Weight stigma is pervasive in most health care settings. As Diabetes Specialists, we have an opportunity to recognize our own biases and take a leadership role in decreasing weight stigma in our work settings.

Last month, Healio Endocrine Today interviewed clinical nutrition manager, Lisa Hodgson, RD, CDN, CDCES, to get her perspective on how health care professionals can address weight stigma within their practice and support long-term healthy behavioral modifications for people living with diabetes. For many, staying motivated to maintain long-term changes can be difficult.

As Hodgson explains, “Weight stigma projected onto people with diabetes by clinicians may lead them to avoid seeking medical care. It may also perpetuate binge eating and overeating, limit physical activity, encourage disordered eating and foster physiological stress.”

These stigmatizing attitudes among providers are often reflected in their interactions with the individuals they treat, which can have negative impacts. That is why it is so important for each of us to address and unlearn our own biases around weight.

7 Steps to Reduce Weight Stigma Within Your Practice

• Use person-centered, encouraging, and respectful language free of judgment
• Create a safe space by asking about and addressing situations where the person experienced weight stigma
• Address emotional eating and offer healthier coping strategies such as meditation, yoga or mindful eating techniques
• Identify what is important to an individual and develop action plans around these areas
• Use past successes to inform a plan for ongoing behavioral changes 
• Customize interventions based on a person’s access to resources and their preferences
• Measure individualized goals at each visit and adjust plan over time

Helpful Resources

• Joint international consensus statement for ending stigma – The ADA announced that they and over 100 professional societies and medical journals are taking the “pledge to eliminate weight bias and stigma.
• Evaluate your Weight Bias –Harvard’s Project Implicit – Project Implicit is a non-profit organization that provides international collaboration between researchers interested in implicit social cognition – the thoughts and feelings outside of conscious awareness and control. The goal of the organization is to educate the public about hidden biases and to provide a “virtual laboratory” for collecting data on the Internet.
• Language & Diabetes Free Webinar – Learn how to uplift your people by choosing language that is non-judgmental and person-centered.

Written by Bryanna, our Director of Operations & Customer Happiness

To read the full interview and to get more tips from Lisa Hodgson, click here.

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A recent study published by BMJ Journals – Gut indicates that enjoying a Mediterranean diet (MedDiet) can promote healthier aging.

The study was conducted over a 12 month period across a large cohort of more than 600 individuals aged 65–79 years, within 5 different European countries (UK, France, Netherlands, Italy, and Poland). The researchers evaluated the differences in the gut microbiota in each individual before and after the year of consuming a MedDiet.

The results indicate that consuming a MedDiet improved cognitive function and the gut microbiome of those in the study. 

The positive effects of these alterations showed that there was an increase in fatty acid production and a decrease in “secondary bile acids, p-cresols, ethanol, and carbon dioxide.” These changes were associated with lower frailty and improved cognitive function and an overall decrease in inflammatory markers, such as C-reactive protein and interleukin-17.

This study shows that changing to a MedDiet can have a positive impact on people as they age.

Read more by clicking here.

Want to learn more about the Mediterranean diet? Click here.

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Medtronic released an update last week for its MiniMed 600 series pumps that we wanted to share with you.

You may remember our recent Blog Byte covering Medtronic’s MiniMed 600 Series Class I recall due to the two model’s pumps’ reservoir retainer rings being broken or missing. These issues resulted in an over or under-delivery of insulin. The pump models are:

• MiniMed™ 630G insulin pump – MMT-1715
• MiniMed™ 670G insulin pump – MMT-1780

MiniMed has made important changes to the 600 series pumps to address this issue. See Medtronic’s full update.

Minimed’s updated info also includes helpful photos and detailed information to identify potential issues with the pumps and who to contact if issues are found. They also stress the importance of careful inspection of pump retainer ring on a regular basis.

Steps to identify potential issues (excerpted from Medtronic update)

1. Examine retainer ring
2. “If the reservoir does not lock into the pump or the retainer ring is loose, damaged or missing, discontinue using the insulin pump and revert to a back-up plan of manual insulin injections per healthcare provider’s recommendations. DO NOT insert the reservoir back into your pump while connected because you could mistakenly give yourself a large insulin bolus. If the reservoir is broken, contact Medtronic (info. below).
3. “If your reservoir properly locks in place by the retainer ring, continue to use your pump. Remember to always follow the Instructions for Use on how to correctly insert the reservoir.”
4. Routinely repeat this check, especially during every pump change.

Contact Information

Customers who have found an issue with their pump or who need additional information or support should call the 24-hour Medtronic Technical Support at 877-585-0166 or visit their website by clicking here.

For more information, please see Medtronic’s full update.

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A study released in the JAMA Pediatrics Journal revealed that approximately 18% of adolescents ages 12-18, and 24% of young adults ages 19-34 have prediabetes. These numbers have risen over the past ten years, putting young people at risk for developing Type 2 diabetes, heart disease, and other conditions down the line.

The authors of the new study says its findings:

“highlight the need for primary and secondary prevention efforts tailored to the young segment of the US population.”

The study analyzed nearly 5,800 individuals and found that prediabetes was more prevalent in males than females, both in the adolescents and young adults category. For adolescents, the study found 22.5% of males had prediabetes while 13.4% of females had prediabetes. For young adults, the ratio was 29.1% vs 18.8%.

To decrease rates of prediabetes in youth, we need to support access to healthy living resources to prevent or delay type 2 diabetes and other serious health problems.

Read more on CNN health.

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Many people with type 1 diabetes purchase dogs specifically trained to detect hypoglycemia and alert the owner of impending low blood sugar. The dogs can cost thousands of dollars and are often described as “lifesaving”.

Unfortunately, some of the dog training companies have faced lawsuits or complaints from consumers that the dogs are not effective. And even though they may be called a “certified” alert dog, there are generally no standardized regulations or performance criteria to earn that recognition.

What does the science say?

Available studies results indicate that, “Overall, they [diabetic alert dogs] really were not that reliable or accurate,” says University of Virginia psychologist Linda Gonder-Frederick tracked the performance of 14 diabetic alert dogs in a 2017 study .

Alert Dogs offer other benefits

While researchers have found little evidence that dogs can reliably sniff out blood sugar changes, they have encountered a kind of paradox: People who get alert dogs tend to do better with their diabetes.

It turns out that the dogs may be a pleasant reminder to check blood glucose and attend to their diabetes. And, the dogs can help people feel less alone and provide comfort when dealing with a daily condition that can be very overwhelming.

Read More Here from NPR: The Hope and Hype of Diabetic Alert Dogs

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There are a number of “life hacks” out there recommending adding butter to coffee, taking specific miracle supplements, or engaging in even more extreme methods like blood transfusion, all in an attempt to slow aging, improve health, and decrease weight.

However, the simple approach of regular exercise, healthy eating, and not smoking increases longevity and enjoyment with the additional benefit of increased lifespan in a multitude of studies.

In 2011, the American Journal of Public Health published such a study showing these lifestyle behaviors can increase lifespan by 11 years.

In 2016, the British Medical Journal found the following lifestyle behaviors reduce all-cause mortality 61 percent! Brad Stulberg of Outside Magazine, has compiled a number of these studies and synthesized the lifestyle changes in to 8 simple steps:

8 Simple Steps to Live Longer

1. Move Around: 30 minutes of moderate to intense daily physical activity can lower heart disease, cancer, and other physiologic diseases as well as psychological ones!
2. Eat “Real Foods”: avoid plastic wrapped foods, it normally means they are ultra processed, which can result in excessive calorie consumption without as much nutrition.
3. Call Friends & Family: social connection is associated with reduced cortisol and improved sleep quality, among other positive effects.
4. Avoid Supplements: without proven deficiency or need, studies have often shown more harm than good from supplements.
5. Sleep 8 Hours: continuous deep sleep is critical for mental and physical health.
6. Enjoy Nature: getting outside can curb negative effects of stress and alleviate anxiety and depression.
7. Don’t Smoke: it’s associated with dozens of cancers and causes 1 out of every 5 deaths in the U.S.
8. Don’t Drink Too Much: excessive alcohol use is associated with chronic diseases. “Moderation is key.”

Read more here.

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Diabetes fatigue or burnout is identifiable from the mental and physical exhaustion exhibited by the person with diabetes. They may feel detached from their condition and apathetic to the need for self-care. This burnout can be as brief as hours and as long as years. Sometimes this person may be mislabeled by caregivers as non-compliant.

Sometimes this person may be wrongly labeled by caregivers as non-compliant.

As health care professionals, we know that living with diabetes is no simple task: checking blood sugar, taking medication, choosing the right foods and/or dosing based on food choice, increasing physical activity, all the while balancing life and relationships. Identifying signs of burnout and helping people with diabetes to avoid or cope with the burnout is essential to caring for them. HealthDay News has given great examples and tips on how to do this:

Taking the Diabetes Distress Scale can help people evaluate their struggle areas

Identifying the Signs

• Detachment: people with diabetes described feeling detached from their identity as a person with diabetes.
• Contributing factors: people with diabetes reporting that the constant burden of self-care becomes tedious – checking blood sugars multiple times a day, waking up in the middle of the night, low blood sugars at inconvenient times, etc.

Preventing Burnout or Helping with Recovery

• Help them identify or build their support network: asking for help from friends, family, apps (see our helpful app page), or providers.
• Discuss burnout ahead of time and strategies to prevent it: switching from insulin shots to pumps, allowing a few days vacation from managing blood sugar as rigorously, decrease feelings of guilt which may be there, etc.

Read more at HealthDay News.

See our Psychosocial Care and Assessment Resource Page

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A study done by the department of neurology at Mokdong Hospital at Ewha Womans University College of Medicine in Seoul, South Korea analyzed data from over 160,000 people who had no history of heart failure or atrial fibrillation. Information collected during the study included weight, height, lifestyle questionnaires, lab tests, oral health disease, dental visits in the past year, and oral hygiene behaviors.

All study participants were examined for periodontal disease. Of all participants present, 3% developed atrial fibrillation and 4.9% developed heart failure after a follow up 10.5 years later.

The study found that people who frequently brushed their teeth (3 or more times per day) had a lower risk of heart failure and atrial fibrillation. Getting teeth professionally cleaned also lessened risked of these problems.

More research is needed to see if there is a causal relationship. However, recommending active oral hygiene is always a great idea!

Read more here.

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