Diabetic Mediterranean Diet

CNN has a few details on the Medtronic MiniMed 670G, which should be available to consumers this spring:

“The Food and Drug Administration approved a so-called artificial pancreas Wednesday. The first-of-its-kind device, the size of a cell phone, monitors and treats patients with type 1 diabetes, also known as juvenile diabetes.In those with type 1 diabetes, the pancreas does not produce enough insulin, a hormone people need to get energy from food. The Medtronic MiniMed 670G system continuously monitors glucose (blood sugar) levels and delivers needed insulin to patients.

“This is a revolutionary day for the treatment of diabetes. We’ve been long awaiting the artificial pancreas, and it’s exciting to see it,” said Dr. Robert Courgi, an endocrinologist at Northwell Health’s South Side Hospital in Bay Shore, New York.”

Source: ‘Artificial pancreas’ for type 1 diabetes wins FDA approval – CNN.com

Cost and insurance coverage issues should be interesting.

Harriet Hall, M.D., looked at the evidence for Plavinol as a diabetes treatment. She’s skeptical about it:

“In a recent article on SBM, Scott Gavura quoted a pharmacy customer who said “I don’t want to take any drugs. Do you have something natural I can use to cut my blood sugar?” Scott went on to cover the questionable evidence for cinnamon in that article. Many other “natural” remedies have been proposed. Here’s an alphabetical list: acetyl L-carnitine, aloe, alpha-lipoic acid, banaba leaf (not banana!), basil, berberine, bilberry, biotin, bitter melon, cinnamon, chromium, coQ10, crepe myrtle, fenugreek, fish oil, fructo-oligosaccharides, green tea, ginseng, glucomannan, gymnema, hibiscus, Indian kino tree extract, magnesium, mistletoe, olive leaf, onion, psyllium, purslane, resveratrol, starch blockers, thiamine, vanadium, and vitamins. I compiled that list from just three websites; I’m sure there are many more natural remedies that I missed. These natural remedies have been recommended on the basis of rather shaky preliminary evidence that they lower blood sugar, usually by only a small amount. Even the CAM-friendly National Center for Complementary and Integrative Health (NCCIH) concluded: “There is not enough scientific evidence to suggest that any dietary supplements can help prevent or manage type 2 diabetes.”

Source: Plavinol and Other Natural Remedies for Diabetes: “Condimentary Medicine”? « Science-Based Medicine

…according to an article at American Journal of Clinical Nutrition.

“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

• high blood pressure (130/85 or higher, or using a high blood pressure medication)
• low HDL cholesterol: under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
• triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
• abdominal fat: waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
  fasting blood glucose over 100 mg/dl (5.55 mmol/l)
• fasting blood glucose over 100 mg/dl (5.55 mmol/l)

I don’t plan on reading the full text of the report because it’s a meta-analysis and I’ve likely reviewed the four component studies here already. Here are the results:

Four RCTs [randomized controlled trials] that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: −2.38 cm; 95% CI: −4.73, −0.04 cm), triglycerides (−0.40 mmol/L; 95% CI: −0.76, −0.04 mmol/L), systolic blood pressure (−3.64 mm Hg; 95% CI: −7.36, 0.08 mm Hg), diastolic blood pressure (−2.48 mm Hg; 95% CI: −4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: −0.03, 0.28 mmol/L), and fasting blood sugar (−0.16 mmol/L; 95% CI: −0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery. None of the RCTs evaluated an improvement in quality of life.

Ways to improve or cure metabolic syndrome include the paleo diet, Mediterranean diet, low-carb diets, ketogenic diets, and exercise. Losing excess fat weight with any reasonable diet would probably work. Enhance effectiveness by exercising.

Steve Parker, M.D.

Reference:Eric W Manheimer,  Esther J van Zuuren, Zbys Fedorowicz, and Hanno Pijl. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. AJCN. First published August 12, 2015, doi: 10.3945/ajcn.115.113613

If you suffer stigmatization and guilt about your diabetes, know that you’re not alone.

diaTribe interviewed Dr. Susan Guzman, a psychologist:

One person with type 1 diabetes told Dr. Guzman that when seeking medical consultation, her endocrinologist called her A1c over 6.5% a “failure” and used critical language to discuss her weight; she felt so ashamed that she tried to conceal her diabetes from friends, employers, and strangers. Dr. Guzman urged physicians to cease using harmful messaging, such as “non-compliant,” “unmotivated,” and “failure.” These terms discourage and embarrass rather than motivate; they are often also misguided in origin. Words like “prevention,” “reversible,” and “cure” can also contribute to stigma by inadequately recognizing the long-term efforts and constant decision-making involved in diabetes.

Source: How Do We Reduce Diabetes Stigma and Guilt? | diaTribe