk at Southside Elementary School throughout the day, culminating in a balloon release at Breanne’s grave site at 3:30 p.m.

This is the fourth walk her mother, Brooke Tidmore, has sponsored to raise awareness and funds for juvenile diabetes research.

When Breanne got sick, Tidmore thought she had a virus. But her doctor knew almost immediately what was wrong. A test showed her blood sugar level was 600. A virus attacked her pancreas, halting insulin production. She went into a diabetic coma and was rushed to Children’s Hospital, where she died.

“We’re doing the best we can to raise money for this,” said Breanne’s great-grandmother, Mary Phillips. “We do it every year in her memory, and I understand it’s helped a lot of kids find out they have juvenile diabetes.”

In previous years, Tidmore said the Gadsden community has raised about $65,000 per year to donate to the diabetes research center at the University of Alabama at Birmingham.

This year has been more difficult than most for raising money and finding sponsors, she said.

The walk this year will be held at Breanne’s former school, which Tidmore said has remained supportive of her efforts despite the troubled economy. Any who wishes to contribute to this year’s cause may call Southside Elementary School at 442-1090 for information.

More than 15,000 children in the U.S. are diagnosed each year with Type 1 diabetes, according to the Juvenile Diabetes Research Foundation.

“Type 1 diabetes is an autoimmune disease in which the body’s immune system attacks and destroys the insulin-producing cells of the pancreas,” the JDRF Web site states.

Although it often strikes children suddenly and with many serious complications, Type 1 diabetes also can occur in adults. Those diagnosed with it must give it constant attention, with multiple daily insulin injections, according to JDRF.

Symptoms of Type 1 diabetes include extreme thirst, frequent urination, drowsiness or lethargy, increased appetite, sudden inexplicable weight loss, sudden vision changes, sugar in urine, fruity odor on breath, heavy or labored breathing, stupor or unconsciousness.

The balloon release is open to the public and will take place at Williams Southside Chapel-Memorial on Alabama Highway 77..0

A Solution For Diabetes: A Vegan Diet

I've been researching the most common and devastating diseases Americans are dealing with, with the aim of finding a common thread running throughout both cause and reversal. As it is now, one out of every two of us will get cancer or heart disease, and one out of every three children born after the year 2000 will be diagnosed with type 2 diabetes. These are devastating diseases, certainly to those who are burdened by them, but also to a health care system that is struggling to keep up.

The extraordinary doctors and nutritional scientists I've spoken with seem to be saying - and saying fervently - the same thing:a diet high in animal protein is disastrous to our health, while a plant-based (vegan) diet prevents disease and is restorative to our health. And they say this with peer-reviewed (the gold standard of studies) science to back them up. Even the very conservative ADA (American Dietetic Association) says: "Vegetarian diets are often associated with a number of health advantages, including lower blood cholesterol levels, lower risk of heart disease, lower blood pressure levels, and lower risk of hypertension and type 2 diabetes. Vegetarians tend to have a lower body mass index (BMI) and lower overall cancer rates."

Diabetes does not just mean you take a pill or injection every day. It means you can lose a decade of life. And you while you inch toward that uncomfortable end, you deal with an increased risk of heart attack, blindness, amputation, and loss of kidney function. It's a very serious disease. The good news is that diabetes can be halted and reversed in a very short time through some diet modifications.

To understand diabetes better, and to learn how to reverse it, I've talked with Dr. Neal Barnard, president of The Physician's Committee for Responsible Medicine. He is an adjunct associate professor of medicine at the George Washington University School of Medicine, and the author of numerous scientific articles in leading peer-reviewed journals, and a frequent lecturer at the American Diabetes Association's scientific sessions. His diabetes research was funded by the National Institutes of Health, the U.S. Government's research branch. He is also the author of Dr. Neal Barnard's Program for Reversing Diabetes.

KF: Why is type 2 diabetes suddenly so prevalent?

NB: Diets are changing, not just in the U.S., but worldwide. Diabetes seems to follow the spread of meaty, high-fat, high-calorie diets. In Japan, for example, the traditional rice-based diet kept the population generally healthy and thin for many centuries. Up until 1980, only 1-5% of Japanese adults over age 40 had diabetes. Starting around that time, however, the rapid westernization of the diet meant that meat, milk, cheese, and sodas became fashionable. Waistlines expanded, and, by 1990, diabetes prevalence in Japan had climbed to 11-12%.

The same sort of trend has occurred in the U.S. Over the last century, per capita meat consumption increased from about 150 pounds per year (which was already very high, compared with other countries) in the early 1900s to over 200 pounds today. In other words, the average American now eats 50 pounds more meat every year, compared with a century ago. In the same interval, cheese intake soared from less than 4 pounds per person per year to about 32 pounds today. Sugar intake has gone up, too, by about 30 pounds per person per year. Where are we putting all that extra meat, cheese, and sugar? It contributes to body fat, of course, and diabetes follows. Today, about 13% of the U.S. adult population has type 2 diabetes, although many of them are not yet aware they have it.

KF: What causes diabetes?

NB: Normally, the cells of the body use the simple sugar glucoseas fuel, the way a car uses gasoline. Glucose comes from starchy or sweet foods we eat, and the hormone insulin escorts it into the muscle cells to power our movements. Glucose also passes into our brain cells to power our thoughts. In type 2 diabetes, the cells resist insulin's action, so glucose has trouble getting into the cells.

KF: What happens to the body when one develops diabetes? What's the fallout?

NB: If glucose can't get into the cells, it builds up in the blood. It is as if gasoline coming out of a gas pump somehow can't get into your gas tank, and it ends up spilling over the side of your car, coming in through your car windows, and dribbling all over the pavement. It is a dangerous situation. The abnormally high levels of glucose circulating in the bloodstream are toxic to the blood vessels, especially the tiny blood vessels of the eyes, the kidneys, the extremities, and the heart.

KF: Is it really that serious, or can we just take a drug for it?

NB: A person with diabetes loses more than a decade of life, on average; about three-quarters will die prematurely of a heart attack. It is also a leading cause of blindness, amputations, and loss of kidney function. Many drugs are available, from insulin to oral medications and an ever-increasing variety of other medications. In order to protect the heart, many patients are also put on medications to lower cholesterol and blood pressure. A person with diabetes who walks into my office is typically using $3,000 to $5,000 worth of medications each year. And yet these medications only slow the progression of the disease; many people have serious complications despite being on medications.

Treating diabetes can benefit baby, mom

NEW YORK (AP) — Treating even mild diabetes that develops during pregnancy helps keep moms and babies from gaining too much weight and makes for easier deliveries, new research shows.

Pregnant women in the U.S. are routinely tested and treated for high blood sugar levels, although it hasn’t been clear whether treating the mildest cases really benefited them and their infants.

In a study of 950 women, those with mild gestational diabetes who were treated had fewer overly large babies, fewer cesarean sections and fewer pregnancy complications, compared to women who didn’t have their diabetes treated.

“There is every reason to fully treat women with even the mildest (gestational diabetes) based on our results,” said the study’s leader, Dr. Mark Landon of Ohio State University Medical Center in Columbus.

Gestational diabetes begins during pregnancy and usually goes away after childbirth. It affects as many as one in seven pregnant women, depending on the population. The mother’s elevated blood sugar can cause the fetus to grow too large, sometimes requiring a C-section and can bring on other health problems for the mother and baby.

Risk factors include being over 25, being obese and a family history of diabetes.

Medical groups support testing pregnant women for the condition and treatment, although the U.S. Preventive Services Task Force, a government health panel, said last year there wasn’t enough evidence to recommend screening.

For the government-funded study, 958 women with mild gestational diabetes were recruited at 15 medical centers. They got diabetes treatment or standard prenatal care. Treatment included diet counseling and insulin if it was needed to control their blood sugar.

In the treatment group, there were fewer babies of unusually large size (7 percent vs. 15 percent in the untreated group) and fewer babies weighed more than about 9 pounds (6 percent vs. 14 percent). On average, the treated women gained 5 fewer pounds after their diagnosis than the untreated ones.

There were also fewer C-sections and cases of preeclampsia, a serious pregnancy complication. There were no deaths in either group, and no difference in other birth-related complications.

Landon noted that a “remarkable” 93 percent of the women in the treatment group kept their blood sugar under control with diet alone; only 7 percent needed insulin.

The findings are reported in Thursday’s New England Journal of Medicine.

Dr. David A. Sacks of Kaiser Foundation Hospital in Bellflower, Calif., said switching to a healthier diet could help other pregnant women limit weight gain, too. More large babies are born to overweight or obese women who don’t have diabetes, he said.

“This is a real easy therapy to apply to every single pregnant lady,” said Sacks, who wrote an editorial about the study in the journal.

Even before she got pregnant, Lorenda Donaugh knew all about gestational diabetes. She works with Landon at Ohio State, doing ultrasounds for his patients, and ended up becoming one after she was diagnosed at 28 weeks with a mild case.

“I knew it was going to be hard work. It takes a lot of time and planning,” said the 27-year-old, who lives in the Columbus suburb of Westerville.

Donaugh, who was not part of the study, monitored her blood sugar several times a day, modified her diet and took extra walks. She eventually took a diabetes medication.

Planning meals and cutting back on sugar was the hardest part, she said. Whenever she was tempted, she thought of her baby. “Being pregnant, you have all those cravings, but you still have to limit that food,” she said.

The work paid off. She delivered a healthy daughter on Sept. 14. Adelynn weighed 6 pounds, 4 ounces and her mom had only gained a modest 22 pounds.

McLeod Medical Center Darlington offering diabetes education classes

McLeod Medical Center Darlington is offering a series of diabetes education classes to the public during the month of October.

The free diabetes self-management program will be taught by a Certified Diabetes Educator from the McLeod Diabetes Center and will teach participants diabetes self-management skills as recommended by the American Diabetes Association.

The four-course series includes Overview of Diabetes and Stress Management, Friday; Monitoring and Prevention of Diabetes Complications, Oct. 9; Diabetes Medications and Exercise Guidelines, Oct. 16; and Diabetes Meal Planning, Oct. 23.

Each class will be from 9 to 11 a.m. in the McLeod Medical Center Darlington Resource Center, located behind McLeod Medical Center Darlington at 701 Cashua Ferry Road, Darlington. Participants should plan to attend all four classes.

Martha Lee of Hartsville went through the series in April. She has been living with diabetes for more than 20 years, but was amazed that she learned new tips to help her manage her diabetes with more ease.

“I learned a lot not only from the McLeod Diabetes Center educators, but from the other participants as well,” she said in a McLeod Health press release.

Lee said the educators taught the material in a way that was easy to understand and remember. She still is following the guidelines and recommendations today, nearly six months later.

Lee said she wanted to take education classes at the McLeod Diabetes Center in Florence, and when she heard about the Darlington series, she signed up immediately because of the convenience of the location and the proximity to her home.

The McLeod Diabetes Center has been recognized by the American Association of Diabetes Educators, the American Diabetes Association and the Diabetes Initiative of South Carolina for meeting national and state standards of diabetes education.

Call McLeod Reservations and Scheduling at (843) 777-2095 to register. Space is limited.