July 22, 2016 · 3:39 AM

FDA Advisory Panel Recommends Continuous Glucose Monitors

Most users of these devices have type 1 diabetes, but I saw a type 2 recently who had one.

“An FDA advisory panel voted 8-2 that the benefits of using a continuous glucose monitoring (CGM) device as a replacement for fingerstick blood glucose testing for diabetic patients outweigh the risks.

They also voted 8-2 that there was a “reasonable assurance” that the expanded indication for the device — a fifth generation CGM from Dexcom currently approved for use as an adjunct to fingersticks — would be safe, and 9-1 that it would be effective. If approved, the broadened use would allow patients to make decisions about their care solely by checking the interstitial fluid glucose concentration values, something many patients reported already doing.”

Source: FDA Panel Says Yes to Expanded CGM Use | Medpage Today

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July 19, 2016 · 5:25 PM

Almost Two of Every Ten U.S. Teens Has Prediabetes

“Fewer than 1% of U.S. teens have diabetes, but nearly 18% have pre-diabetes, according to a new analysis of data from the National Health and Nutrition Examination Survey (NHANES).Researchers tested 2,606 adolescents, ages 12 to 19, for diabetes and found that the weighted prevalence was 0.8%, of which 28.5% of cases were undiagnosed, according to Andy Menke, PhD, of Social & Scientific Systems in Silver Spring, Md., and colleagues.”

Source: Pre-Diabetes Prevalent Among U.S. Teens | Medpage Today

Among U.S. adolescents with diabetes, 90% of it is type 1.

Prediabetes tends to progress into type 2 diabetes over time. We don’t know much about stopping that in adolescents. I bet these steps would help:

  1.  If you’re overweight or obese, lose excess fat weight. How much should you lose? Aim for at least 5% of body weight and see if that cures your prediabetes. For instance, if you weigh 200 lb (91 kg), lose 10 lb (4.5 kg).
  2. If you’re sedentary, start exercising regularly.
  3. Cut back on your consumption of sugar-sweetened beverages, other sugar sources, and other refined carbohydrates like wheat flour.

Steve Parker, M.D.

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July 19, 2016 · 4:47 PM

No Clear Survival Differences Seen Between Diabetes Drugs

"How about this one?"

“How about this one?”

A multinational group of researchers tried to determine which drugs for type 2 diabetes were better at prolonging life and preventing cardiovascular deaths. They reviewed the existing literature (i.e., they did a meta-analysis of prior clinical studies.

There are no clear winners. Placebo worked as well as the eight drug classes examined!

Unfortunately, the abstract doesn’t say how long the clinical studies lasted, only mentioning that they were at least 24 weeks long. It’s quite possible it would take at least three to five years to see an effect on death rates.

Click the source link at the bottom of the page for details at MPT.

Selected quotes:

“Eight different diabetes drug classes examined in a meta-analysis failed to demonstrate improved cardiovascular or all-cause mortality compared with placebo.Researchers analyzed 301 randomized clinical trials of patients with type 2 diabetes, and found that, metformin outperformed some other drug classes for its effect on hemoglobin A1c levels, there were no significant differences in mortality — including when placebo was included as a drug class.”

***

“A central finding in this meta-analysis was that despite more than 300 available clinical trials involving nearly 120,000 adults and 1.4 million patient-months of treatment, there was limited evidence that any glucose-lowering drug stratified by coexisting treatment prolonged life expectancy or prevented cardiovascular disease,” the authors wrote.”

***

“The authors wrote that their findings are consistent with guidelines from the American Diabetes Association, which — like the algorithm from the American Association of Clinical Endocrinologists — recommend that metformin monotherapy be used for the initial treatment of patients with type 2 diabetes. “Based on this review, clinicians and patients may prefer to avoid sulfonylureas or basal insulin for patients who wish to minimize hypoglycemia, choose GLP-1 receptor agonists when weight management is a priority, or consider SGLT-2 inhibitors based on their favorable combined safety and efficacy profile,” the authors wrote.”

Source: No Clear Survival Benefit Seen Among Diabetes Drugs | Medpage Today

Open wide!

Open wide!

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July 19, 2016 · 2:37 AM

“The World’s Most Cutting-Edge Fat-Burning Performance Meal Plan: The Keto Diet”

Odd cover, huh?

Odd cover, huh?

Men’s Fitness has an article extolling the virtues of ketogenic diets, particularly as they relate to athletic performance. Sadly, the piece doesn’t mention my Ketogenic Mediterranean Diet, which is incorporated into The Advance Mediterranean Diet (2nd ed.) and Conquer Diabetes and Prediabetes.

The article focuses on Professor Timothy Noakes (who also has an M.D. degree. Some quotes:

“Noakes’s war on sugar goes back a generation, to when his father developed type-2 diabetes. Type-2 is a disease in which the body gradually loses its ability to regulate blood sugar through the production of the hormone insulin. It’s linked to genetics, but also to diet—particularly sugar and refined carbs—as well as obesity and inactivity. Diabetes experts estimate that the disease speeds up the aging process by roughly a third, damaging the body from the inside out. Too much blood sugar slowly destroys blood vessels, with results ranging from mild—early wrinkling of skin—to catastrophic: heart disease, blindness, stroke, amputations due to poor circulation, and even Alzheimer’s disease (more on that later).

Noakes’ father eventually died from type-2, but because Noakes himself followed a low-fat diet, exercised regularly (he’s run upward of 70 marathons, as well as a handful of ultras), and didn’t smoke, he figured he’d be spared. To be sure, as he got older he put on some weight, and his energy sagged, but he was in good shape.

Regardless, in 2010, Noakes was diagnosed with type-2 diabetes. Though he didn’t know it yet, a lifetime of well-intentioned carbo- loading for his athletic endeavors had set him up for a fall.”

Source: The Truth Behind the World’s Most Cutting-Edge Fat-Burning Performance Meal Plan: The Keto Diet

CDP front cover_Amazon

AMD-2-EBook-Front Cover

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July 16, 2016 · 11:29 AM

New Scientific Review: Mediterranean Diet Helps Control Diabetes and Reduce Heart Disease

Conquer Diabetes and Prediabetes, Steve Parker MD

Olive oil and vinegar: prominent features of the Mediterranean diet

“The Mediterranean diet can be described as a dietary pattern characterized by the high consumption of plant-based foods, olive oil as the main source of fat, low-to-moderate consumption of fish, dairy products and poultry, low consumption of red and processed meat, and low-to-moderate consumption of wine with meals. The American Diabetes Association and the American Heart Association recommend Mediterranean diet for improving glycemic control and cardiovascular risk factors in type 2 diabetes. Prospective studies show that higher adherence to the Mediterranean diet is associated with a 20-23 % reduced risk of developing type 2 diabetes, while the results of randomized controlled trials show that Mediterranean diet reduces glycosylated hemoglobin levels by 0.30-0.47 %, and is also associated with a 28-30 % reduced risk for cardiovascular events.”

Source: Mediterranean diet for type 2 diabetes: cardiometabolic benefits. – PubMed – NCBI

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July 16, 2016 · 10:10 AM

Are You Visiting This Site From India?

Gadi Sagar temple on Gadisar lake at sunset, Jaisalmer, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

I’ve been surprised by how many blog visitors I get from India—often more than I see from U.K, Canada, or Australia.

If you’re Indian, is there anything in particular you’d like to see me address here? Leave a comment below or email me at steveparkermd AT gmail.com. Thank you.

Steve Parker, M.D.

PS: Please let me know if you are aware of a good source of low-carb Indian recipes in English. I have a growing interest in curries.

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July 15, 2016 · 7:56 AM

Sitting Is the New Smoking: Too Much Is Bad for Your Heart

“How much sitting can a body take without hurting the heart? A meta-analysis of prospective cohort studies found a nonlinear association with cardiovascular disease (CVD), suggesting that 10 hours a day might be a critical threshold.”

Source: Long Periods of Sitting Take Toll on the Heart | Medpage Today

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July 12, 2016 · 5:10 PM

One-Third of Healthy-Weight U.S. Adults Over 45 Now Have Prediabetes

Prediabetes can be defined as having hemoglobin A1c, a blood test, of 5.7 to 6.4%. We usually consider accumulation of fat around the abdomen to be a risk factor for prediabetes and type 2 diabetes. The study at hand (link below) didn’t find this to be the case in adults who were at a “healthy weight” defined as Body Mass Index of 18.5 to 24.9.

For this population, we need to identify other modifiable factors that predispose to type 2 diabetes, such as physical inactivity, lack of muscle mass, poor diet, and environmental toxins.

“PURPOSE Trends in sedentary lifestyle may have influenced adult body composition and metabolic health among individuals at presumably healthy weights. This study examines the nationally representative prevalence of prediabetes and abdominal obesity among healthy-weight adults in 1988 through 2012.”

Source: Prevalence of Prediabetes and Abdominal Obesity Among Healthy-Weight Adults: 18-Year Trend

PS: To prevent prediabetes from transmogrifying to diabetes, click here.

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July 11, 2016 · 6:03 AM

Higher risk of cancer before and after diabetes diagnosis 

The lifetime probability of an individual developing invasive cancer in the U.S. is about 4 in 10 (40%). A little higher in men (45%), a little lower in women (38%).

The good news is that cancer death rates in the U.S. have dropped over the last 20 years. The reduction is 18% for men and 10% for women.

The bad news is that the American Cancer Society projects around 600,000 yearly deaths from cancer in the U.S.

If we look at deaths of people under 85, cancer kills more people than heart disease.

In men, 25% of all invasive cancers will be prostate cancer. In women, breast cancer is the leader, comprising 26% of all cancers. (Common skin cancers are rarely invasive or fatal and are not included in these statistics. Melanoma, on the other hand, is invasive and dangerous.)

New research indicates that people with diabetes may be more prone to several cancers. Older research says men with diabetes are less likely than average to get prostate cancer. Don’t ask me why.

Medical News Today provides a few details:

People who have diabetes may have a higher chance of developing cancer either before or immediately after receiving a diagnosis of diabetes, according to a study published online in the American Cancer Society’s journal, Cancer.

Additional healthcare when people receive a diagnosis of diabetes may lead to more cancer diagnoses around the same time.The results indicate that there is a need for better understanding of the association between cancer and diabetes.

Previous studies have suggested that people with type 2 diabetes have a higher risk of developing several different types of cancer.

Source: Higher risk of cancer before and after diabetes diagnosis – Medical News Today

Steve Parker, M.D.

PS: The traditional Mediterranean diet protects against cancer. We don’t know if my versions of it are even better at preventing cancer.

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July 8, 2016 · 4:42 PM

Professor Tim Noakes Explains Why He Favors a Low-Carb Diet for Diabetes

Click the link below for details.

Overall, Prof. Noakes makes a lot of sense. I like the concept of diabetes as a disease of carbohydrate intolerance. He may not have everything right. For instance, experts debate whether insulin resistance is a cause or result of type 2 diabetes.

The professor writes:

“My interest in the dietary management of diabetes stems from watching my father’s rapid downward physical decent in the years after he was diagnosed with Type 2 diabetes mellitus (T2DM); the diagnosis of T2DM in myself; and my reading of the “alternative” literature which convinces me that T2DM does not have to be an inevitably progressive disease:My conclusion is that unlike my father, it is not my pre-ordained fate to die from the final common pathway in fatal T2DM – disseminated obstructive arterial disease. But to achieve that I will have to ignore what I was taught and which, in turn, I have conveyed to two generations of students:So to prevent the development of the disseminated obstructive arterial disease of T2DM, I will have to follow dietary practices that are the polar opposite of those my father was advised to adopt and which hastened his death; advice that I personally practised for 33 years and which ultimately caused me also to develop T2DM.”

Source: The Low Carb Diabetic: NOAKES: DOCTORS, DIETITIANS MAKE DIABETES A THREAT TO LIFE?

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