September 24, 2016

Silver Nanoparticles Help Prevent Foot Amputations

One of the major complications of diabetes is the appearance of wounds in the lower extremities that do not heal properly. In this situation, a group of researchers from the UNAM created a solution made of silver nanoparticles, which in clinical trials has healed ulcers in people with diabetic foot, avoiding the amputation of more than 90 percent of patients treated.

"The ulcer is an open wound, susceptible to infection by bacteria and fungi that generate inflammation, which prevents the injury from healing; however, in applying the silver nanoparticles an antibacterial effect that contributes to create healthy tissue," said Dr. Karla Oyuky Juárez Moreno, researcher at the Center for Nanoscience and Nanotechnology (CNyN) located in Ensenada, Baja California.

The development, called Nagsil Dermo® works in three months to heal diabetic foot ulcers. First, a doctor should remove dead tissue and then apply the solution spray. Dr. Juarez Moreno stressed that for an effective treatment this must be applied daily and be supervised by specialists.

According to data from the Ministry of Health, seven out of ten cases of diabetic foot ulcers result in amputation and the World Health Organization (WHO) reports that due to the lack of control of blood glucose, between 40 and 85 percent of patients lose a limb.

The solution applied in patients that had a treatment with antibiotic during more than six months but don't see improvements, some had the diagnostic of amputation. "With our development report of a cicatrization, the time depends on the ulcer.

Four types of vascular damage and tissue exist. "Those who have the levels one, two and three relieved in less of six months, therefore those which have the level four where the amputation is inevitable, in this cases there is a ten percent of success," detailed Dr. Juarez Moreno.

The group of scientists has implemented innovation in private clinics and health sector, including ISSSTECALI hospitals and General de Rosarito, both located in Baja California, in the latter over a hundred cases were treated and 94 percent saved their limbs.

At national level there are 60 patients who have saved their limbs from the use of Nagsil Dermo®, an economic cosmetic product whose price is 550 pesos for a bottle of 50 milliliters, which is marketed through Bionag, a spin off created by the Network Conacyt located in Tijuana.

Scientific and technological development has international certificates toxicity committees supporting the safety of silver nanoparticles for use as a cosmetic in humans. They are also coated with a polymer that provides stability for more than two years.

September 23, 2016

A Dentist Is an Important Member of Your Diabetes Team

Diabetes can affect your teeth and gums. If you manage your blood glucose level at or as near normal as possible, this should go a long way toward preventing gum and teeth problems. Yes, there are other self care measures that you must do.

Take good care of your teeth and gums by brushing at least twice a day, flossing daily as well as rinsing with an antiseptic mouthwash. Make regular visits to your dentist. That can help you prevent pain, infections, and other problems.

When you have high blood glucose levels from diabetes, your saliva around your teeth and under your gums has more sugars in it. This helps harmful germs and plaque grow. Plaque irritates your gums and can lead to gum disease, tooth decay, and tooth loss. Gum disease makes your gums bleed, look red, and swell. High blood glucose can make gum disease get worse faster.

If you control your blood glucose well, you're less likely to have these problems. Studies show that people who have good management of their diabetes are less likely to have gum disease than those who don't manage their diabetes well. They also tend to lose fewer teeth from gum disease.

What’s more, recent research shows that having gum disease may make your blood glucose worse. But prompt help for gum disease can improve your blood glucose levels.

See your dentist regularly. Schedule a visit right away if you have any of these signs of gum disease:
  • Gums that are red, swollen, sore, or bleed easily
  • Gums that pull away from your teeth
  • Sensitive or loose teeth
  • Changes in the way your bite feels
  • Dentures that don’t fit right
  • Bad breath or a bad taste in your mouth

Gum disease is the most common mouth problem for people with diabetes. But diabetes raises your chances of other mouth problems, too. You can't fight infections as well, and high blood glucose makes it easier for germs and bacteria to grow in your mouth.

Thrush, a type of fungal infection, is more common if you have diabetes, especially if you also smoke or wear dentures. Thrush causes white or red patches in your mouth that can burn or feel sore. Having thrush can also make it hard to swallow and affects how food tastes. If you have any symptoms of thrush, see your doctor or dentist. You may need to take an antifungal drug to treat it. Avoid smoking, maintain good blood sugar control, and if you wear dentures, remove and clean them daily.

Diabetes also makes dry mouth and problems with healing more likely. A dry mouth can cause soreness and ulcers and lead to cavities and salivary gland infections. If your mouth is dry, try drinking more water or chewing sugar-free gum. You can also use a saliva substitute, which is sold in most drugstores.

If you have problems with healing, it may take longer for your mouth to heal after any type of dental surgery. Healing problems can also raise your chances of infection. Be sure to let your dentist know you have diabetes.

For more information on the importance of having a dentist on your diabetes team and periodontal disease read more of my blogs, blog 1, blog 2, blog 3, and blog 4.

September 22, 2016

Metformin Is Recommended for Prediabetes

In a controlled trial, 600 overweight and obese people with prediabetes were given metformin in Chennai,India.

Metformin is in the biguanide class. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues. It also can possibly help patients to lose weight, and possibly prevent some forms of cancer. Metformin was discovered in 1922. It is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic healthcare system. Metformin is believed to be the most widely used medication for diabetes, which is taken by mouth. It is available as a generic medication.

For those patients who are under age 60 with prediabetes, the ADA has recommended metformin for those with a BMI over 34 and for women with gestational diabetes in the past. But, for others, especially for those over the age of 60, and even teenagers who rarely are treated with metformin, the study found that just 3.7% of those with prediabetes were actually prescribed metformin, over a 3-year period. Since metformin has been around since 1950 and even longer overseas and has even been shown to possibly prevent certain kinds of cancer, why should it not be standard procedure to provide all those with prediabetes the option to be treated with metformin?

With the cost for the 29 million patients with diabetes at over 300 billion dollars, should we be asking the question: with more than 90 million people in the U.S. with prediabetes — a number that’s still growing — why doesn’t the FDA or the ADA recommend starting patients on metformin immediately after diagnosis?

In a randomized controlled trial of almost 600 overweight or obese people with prediabetes in Chennai, India, significantly fewer of those who followed an intensive lifestyle-intervention program, with metformin if needed, went on to develop diabetes compared with persons managed with standard care. But, the intervention’s effectiveness varied according to differences in the metabolic nature of their prediabetes.

The intervention in the trial, called the Diabetes Community Lifestyle Improvement Program (D-CLIP), was modeled after the U.S. Diabetes Prevention Program (DPP), but adapted for India. It consisted of 4 months of weekly educational sessions on diet and exercise, followed by a 2-month maintenance program of weekly educational meetings, plus metformin as needed.

Patients in the intervention arm who had both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) showed a 36% lower risk of developing diabetes compared with those in the control arm. And those with only isolated IGT had a 31% lower risk. But the benefit was smaller in patients with only isolated IFG at baseline; they showed a 12% lower risk of developing diabetes.

Participants in the control arm received standard care, which consisted of a one-time visit with a physician, a dietitian, and a fitness trainer, and a group class on diabetes prevention (with instruction on, for example, how to follow a low-fat diet rich in complex carbohydrates and fresh fruits and vegetables, and how to increase physical activity), but none received metformin. Low-fat diet has to have been a factor in the study and caused some data irregularities.

Participants in the intervention group received 16 weekly core classes for 4 months followed by eight weekly maintenance classes for 2 months. The classes were 1.5 hours long, for groups of eight to 24 participants, and included an exercise class following the educational talk.

The intervention’s goals were the same as those in the DPP: greater than 7% weight loss and greater than 150 minutes/week of moderate-intensity exercise. At 4 months, participants who still had IFG and either IGT or HbA1c greater than 5.7% received 500 mg twice-daily metformin. During the 3-year follow-up, a per-year mean of 11.1% of participants in the control group vs 7.8% of participants in the intervention group developed diabetes (P = .014). The number needed to treat to prevent one case of diabetes with the intervention was 9.8.

September 21, 2016

Telemedicine could improve eye exam access for PWD

When I write a blog, I often wonder if there will be more about the same topic. Yes, this time there is and I did a double take when I read the second article. In the first article here, the following was stated - “Opponents suggest that new technology should be approached with caution, as it sometimes proves unreliable and might lead to improper diagnosis and treatment, absent the physical examination. For example, the American Optometric Association opposed online eye exams (and parity in their reimbursement) and called such methods "substandard model[s] of care."

Now the University of Michigan promotes telemedicine as a way of examining people with diabetes to prevent eye diseases caused by diabetes. After a nationwide telemedicine diabetic screening program in England and Wales, for example, diabetic retinopathy is no longer the leading cause of blindness there.

Similar e-health programs could grow stateside, where diabetic retinopathy remains the main driver of new-onset blindness. But it hasn't been known if patients would participate.

Researchers at the University of Michigan's Kellogg Eye Center conducted a study of older adults to find out. If services are convenient, patients will use them, the investigation found.

"Telemedicine has been shown to be a safe method to provide monitoring for diabetic eye care. If physicians plan to change the way that people get care, we must create a service that is appealing and tailored to the patients," says senior study author Maria Woodward, M.D., assistant professor of ophthalmology at Kellogg Eye Center.

Early detection and treatment is key to prevent blindness from diabetic retinopathy, but fewer than 65 percent of U.S. adults with diabetes undergo screening.

Shifting screening to a telemedicine program could ease the burden on patients who face high costs of care, lack of access to care or have difficulty with transportation or getting time away from work, researchers say.

Telemedicine allows primary care doctors to play a critical role in preventing eye damage.

Retinal photographs are taken of both eyes at the doctor's office using a no-dilation retina camera. The images can be sent over a secure, cloud-based network to an eye care provider who sends a report back to the primary care physician. Based on the findings, the patient is either scheduled for more photographs in the clinic or referred to an ophthalmologist.

In the study, published in Telemedicine and e-Health, only 3 percent of the 97 patients surveyed had heard of telemedicine. But once telemedicine was explained, 69 percent believed telemedicine could be more convenient than traditional one-on-one exams with a specialist.

Patients were less interested in telemedicine if they had been living with diabetes for a number of years, or if they had a good relationship with their doctor. They were more willing to participate if they thought telemedicine would be more convenient than a routine eye exam or they had other health issues that made it harder for them to get to the doctor.

September 20, 2016

A1C Should Not Be the End-All

Again, diaTribe has touched on the right topic. For the FDA and many payers, A1c is currently the “gold standard” used to assess diabetes therapy. Even the many diabetes organizations recommend the A1c as the tool for diabetes diagnosis.

But A1c has limits: it cannot capture other critical outcomes that matter to patients on a daily basis. Low blood sugar (hypoglycemia) can be fatal, and yet, A1c tells us nothing about it. New therapies may dramatically improve quality of life, but those improvements won’t show up in an A1c value. Two people can have the exact same A1c value, but spend wildly different amounts of time at high and low blood glucose values.

Given recent improvements in glucose sensing devices and understanding of people living with diabetes, A1c should now be supplemented by other important tools.

Therapies that reduce hypoglycemia will dramatically help patients, even if they do not change A1c. In fact, reducing episodes of hypoglycemia could raise A1c levels but significantly reduce the risk of death, serious injury, or a trip to the ER. Fear of hypoglycemia also stands as the biggest barrier to tighter glycemic control.

The A1c of 7% could reflect 100% time-in-range or 18% time-in-range over a period of three months. We need a more nuanced understanding of blood glucose changes.

The accuracy of glucose sensors has improved dramatically in the past three years. Reliable sensors now exist that offer more comprehensive and actionable measurement of glucose than A1c or fingersticks.

Diabetes is an extremely burdensome, 24/7 condition that leads to many negative feelings (e.g., stress, guilt, failure, exhaustion, fear) and doubles the risk of depression. A1c does not capture how different therapies affect quality of life.

A1c is an average that does not capture many important variables, including time spent in different glucose ranges and glycemic variability. A single measure reflecting a two-to-three-month period is too crude to adequately characterize glycemic control that changes minute to minute, often unpredictably and dangerously (especially in insulin users).

The FDA has requested tighter accuracy ranges, but as of the current time has not implemented anything and is still using the old standards. Several diabetes test strip manufacturers have test strip accuracy improvements in place, but not in the manufacturing line because the FDA will not get off the dime. Even most of the European diabetes test strip manufacturers have the tighter accuracy ranges because they are already required to have the tighter accuracy.

Please take time to read the full article here as I only skimmed the surface.

September 19, 2016

More Reactions by Excluded Group

I must have really made the other group very angry! The last week has been very busy with emails from the natural medications group. They are highly agitated and are taking out their frustrations on me. Two of the group apparently asked Tim to bring them to my apartment last Saturday. I did have company when they stopped by unannounced and they were rather timid when I introduced them to one of my friends with the highway patrol.

Because he was off-duty and driving his own car, one of the two got a little bolder and made a threat toward me. That caused my friend to show his badge and tell him he was under arrest. When the fellow turned to flee, my friend told me to call 911 and request officer needs assistance. I supplied as much information as I could and my other friend told Tim and the second fellow to step outside the building and stand there.

Two of the city police soon had the first fellow under arrest and brought him back to the apartment. The highway patrolman told them the charges to take him to the county jail for holding and asked if I had any questions. I just said the other two should leave and not come back. As they left, my friend said he would go file his report and come back.

His friend is also a highway patrolman living in our town and he asked if this was a common occurrence for me. I said that our diabetes support group had recently become two groups and the one group is not happy as they thought they had excluded me from both groups. The disagreement is about dietary supplements and alternative medicine and my statements that these need to be disclosed to doctors. Most people say these are natural and the doctors don't need this information.

Even he understood this and said the fellow made a threat over this. I said yes, and because about half of the support group believed me and support me, and the other half disagrees with me. Then on 1 September, the group that supports me had a meeting and made me a member again after I had been told by the past leader that I was no longer a member. The group that wanted me out was not invited to the meeting and when they retaliated about that, they were told that they were not invited or wanted.

Two other groups don't want these people as members and they are beginning to understand that. I think this was the purpose of their visit and I am thankful you two happened to be here.

At that point, my friend returned and he said there were more problems and more charges against the individual.

I thanked both for being there and my friend said that he had wanted his fellow patrolman to meet me and to know what my background in transportation involved. He then asked me if I might expect more trouble. I said anything is possible, but I was surprised by the threat, as I don't think the other two would have brought the fellow if they had suspected him of doing what he did. They both agreed and said they would stay in touch and said good-bye.

September 18, 2016

Glycemic Index Is Unreliable

It is about time! High variability suggests glycemic index is unreliable indicator of blood sugar response and much more. I know that the only solution is to use your blood glucose meter and your test strips to determine how you react to each food and type of food.

What surprises me the most is why it took so long to make this known. Consider that the glycemic numbers were developed using healthy people and not people with diabetes. For years many of us with diabetes have been saying that we have found the glycemic numbers have not matched what our meters tell us and are often even well outside the 15 percent possible error for the test strips we use.

The glycemic index of a given food, a value that aims to quantify how fast blood sugar rises after eating it, can vary by an average of 20 percent within an individual and 25 percent among individuals, report scientists from the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HRNCA) at Tufts University.

The study, published in the American Journal of Clinical Nutrition on Sept. 7, suggests glycemic index has limited utility as a tool to predict how a food affects blood sugar levels.

Developed as a way to help diabetic individuals control their blood sugar, glycemic index is intended to represent the inherent effect a food has on blood sugar levels. However, the glycemic index is becoming used for broader purposes such as food labeling, and has served as the basis for several popular diets.

"Reports frequently tout the benefits of choosing foods with low glycemic index and glycemic load values. Our data suggest those values may not be reliable in terms of a daily intake. A better approach to choosing foods is to consume a diet primarily composed of vegetables, fruits, whole grains, nonfat and low-fat dairy products, fish, legumes (beans), lean meats with preference to preparing food with liquid vegetable oils, and equally as important, to choose healthy foods and beverages you really enjoy," said senior study author Alice H. Lichtenstein, D.Sc., senior scientist and director of the Cardiovascular Nutrition Laboratory at the USDA HNRCA. Lichtenstein is also the Gershoff Professor at the Friedman School of Nutrition Science and Policy at Tufts.

The variability in glycemic index values occurred despite sample sizes larger than required by standard calculations. The study cohort of 63 individuals far exceeded the 10 individuals used by typical glycemic index methodology, as did the six feeding challenges and five-hour blood glucose measuring window.

The team also tested for the influence of biological characteristics: sex, body-mass index, blood pressure, physical activity, and several others. Most factors had only a minor statistical effect on glycemic index variability. Blood insulin response as measured by insulin index and HbA1c, a measure of longer term glucose control, had the largest effect, accounting for 15 and 16 percent of the variability, respectively.