Remission of type 2 diabetes: Mission Not Impossible.

Increased knowledge of how gut bacteria ratios change as a marker of inflammation could help delay the development of Type 1 Diabetes. Researchers from  the University of Queensland proposed that monitoring the microorganisms living in the gut may aid in understanding the disease better as a whole.

Participants in the study were all newly diagnosed with Type 1 Diabetes and were asked to provide a stool sample. The researchers analyzed these samples and found that, “certain proteins can be used to differentiate risk levels.” 

UQ Diamantina Institute Senior Research Fellow Dr Emma Hamilton-Williams said: “By studying the stool samples of participants, we found that changes in gut bacteria weren’t just a side effect of the disease, but are likely related to disease progression.”

Research on the topic is new and fairly undeveloped. However, there are plans to carry out further research on the bacteria associated proteins, analyzing why they may signify an increased risk of Type 1 Diabetes expression.

The researchers are hoping to use this microbial information to monitor disease progression or develop therapies aimed at restoring a healthy microbiota in people at risk of type 1 diabetes.

For more information, Join our FREE Getting to the Gut, Meet Your Microbiome –
Live Webinar November 14th, 2018 at 11:30am PST

Read original article in Diabetes Care – Intestinal Metaproteomics Reveals Host-Microbiota Interactions in Subjects at Risk for Type 1 Diabetes – Diabetes Care 2018 Aug; dc180777.

And visit Monitoring gut changes could help delay type 1 diabetes.

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As diabetes educators, having eye contact and listening carefully without distraction, is a critical part of our assessment.  This initial meeting helps us sort out what is working with the person’s diabetes and what barriers might be getting in the way. The words we use, our body language, and how we engage in this encounter sets the stage for our ongoing working relationship. Plus, it can influence the self-perception of the person sitting across from us. 

However, many providers and educators may rely on computers to review notes and labs and to document the visit. This means there may be moments spent looking at the screen instead of the person sitting across from us.

Unfortunately, people with diabetes may feel that the computer is a distraction and a barrier to effective two-way communication.

Good news! There are strategies to compassionately engage with people with diabetes during the visit, while using the computer.

At the American College of Physicians Internal Medicine Meeting, speaker Wei Wei Lee MD, assistant professor of medicine at the University of Chicago, said utilizing the mnemonic HUMAN LEVEL provide guidance on how to succeed with electronic charting. 

The mnemonic HUMAN LEVEL stands for:

H stands for honoring the golden minute. “The first minute of the visit with the patient should be completely technology free. Greet the patient, start with what’s on their mind, what their agenda is and then transition into using the computer,” she said.

U – Use the triangle of trust by placing the computer so that you and the patient can see the screen at the same time.

M – Maximize interaction by engaging the patients as much as possible, as you work on the computer.

A – Acquaint yourself with the patient’s chart before entering the examination room.

N – Not focusing exclusively on the screen during the visit, especially when the patient is talking about sensitive subjects.

 

For the complete mnemonic and more info on establishing a collaborative relationship, here is the article by Healio – “Doctors, patients benefit when the ‘eyes’ have it”

We have also created a resource page called the ABCs of Language Use in Diabetes, which provides insights on using strength-bases language in the clinical setting.

 

A series of studies performed at the Mayo Clinic in Minnesota, Rochester and Johns Hopkins Medical Center have encouraged a 510 (k) clearance of the StatStrip, ” a finger-stick capillary testing meter for critically ill patients with or without diabetes.” The subjects utilized for these studies were between the ages of 1 month and 106 years old and all received medical care in intensive care such as the burn unit, cardiac, orthopedic, surgical or neurological. A total of 16,778 individuals participated in this study.

Results concluded that the capillary testing meter showed the same glucose results as arterial or venous plasma results. The FDA has cleared the capillary meter to be a safe method to use on critically ill patients.

Currently, StatStrip is the only approved glucose meter that can now be used with arterial, venous or capillary specimens from all patients, including those who are critically ill.

The FDA clearance indicates that StatStrip is safe, effective and reliable for use by CLIA-waived operator for point-of-care testing that measures and corrects for abnormal hematocrit and has no clinically significant interferences, which can lead to the mismanagement of critically ill patients, the release stated.

A hematocrit study was performed to verify that, “varying hematocrit levels do not affect the glucose results.” 

The StatStrip was initially cleared in 2006 to monitor diabetes but was not available for use on critically ill patients. It did not become available to critically ill patients until 2014. However, it only had clearance for arterial and venous specimens. It is now the, “only glucose meter to earn this clearance and can now be used with arterial, venous, or capillary specimens from all patients.”

To learn more about the StatStrip glucose hospital meter system, visit FDA clears first glucose meter for critically ill patients.

To view the full decision summary, visit Review Memorandum for a list of intended uses as well as all studies included in the decision making process.

Contributed by: Sofia Sepulveda

Within the medical community, we often use the terms “good cholesterol” and “bad cholesterol.” HDL, or high density lipoprotein cholesterol, is most often viewed as “protective from cardiovascular disease and death,” or the “good cholesterol” However, a recent study by the Emory University School of Medicine in Atlanta found that high levels HDL may actually be considered harmful.

The study assessed 60,000 men and women and tracked their cholesterol levels and risk for heart disease over the course of four years. HDL levels ranged, “from a low, less than 30 mg/dL to a high, greater than 60 mg/dL of blood.” Over the duration of the study, about 13% of test subjects either suffered from a heart attack or died.

“Specifically, patients with HDL levels exceeding 60 were found to have a 50 percent greater risk of heart disease death or heart attack, compared with those in the middle-range, the investigators reported.” 

At the study’s end, the researchers concluded that patients with HDL levels in the middle-range of the spectrum — meaning between 41 to 60 mg/dL of blood — fared the best, having the lowest risk for heart attack or death from heart disease.

Allard-Ratick, head researcher on this study says concerned patients with high HDL cholesterol, “should continue to address other modifiable risk factors such as high blood pressure, smoking, and obesity to reduce cardiovascular disease”.

To read more about this study, visit Could too much HDL cholesterol be bad for your heart?

To learn more about cholesterol management, visit Cholesterol 101: An introduction.

A study conducted by the Canadian Medical Association has found that common household disinfectants may increase the risk of obesity in children. The chemicals present in cleaning products we use every single day may alter the gut flora of children in their first few months of life.  However, the children in households that used eco-friendly cleaners were less likely to be overweight.

Researchers from across Canada looked at data on microbes in infant fecal matter among children enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort. The study assessed 757 infants from the ages of three-four months. Their gut flora and BMI were recorded for the purpose of this research. Researchers found that, “infants living in households with disinfectants being used at least weekly were twice as likely to have higher levels of the gut microbes Lachnospiraceae at age three to four months.” said principal investigator Anita Kozyrskyj, a professor of pediatrics at the University of Alberta.

Lachnospiraceae is a common bacteria in the gut that is non-pathogenic. The children who were not exposed to disinfectants at an early age had lower BMIs than those  with frequent exposure. 

“When they were three years old, their body mass index was higher than children not exposed to heavy home use of disinfectants as an infant,” she added.

In contrast, the study found that babies living in households that used eco-friendly cleaners had different microbiota and were less likely to be overweight as toddlers.

No exact evidence has been found that changes of the microbiome may actually be linked to obesity. However, they call for further studies “to explore the intriguing possibility that use of household disinfectants might contribute to the complex causes of obesity through microbially mediated mechanisms.”

“Cleaning products have the capacity to change the environmental microbiome and alter risk for child overweight,” write the authors.This is particularly important during the developmental stages of life. 

For more information on household cleaners and gut flora, visit Household cleaners may alter kid’s gut flora and contribute to being overweight.

Contributed By: Sofia Sepulveda

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Quincy the Queensland Koala was lethargic and kept drinking lots of water. The veterinary staff at the Los Angeles Zoo diagnosed diabetes and then asked a team of experts for help.

Thanks to the expertise of Dr. Athena Philis-Tsimikas, of the Scripps Whittier Diabetes Institute, Quincy is now sporting his very own CGM. His blood sugars are carefully tracked by Dr. Philis-Tsimikas and the medical team.

Quincy doesn’t weight enough to comfortably wear an insulin pump, so daily injections are required. And, since he is so tiny, insulin doses are minuscule to avoid hypoglycemia.

The good news is the Quincy is keeping a healthy weight and continues to be active.

Great job team!

Read more about Quincy in A SweetLife News

To learn more, enjoy: What do you call a koala who is too sweet for its own good? Diabetic – Clinical Endocrinology Today

Nearly 40% of adults in the United States are now considered obese and another 30% are overweight.

The Centers for Disease Control and Prevention have stated that, “the average American man now stands at 5’9 and weighs 196 pounds which is 15 pounds higher from 20 years ago.

The average female today stands 5-feet-3 3/4 inches and weighs 169 pounds, a 20 pound increase over the past 20 years.

Rates of chronic diseases such as diabetes, heart disease, and metabolic disease have mirrored the rise of obesity.

According to the CDC, the United States as a whole is consuming more energy than they are burning. The more complex answer however relates to the food environment of this country and how it influences what we eat and how much we eat.

The biggest concern according to Scott Kahan, the director of the National Center for Weight and Wellness, is that, “the unhealthiest foods are the tastiest foods, the cheapest foods, the largest-portion foods, the most available foods, the most fun foods.”

An article published by Vox magazine demonstrates just how exactly our food environment is affecting the health outcomes of the United States:

1. Americans tend to eat out a lot. Convenience foods are an everyday part of our fast paced society. Americans are cooking less and spending more money eating out. Researchers have found that individuals usually eat 20-40% more calories when eating out.
2.  Portion sizes increased by four fold over the past decades. According to the Center for Disease Control, the average caloric intake of American citizens has risen by nearly 500 calories in just forty years. The average restaurant meal today is more than four times the size of typical 1950s fare.
3. Easy access and consumption of sugary beverages, which increases likelihood of obesity and other chronic diseases.
4. Under consumption of high fiber foods. The recommendation by the FDA is 1.5-2 cups of fruit and 2-3 cups of vegetables per day. However, only about 10% of Americans are consuming enough vegetables and 15% are meeting the guidelines for fruit.
5. Many meals, especially breakfast, are often a “disguised dessert.” The added sugars and lack of fiber reduce nutrient density in our diets while simultaneously increasing calorie consumption.

In order to improve the health of our country, action to improve our food environment is critical.  This means implementing public health initiatives to provide our communities with healthier choices through out their day and lives.

For more CDC Stats – See CDC Info Page on current U.S. Weight Trends

For more information on how our food environment is affecting health outcomes, visit “It’s easy to become obese in America.”

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