Diabetics Who Adhere to Their Medication Have a 31% Associated Lower Risk of Hospitalization

Lifestyle-related diseases stemming from tobacco, alcohol and obesity, have taken over infectious diseases such as HIV and malaria to become the greatest killer of people worldwide, says a new World Health Organization report. Indeed, chronic illnesses like cancer, heart disease and diabetes have reached global epidemic proportions and now cause more deaths than all other diseases combined.

Evidence shows that a comprehensive focus on prevention and improved treatment leads to dramatic declines in mortality rates. Currently, the report points out, the main focus of health care for non-communicable diseases (NCDs) in many low- and middle-income countries is hospital-centered acute care. This is a very expensive approach that will not contribute to a significant reduction of the NCD burden. It also denies people the health benefits of taking care of their conditions at an early stage.

To contain the diabetes worldwide epidemic, WHO says at least three interventions for prevention and management of diabetes are shown to reduce costs while improving health. Blood pressure and glycemic control, and foot care are feasible and cost-effective interventions for people with diabetes, including in low- and middle-income countries.

WHO’s recommendations have been validated by a new study in the U.S. which shows that individuals with diabetes who adhere to their medication have lower risk of hospitalization by one-third when compared to patients who do not adhere to their medication.

The results of the study by Prime Therapeutics (Prime), a thought leader in pharmacy benefit management, are being presented the last week in April at the Academy of Managed Care Pharmacy's 23rd Annual Meeting and Showcase in Minneapolis earlier this week.

Nearly 300 million people worldwide have (mostly type 2) diabetes. In the U.S. alone, more than 23 million Americans have been diagnosed with diabetes mellitus (DM) and each year another 1.6 million people are diagnosed with the condition.

Poor medication adherence has been associated with worse medical outcomes and increased medical costs for patients with diabetes in a single employer or the elderly.

Until now, there has been little data quantifying the potential value of improved outcomes and costs possible with better medication adherence in a large commercially insured population. In this study, one of the largest of its kind, more than 15,000 commercially insured individuals with a diabetes diagnosis medical claim were followed for one year.

"Our research found adherent individuals had $1,010 lower medical costs during the year," said Patrick Gleason, PharmD, director of Clinical Outcomes Assessment at Prime, in a press release. "Besides the medical cost savings, patients that adhere to their medications are likely to have improved health and increased quality of life. Yet in this study, we found one-quarter of patients do not stick to their diabetes medication, so the medical community must find ways to increase adherence for those most at-risk."

Researchers from Prime and one of its Blue Cross and Blue Shield clients reviewed pharmacy and medical claims from a commercial medical plan with 1.3 million members. The study identified individuals continuously enrolled between 2007 and 2009.

Researchers then focused on members who had either two separate office visits for diabetes or a diabetes-related hospitalization in 2008 and with a DM medication supply or a diagnosis of diabetes with microvascular disease. All medical and pharmacy claim costs were added up to determine the total cost of care.

A total of 15,043 members were followed for one year. Of that group, 73.9 percent (11,108 members) were adherent to their medication and 26.1 percent (3,935 members) were non-adherent. While those individuals adherent to DM medication had higher pharmacy costs which led to an increase in the overall total cost of care ($572), those adhering to medications were found to have a 31 percent lower risk of hospitalization and significantly lower overall medical costs ($1,010) than the non-adherent group.

Earlier studies, too, have shown that non-adherence with medication regimens results in increased use of medical resources, such as physician visits, laboratory tests, unnecessary additional treatments, emergency department visits, and hospital or nursing home admissions. Non-adherence may also result in treatment failure.

In the context of disease, medication non-adherence can be termed an "epidemic." More than 10% of older adult hospital admissions may be due to non-adherence with medication regimens. In one study, one-third of older persons admitted to the hospital had a history of non-adherence. Nearly one-fourth of nursing home admissions may be due to older persons' inability to self-administer medications.

Problems with medication adherence were cited as a contributing factor in more than 20% of cases of preventable adverse drug events among older persons in the ambulatory setting. It is estimated that non-adherence costs the US health care system $100 billion per year. In addition, approximately 125,000 deaths occur annually in the U.S. due to non-adherence with cardiovascular medications.

Of all age groups, older persons with chronic diseases and conditions benefit the most from taking medications, and risk the most from failing to take them properly. Among older adults the consequences of medication non-adherence may be more serious, less easily detected, and less easily resolved than in younger age groups.

Improving adherence with medication regimens can make a difference. A recently published study found that for a number of chronic medical conditions - diabetes, hypertension, hypercholesterolemia, and congestive heart failure - higher rates of medication adherence were associated with lower rates of hospitalization (see diagram), and a reduction in total medical costs.

Intensive Diabetes Education Programs Improve Blood-Sugar Control

DIABETICS need information in order to manage their disease; but their knowledge about the facts is still not enough for the behavioral change. What is needed is to find a way to be able to give people the skills to solve their problems in all areas of their lives so that they can be able to start caring for themselves.

One of the most important aspects of diabetes management is educating the patient to manage their condition themselves. This is known as Diabetes Self-Management Education, better known by its acronym DSME. It has been demonstrated by many studies that education works.

A team of researchers at Johns Hopkins University School of Medicine have developed a diabetes education program that significantly improves long-term blood-sugar control among patients by educating low income, poorly educated diabetes patients to be able to manage their disease. Their findings have been published online in the March issue Journal of General Internal Medicine.

The researcher’s premise was that lower socioeconomic status is associated with excess disease burden from diabetes and that diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change.

Promoting Self-Management is Essential to Properly Treat Type 2 Diabetes
Dividing about 56 participants into two groups, the researchers provided an intensive problem solving course in the first group that lasted more than nine sessions and covered standard diabetes self-management and care. They also include the way in managing financial, social, resource and interpersonal issues that relate to the disease.

The second group received only a solid two-session version of the program.

At the end of the program after three months, those who were in the intensive group showed a fall in hemoglobin levels by an average of 0.7 as compared to the levels they had before the program started. Below 5.7 is considered normal while the target of people with diabetes is below 7. The participants in the two-session group did not see any improvement.

The researchers conclude that literacy-adapted, intensive, problem-solving-based diabetes self-management training is effective for key clinical and behavioral outcomes in lower income patients.

Peer Support Improves Diabetes Self-Management
"We know that people need information to manage their disease, but having knowledge of the facts is not enough for behavioral change," said Felicia Hill-Briggs, an associate professor in the general internal medicine division at the Johns Hopkins University School of Medicine and the study's lead author.

"With this novel approach, we have found a way to give people the skills to solve problems in all areas of their lives so that they can take diabetes off the back burner and start caring for their health."

Another DSME advocate Linda Siminerio, RN, PhD, CDE, director of the University of Pittsburgh Diabetes Institute, and associate professor at the University of Pittsburgh School of Medicine and the School of Nursing points out, “Diabetes self-management education (DSME) should always be considered as part of the treatment plan, even if a patient is reported to have excellent metabolic control.

“Attention to self-care behaviors and psychosocial needs are equally as important as metabolic outcomes when managing a burdensome, chronic disease like diabetes. Active listening, providing accurate information and building a patient’s confidence are all important tools used in diabetes education.

"It is (therefore) essential that physicians and everyone on the diabetes care team work together to support patient self-management by developing patient-centered goals that will be more likely to be achieved.”

All Eyes on Research That May Provide Cure for Diabetic Neuropathy

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An Australian optometrist researching how contact lenses affect the eye accidentally discovered a new way to study diabetic neuropathy. The discovery holds the key to monitor nerve degeneration over time.

The extreme magnification of a special microscope, called a corneal confocal microscope, allowed Nathan Efron, a professor at the Queensland University of Technology's School of Optometry at Brisbane, Australia, to see fine nerves in the cornea that had never been seen before.

Efron found that the nerves affected by neuropathy are an exact match to nerves found in front of the eye, and is testing whether looking at their level of degeneration in these nerves over a period of time would match the nerve degeneration found in arms and legs.

"We want to see how well the degeneration of the nerves in the cornea matches the degeneration of nerves throughout the body, and if it matches it will mean that we can monitor diabetic neuropathy using a simple eye test," Efron says.

The breakthrough is so profound and important that Efron was honored last November with the Glenn A. Fry Lecture Award from the American Academy of Optometry for his research into non-invasive ophthalmic diagnosis of diabetic nerve damage.

As the principal researcher of a five-year study ‒ Expanding the Role of Optometry in Diabetes Management: Determining the Discrimination Capacity of a Novel New Ophthalmic Marker of Diabetic Neuropathy ‒ Efron says early indications are promising and he is presenting his findings at the Asia Pacific Academy of Opthamology Congress in Sydney this week.

When he first saw the nerves, Efron, who has type 2 diabetes, knew at once that what he was seeing was something unique. One of the serious consequences of the disease is diabetic neuropathy – a condition that causes nerve damage and can result in ulcers and amputations ‒ that affects about half of diabetics in varying degrees of severity, which causes the degeneration of nerves, mostly in the arms and leg. (See my post ‘Don’t Ignore Diabetic Nerve Pain’ here.)

"I wondered if my own diabetes specialist might be interested in the technology and it turned out he was a world authority on diabetic neuropathy. He thought it was astonishing,” recalls Efron. It was ideas generated by discussions with his diabetes specialist that led Efron to investigate linkages between the nerves in the eyes and nerves elsewhere in the body with the aim of developing a relatively simple and non-invasive eye test to identify neuropathy (or diabetic nerve disease).

Neuropathy is typically measured by taking skin biopsies from the foot and running a series of specialized tests that can take up to a week to complete. In many cases, this debilitating condition is not identified until serious, and irreparable, damage has already been done.

On the other hand, the quick and non-invasive eye tests would see results in a matter of minutes. In short, the importance of Efron’s discovery lies in the fact that since the eye is a transparent structure, it is the only place in the body where you can look directly at nerves and their degeneration over time.

Efron and his team have established a four-year clinical trial assessing the optimal method of ophthalmic neuropathy diagnosis. This will hopefully lead to a standard protocol for optometrists and ophthalmologists to quickly and simply identify people at risk of neuropathy, anticipate the level of damage and assess treatment outcomes.

There are multiple benefits of being able to measure the onset of neuropathy, one being that there are drugs in development that aim to cure diabetic neuropathy. "When these drugs are ready to come onto the market, we will, using our method, be able to detect nerve degeneration early and then hopefully cure it," he says.

For the tests, patients would receive a drop of anesthetic in the eye, then a corneal confocal microscope would capture a 20 second "movie" of their eye for analysis.

There are also three more tests being looked at - the first, called non-contact corneal aesthesiometry, measures how nerve degeneration is affecting the function of the cornea, by projecting tiny puffs of air into the eye, growing progressively stronger until the patient can feel it.

Two more eye tests will look at the effect of nerve degeneration on the retina.

"Diabetic patients currently go for yearly eye tests anyway, so we are saying that these tests could be done at the same time, and only take a few minutes," Efron says.

Efron hopes his discoveries will lead to early testing for diabetic neuropathy that will motivate sufferers to better manage their disease. Testing could be carried out at the same time as diabetes patients are tested for other eye problems caused by the disease.

The test has been used to monitor nerve regeneration in patients who have undergone kidney and pancreas transplants, and it could help track the effects of new treatments.

Based on a news report in Sunday Star Times

Diabetes Self-Monitoring: Shed a Tear to Test Blood Sugar Level

For a diabetic, nothing is more bothersome than self-testing to monitor blood sugar levels. Current monitoring devices typically require patients to perform the painful task of pricking their finger to draw blood for a test sample. And many patients must do it several times each day. Indeed, comments in one TuDiabetes forum over the past 6 weeks have underscored this issue.

Even as diabetics discuss lancet devices, painful pricks, first drop of blood, and callused fingertips, a team of researchers at the Arizona State University in collaboration with the Mayo Clinic is developing a new sensor that could make the lives of diabetes patients much easier.

Led by bioengineer Jeffrey T LaBelle, a research professor in the School of Biological and Health Systems Engineering at the ASU’s Ira A. Fulton Schools of Engineering, the team has come up with a new sensor which would enable patients to take tear fluid from their eye to test their glucose levels. The researchers claim the tear sample would give just as accurate a reading as a blood test does. The diagram above explains how the device works.

LaBelle correctly points out that the painful finger prick, which is the current norm, makes people reluctant to take the test. Glucose in tear fluid may give an indication of glucose levels in the blood as accurately as a test using a blood sample, the research claims.

“The problem with current self-monitoring blood glucose technologies is not so much the sensor. It’s the painful finger prick that makes people reluctant to perform the test. This new technology might encourage patients to check their blood sugars more often, which could lead to better control of their diabetes by a simple touch to the eye,” says LaBelle.

The research findings have been published in Journal of Diabetes Science and Technology (2:6, 307-11).

The research team comprises LaBelle, the designer of the device technology, and Mayo Clinic physicians Curtiss B. Cook, an endocrinologist, and Dharmendra (Dave) Patel, chair of Mayo’s Department of Surgical Ophthalmology.

The ASU-Mayo research team began the project with funds from a seed grant from Mayo Clinic. Researchers got assistance in the laboratory from ASU students involved in research at ASU’s Biodesign Institute and the Ira A. Fulton Schools of Engineering Fulton Undergraduate Research Initiative program.

Team members assessed how current devices were working – or failing – and how others have attempted to solve monitoring problems. They came up with a device that can be dabbed in the corner of the eye, absorbing a small amount of tear fluid like a wick that can then be used to measure glucose.

The major challenges are performing the test quickly, efficiently, with reproducible results, without letting the test sample evaporate and without stimulating a stress response that causes people to rub their eyes intensely.

Because of its potential impact on health care, the technology has drawn interest from BioAccel, an Arizona nonprofit that works to accelerate efforts to bring biomedical technologies to the marketplace, says a Mayo Clinic press release.

“A critical element to commercialization is the validation of technology through proof-of -concept testing,” says Nikki Corday, BioAccel business and development manager. “Positive results will help ensure that the data is available to help the research team clear the technical hurdles to commercialization.”

The researchers must now compile the proper data set to allow for approval of human testing of the device. “With funding provided by BioAccel, the research team will conduct critical experiments to determine how well the new device correlates with use of the current technology that uses blood sampling,” says Ron King, BioAccel’s chief scientific and business officer.

The results should help efforts to secure downstream funding for further development work from such sources as the National Institutes of Health and the Small Business Incentive Research Program, King says.

BioAccel will also provide assistance using a network of technical and business experts, including the New Venture Group, a business consulting team affiliated with the WP Carey School of Business at ASU under the supervision of associate professor Daniel Brooks.

Untreated Diabetes: Millions Risk Early Death Because of Poor Diagnosis and Ineffective Treatment

• In the United States alone, nearly 90% of adult diabetics – more than 16 million adults aged 35 and older – have blood sugar, blood pressure, and cholesterol that are not treated effectively, meaning they do not meet widely accepted targets for healthy levels of blood sugar, blood pressure, and cholesterol.

• In Mexico, 99% of adult diabetics are not meeting those targets.

• Up to 62% of diabetic men in Thailand are undiagnosed or untreated for diabetes. This translates to more than 663,000 people in that country.

A new study, published in the Bulletin of the World Health Organization's March edition, has found that millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment.

The objective of the study was to examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socio-economic factors.

Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, who examined diabetes diagnosis, treatment, and management in the US, Thailand, Mexico, Colombia, England, Iran, and Scotland have come to the conclusion that "too many people are not being properly diagnosed with diabetes and related cardiovascular risk factors. Those who are diagnosed aren't being effectively treated. This is a huge missed opportunity to lower the burden of disease in both rich and poor countries."

The percentage of diabetics in the seven countries studied who are reaching International Diabetes Federation treatment goals for blood glucose, blood pressure, and serum cholesterol is very low, ranging from 1% to 12%. The researchers conclude there are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia.

In an attempt to determine the cause of the low rates of diagnosis and effective treatment, researchers examined a range of factors and were surprised to find that “no large socio-economic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.”

"We were very surprised to see that wealth did not have a big impact on diagnosis and treatment," said Dr. Emmanuela Gakidou, the paper's lead author and an Associate Professor of Global Health at IHME. "And in the three countries where we had health insurance data, we thought it was noteworthy that health insurance actually played a much bigger role than wealth, especially in the US."

In the US, people who had insurance were twice as likely to be diagnosed and effectively treated for diabetes as those who did not have insurance.

The researchers said the findings underscore the need for countries to tackle the growing problem of non-communicable diseases (NCDs) like diabetes, hypertension and cardiovascular diseases in part by gathering better data.

"We don't have enough data from actual physical exams to accurately document the trend in most countries," said Dr. Rafael Lozano, a co-author on the paper and a Professor of Global Health at IHME. "We looked at surveys from nearly 200 countries and only could find data on blood glucose, cholesterol, or blood pressure in seven. We hope that in the build-up to the UN Summit on NCDs this September, countries will make a commitment to more surveys that take blood samples from a representative percentage of the population."

###

IHME researchers gathered data and performed their analysis in collaboration with researchers at the University of California, San Francisco, School of Medicine; the Harvard Global Equity Initiative; the National Institute of Public Health in Mexico; and Ramathibodi Hospital in Thailand.

For more information, please visit the IHME website 

Promoting Self-Management is Essential to Properly Treat Type 2 Diabetes

One of the most important aspects of diabetes management is educating the patient to manage their condition themselves. This is known as Diabetes Self-Management Education, better known by its acronym DSME. It has been demonstrated by many studies that education works.

DSME is defined as the ongoing process of facilitating the knowledge, skill and ability necessary for effective self-management and is guided by evidence-based standards. Patients with diabetes who do not receive DSME are found to be four times more likely to develop a major complication of diabetes and incur higher diabetes-related hospital costs.

I support the concept of DSME, given the fact that many family doctors do not have enough knowledge to effectively advise diabetes patients (see my earlier post ‘Why most doctors are clueless about treating diabetes’) and visits to a specialist involve long waiting periods and longer commutes.

In this interesting interview conducted by Endocrine Today, Linda Siminerio, RN, PhD, CDE, director of the University of Pittsburgh Diabetes Institute, and associate professor at the University of Pittsburgh School of Medicine and the School of Nursing answers many questions regarding DSME.

How can physicians effectively educate patients who currently have type 2 diabetes?
I think it is always helpful when physicians have access to additional resources to support team-based care. For example, referral to dietitians and diabetes education programs can be a powerful adjunct for comprehensive, quality care given the limited time they have available to spend with their patients. I have been involved in many studies and national surveys on referral practices, and we found that physicians often do not refer patients to these programs.

How can physicians effectively educate patients who are at risk for developing type 2 diabetes?
It is important for physicians to know what lifestyle intervention resources that address weight reduction and physical activity are available in their communities so that they can refer patients appropriately. Local YMCAs that offer lifestyle programs can be a valuable resource for physicians and patients. For example, in Indiana, some YMCAs have adapted the Diabetes Prevention Program (DPP) into a 16-week diabetes reduction program in the community setting. In Pittsburgh, the Diabetes Prevention Resource Center offers a 12–week Group Lifestyle Balance (GLB) program adapted from the DPP that is offered at community sites and in primary care practices. Physicians and practice staff should explore their respective communities to find community-friendly resources for their patients at risk for chronic disease.

What are your recommendations for creating collaboration between physicians and educators?
Physicians can refer their patients to the American Diabetes Association Web site to learn about community-based, recognized self-management education programs. Additionally, the American Association of Diabetes Educators Web site provides a variety of education materials that can be downloaded.

Even if patients obtain referrals from their physicians to participate in a program, they may not attend. I recommend that educators be integrated in the practice so that the educator becomes a part of the practice team. Educators and physicians should work together. Other support mechanisms are available in communities, but they are not always used. Primary care physicians should work with others in the community, such as local pharmacists, to effectively educate patients.

How can physicians promote diabetes self-management?
Diabetes self-management education (DSME) should always be considered as part of the treatment plan, even if a patient is reported to have excellent metabolic control. Attention to self-care behaviors and psychosocial needs are equally as important as metabolic outcomes when managing a burdensome, chronic disease like diabetes. Active listening, providing accurate information and building a patient’s confidence are all important tools used in diabetes education. It is essential that physicians and everyone on the diabetes care team work together to support patient self-management by developing patient-centered goals that will be more likely to be achieved.

How do you determine the best treatment option for patients?
Every patient and situation is individual. Thus, it is important for everyone on the diabetes care team to take time to listen to the patient’s needs and desires. The physician, along with the team, should provide patients with the necessary information to build a realistic care plan. Patients need to be informed so they can make informed decisions about their own care.

Do patients who have received this sort of patient-centered care have better results in the long run versus patients who may not receive ongoing support?
Research shows that diabetes self-management is an important component of diabetes care and has an impressive effect on HbA1c levels. In a meta-analysis, diabetes education was reported to reduce HbA1c by 0.76%. Since a 1% decrease in HbA1c is associated with a dramatic reduction in myocardial infarctions, micro-vascular disease and death, a 0.76% reduction can be considered an enormous benefit. Further, duration of contact time between a patient and an educator is the only significant predictor of the DSME effect. This suggests that DSME alone is not sufficient to maintain improved behaviors and that sustained improvements require contact and follow up.

We also know that if education is not sustained or supported, then HbA1c levels go back up. So, we need to continue to explore opportunities for continued support. Community-based programs, like wellness programs, YMCAs, churches and senior centers are potential forums for community friendly self-management support systems.

Diabetes Management System Could Be ‘iTunes of Diabetes Care’

With technology increasingly becoming part of diabetes management, here comes news of a development that may make a diabetic's life easier. (Of course, it'll put a further drain on your resources!)

London-based Cellnovo closes $48 million B round to fund commercialization of the first all mobile diabetes management system, which is drawing comparisons to Apple Inc.’s blockbuster iPhone and iPod platforms.

Cellnovo announced its presence as a major player in the diabetes race with $48 million in new funding for what industry observers have called the “iTunes of diabetes care.”

The B round for the London-based company was led by Edmond de Rothschild Investment Partners (EdRIP), with Forbion Capital Partners, Auriga Partners, NBGI Ventures and Credit Agricole Private Equity.

Previous investors Advent Venture Partners, HealthCare Ventures and NESTA also participated in the round, according to a prepared release.

Cellnovo officials said they would use the proceeds to commercialize and expand markets for its diabetes management system, which includes an insulin pump, mobile handset and online management system for diabetics. The pump’s appearance, size and interface have drawn comparisons to Apple Inc.’s iPhone and iTunes products by both industry observers and the company itself.

“If people understand Cellnovo as a device that sends data to a website, they are missing the point,” Cellnovo CEO Bill Mckeon told the medical device publication Invivo last year. “If you had asked Steve Jobs at Apple about his new MP3 player called the iPod, and how it compares to other MP3 players, he might have said, ‘I am not making an MP3 player. I’m bringing entertainment into your life in a number of ways.’”

Mckeon went on to tell the magazine that he puts the Cellnovo system in the same category.

“We believed that the rest of the world was looking at diabetes and the delivery of insulin with a very device-centric mindset. There is a device that pumps insulin, another device that measures blood glucose and another device with continuous sensors,” he said.

David Kliff, an independent diabetes analyst, who publishes the Diabetic Investor, wrote on his web site that Cellnovo’s approach is a “somewhat radical departure from the traditional approach to the market, which is more concerned with building a cheaper version of what’s already on the market while ignoring how patients actually use these systems in a real world setting.”

Kliff added that he believed Cellnovo would be able to attract the attention of the big players in the diabetes market if it’s in search of an exit. Currently, there’s a glut of companies duking it out in the insulin pump and diabetes management market including medical device goliath Medtronic Inc, Johnson & Johnson subsidiary LifeScan and smaller players like Insulet, which makes the OmniPod.

Good News! Even Telephonic Intervention Improves Diabetes Control

A health educator-implemented telephonic intervention is more effective than a print intervention in helping low-income adults in an urban population control their diabetes, according to research published in the January issue ofDiabetes Care.

Elizabeth A. Walker, Ph.D., R.N., of the Albert Einstein College of Medicine in Bronx, N.Y., and colleagues randomized 526 low-income, urban, minority individuals with an A1C of 7.5 percent or higher to telephonic intervention or print intervention to compare the effectiveness of the two approaches in improving diabetes control over one year in this patient population.

The researchers note that the telephone group experienced a mean decline in A1C of 0.23, while the print group experienced a rise of 0.13. Medication adherence among those not taking insulin was associated with the telephone intervention.

"A one-year tailored telephonic intervention implemented by health educators was successful in significantly, albeit modestly, improving diabetes control compared with a print intervention in a low-income, insured, minority population," the authors write.

The full study published in the January 2011 issue of the journal Diabetes Care can be found here.

US Drugmaker Abbot Labs Recalls 359m Blood Sugar Testing Strips

US drug maker Abbott Laboratories on Wednesday announced a recall of up to 359 million diabetes testing strips due to safety hazards.

The recall was initiated because the strips used by diabetics could give false low readings, the company said in a statement.

Abbott uncovered the problem after a routine internal review found that certain lots of the strips took too long to absorb the blood from a patient's finger, which could lead to inaccurate low readings of their blood sugar levels, the statement said.

The affected products should not be used and would be replaced at no cost, said the statement.

Meanwhile, the Food and Drug Administration (FDA) issued a warning that inaccurately low measurements by the strips may lead patients to raise their blood sugar levels unnecessarily or fail to detect dangerously high blood sugar levels.

The recalled strips were made between January and May and sold both to consumers and healthcare facilities, the FDA said.

"FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future," said Alberto Gutierrez, head of FDA's Office of In Vitro Diagnostics.

The lots of affected products were only distributed in the U.S. and Puerto Rico, according to Greg Miley, director of public affairs for Abbott Diabetes Care.

The products were marketed under a half-dozen brand names, including Precision Xceed Pro., Precision Xtra, Medisense Optium, Optium, OptiumEZ and ReliOn Ultima, the Abbott statement said.

Fatty Acid Tied to Lower Diabetes and Dyslipidemia Risk

Higher levels of circulating trans-palmitoleate, which may result from consumption of whole-fat dairy products, appear to be associated with lower insulin resistance, dyslipidemia, and incident diabetes, according to a study in the Dec. 21 issue of the Annals of Internal Medicine.

Watching your diet? If so, whole milk, butter, and cheese probably aren't regulars on your shopping list.

Should they be?

Scientists at Harvard School of Public Health have identified a fatty acid in whole dairy foods that is linked to a lower risk of type 2 diabetes. The compound, trans-palmitoleic acid, is a chemical cousin of cis-palmitoleic acid, a diabetes-blocking acid produced naturally in the liver.

In the study of data from 3,736 men and women, those with the highest levels of trans-palmitoleic acid in the blood were found to have a significantly lower risk of developing diabetes, as measured by blood glucose levels and other risk factors.

Lead researcher Dr. Dariush Mozaffarian, associate professor of epidemiology at the school, wonders if trans-palmitoleic acid may make up for the work that used to be performed by the cis-palmitoleic acid.

The study was published in the Dec. 21, 2010 edition of the Annals of Internal Medicine.

"Our working hypothesis, based on several observations," says Mozaffarian, "is that with modern diets being so high in carbohydrates and calories, the body's synthesis of cis-palmitoleic acid might be limited."

In other words, we might be eating so much that we are keeping cis-palmitoleic acid from doing its job.

"Trans-palmitoleic acid may be stepping in as a 'pinch hitter' for at least some of the functions of cis-palmitoleic acid," says Mozaffarian.

"I don't think there's enough evidence to show that we should start drinking whole milk," Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, told Health Day. "We need to understand the mechanism behind this association. Dietary changes in this country tend to be to extremes, but this study should not be used to make changes in the diet; it's just an observation right now."

Mozaffarian says he hopes his work will encourage more research, and that one day trans-palmitoleic acid could be used as a supplement.

So don't buy out the dairy section just yet. 

Courtesy: CBS News

Limiting Salt Lowers Blood Pressure and Health Risks in Diabetes

For patients living with diabetes, reducing the amount of salt in their daily diet is key to warding off serious threats to their health, a new review of studies finds.

In the Cochrane review, the authors evaluated 13 studies with 254 adults who had either type 1 or type 2 diabetes. For an average duration of one week, participants were restricted to large reduction in their daily salt intake to see how the change would affect their blood pressure.

“We were surprised to find so few studies of modest, practical salt reduction in diabetes where patients are at high cardiovascular risk and stand much to gain from interventions that reduce blood pressure,” said lead reviewer Rebecca Suckling. “However, despite this, there was a consistent reduction in blood pressure when salt intake was reduced.”

Suckling is part of the Blood Pressure Unit at St. George’s Hospital Medical School, in London.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Patients with diabetes need to be extra cautious to maintain their blood pressure at an acceptable range of less than 130/80 mmHg. However, in the 2003-2004 period, 75 percent of adults with diabetes had blood pressure greater than or equal to 130/80 mmHg or used prescription hypertension medications, according to the American Diabetes Association (ADA).

High salt intake is a major cause for increased blood pressure and, in those with diabetes, elevated blood pressure can lead to more serious health problems, including stroke, heart attack and diabetic kidney disease. The ADA also reports that diabetic kidney disease is the leading cause of chronic kidney disease, accounting for 44 percent of new cases in 2005.

In the Cochrane review, the participants’ average salt intake was restricted by 11.9 grams a day for those with type 1 diabetes and by 7.3 grams a day for those with type 2.

The reviewers wrote that reducing salt intake by 8.5 grams a day could lower patients’ blood pressure by 7/3 mmHg. This was true for patients with both type 1 and type 2 diabetes. The reviewers noted that this reduction in blood pressure is similar to that found from taking blood pressure medication.

Suckling acknowledged that studies in the review only lasted for a week and that the type of salt restriction probably would not be manageable for longer periods.

“The majority of studies were small and only of a short duration with large changes in salt intake,” she said. “These studies are easy to perform and give information on the short-term effects of salt reduction.”

However, Suckling said, the review also found that in studies greater than two weeks, where salt was reduced by a more achievable and sustainable amount of 4.5 grams a day, blood pressure was reduced by 6/4 mmHg.

Diabetes specialist Todd Brown, M.D., of the Division of Endocrinology and Metabolism at Johns Hopkins University, said that practicing low-salt diets of these types is quite challenging for most patients with diabetes even though they know the health risks.

“The effects of salt on blood pressure are well known to health professionals and most patients, but what is less well known is where the salt comes from in our diet,” Brown said.

“The overwhelming majority comes from the processed foods that we eat,” he said. “If we are going to realize the benefits of sodium reduction on blood pressure and other health outcomes, we should focus less on the salt shaker and more on what we buy in the supermarket and at chain restaurants.”

Thank you Health Behavior News Service

Diabetes Treatment: How Much Insulin Do You Need?

If you have type 2 diabetes and your doctor thinks it might be a good time to start insulin therapy, there are two important factors to consider: How much insulin do you need to take? When do you need to take it? 

And both are very personal.

"You can't paint everyone with type 2 diabetes with the same brush," says Mark Feinglos, M.D., division chief of endocrinology, metabolism,\ and nutrition at the Duke University School of Medicine, in Durham, N.C. "You need to tailor the regimen to an individual's needs."

A person with type 2 diabetes might start off on half a unit of insulin per kilogram of body weight per day, especially if there is not much known about the nature of his or her diabetes. Still, it is not unusual to need more like one unit, says Dr. Feinglos. (One unit per kilogram would be 68 units per day for someone who weighs 150 pounds, which is about 68 kilograms.)

A lot depends on your specific health situation. People with type 2 diabetes suffer from insulin resistance, a situation in which the body loses its ability to use the hormone properly. Early in the course of the disease, the insulin-producing cells of the pancreas respond to insulin resistance by churning out even more of the hormone. Overtime, though, insulin production declines.

Taking insulin can help you overcome the body's insulin resistance, though many factors can affect your dosage. If your body is still sensitive to insulin but the pancreas is no longer making much insulin, for example, Dr. Feinglos says that you would require less insulin than someone who is really resistant to insulin.

"But the most important issue is not necessarily how much you need to take," he adds. "Rather, it's the timing of what you to take. Timing is everything."

One Shot A Day Or More?

If you wake up with high blood sugar in the morning, it's very likely that you will need at least a once-a-day injection combined with oral drugs, says Dr. Feinglos. Oral medication can lower your insulin resistance, and a long-acting, once-a-day insulin shot (usually taken at bedtime) can mimic the low level of insulin made by the pancreas. (And the shots may not be how you picture them -- painful and complicated. You can use pen-like injectors that have short, thin needles and that allow you to dial the amount of insulin you require, rather than draw it up from a vial using a syringe.)

If your blood sugar tends to spike after meals despite using medication and watching what you eat, you may have to take a dose of rapid-action insulin before every meal.

"There's controversy over how much better you can really do with additional shots," says John Buse, M.D., Ph.D., director of the Diabetes Care Center at the University of North Carolina School of Medicine, in Chapel Hill. "I don't see much improvement in overall glucose control in many patients with the rapid-acting insulin taken at meals. And it does promote weight gain and low blood sugar. Is the burden worth the benefit?"

Either way, a once-a-day long-acting formulation is usually the best way to start, according to Dr. Buse. A standard initial dose might be 10 units. The dosage is then increased until blood sugar levels are lowered into the normal range.

"If a person still has substantial insulin secretion left in their pancreas, one shot a day is probably more than enough to top it off," agrees Robert Rizza, M.D., professor of medicine and executive dean of research at the Mayo Clinic, in Rochester, Minn. "But if you're really running out of insulin and can't store it between meals, then you may need to take both the long and short-acting injections."

Taking Insulin With Meals

If you do end up taking insulin at meals, the doctors agree that it is particularly important to match food intake with insulin, while also accounting for physical activity. (Exercise naturally lowers blood sugar, so if you're working out, you may need to take that into account.)

"Some people recommend matching insulin to carbohydrate counts," says Dr. Buse. "Others suggest eating a set serving of carbohydrates at each meal for a particular dose of insulin."

Even more crucial, according to Dr. Feinglos, is moderating food intake before insulin is ever initiated. "If you're not controlling the calories first, and just start giving insulin," he warns, "then all a patient is going to do is gain weight and get more insulin resistant and end up needing larger doses of insulin."

It Can Be A Vicious Cycle

"The relationship between food and exercise with medicine is so critical in diabetes," he adds. "If you just keep pouring medicine into the problem, it doesn't really solve it."

Nevertheless, a patient may do everything right -- eat well, work out and routinely take his or her medicine -- but still require more insulin over time due to the progressive nature of the disease. Adjustments can come through higher doses, increased frequency of injections, or both.

On a positive note, with improved diet and exercise, some patients are actually able to reduce their intake, even to the point of discontinuing insulin injections altogether.

"There are multiple ways to get to the same point," says Dr. Rizza. "The bottom line is to keep blood sugar normal."

3G Wireless Technology Delivers Diabetes Health Care In Innovative Project

An innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition.

In less than four decades, diabetes has become the U.S.-Mexico border’s most prominent public health problem, affecting over 1.2 million inhabitants. A bi-national and multi-sector alliance thus chose to focus on diabetes care with 3G wireless applications and services. The resultant effort is a pilot project.  Participants will determine if this approach might work as a regional model.

The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated earlier this month, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Delivery of health care through wireless technology assists providers and patients in a variety of ways. It allows promotores (health care workers) the real-time ability to locate and receive confidential access to patient information, to manage patient appointments and to review training curriculum. Patients benefit because they can review diabetes information —such as instructional videos— online, participate in interactive surveys that help their providers learn how they are managing their diabetes and receive notifications from an alert system.

“This project is a significant step forward in increasing patient access to proper diabetes care in Tijuana,” said Dr. Paul E. Jacobs, chairman and chief executive officer of Qualcomm.

“The use of mobile technology has the potential to improve health outcomes, bring down costs and provide more people with access to care.”

An equally significant aspect of the project is the cooperation it engendered among a variety of public, private and nonprofit organizations across two nations. The diverse groups collaborated to empower diabetic patients to take control of their health.

The project operates from IMSS Clinic #27, the largest IMSS (Social Security) clinic in Mexico. But the project’s impact could extend far beyond the bounds of the Mexican border. Should it prove successful, this approach to the public health problem of diabetes could “scientifically prove the positive impact of this innovative solution on the public health problem of diabetes in order to provide this alternative as an effective model of care for all of Mexico and the world,” according to Pablo Contreras Rodriguez, IMSS regional delegate for Baja California.

Bringing health care to marginalized areas entails specific challenges, according to Marcela Merino, director general of Fronteras Unidas PRO SALUD, a nonprofit organization serving Tijuana communities.

“One of the greatest issues that these communities face is that —because of distance, public transportation challenges and lack of time— it is extremely difficult to visit doctors and nurses. With this project, patients are now connected to their health care providers, including promotoras, wirelessly via their mobile devices, which will enable them to obtain care they could not receive in the past and help them to live healthier lives.”

The Scripps Whittier Diabetes Institute of San Diego provided background and expertise in training and developing peer educators to deliver a clear and understandable message for diabetes patients. They train peer educators south of the border helping Mexicans implement programs similar to Project Dulce activities in San Diego.

“Diabetes is exceedingly prevalent along the border region so it makes perfect sense for us, if we are going to treat the disease, to treat it in similar ways across both sides of the border,” explained Dr. Athena Philis-Tsimikas, vice president of the SWDI.

The organizations collaborating with Wireless Reach to provide technical assistance, program management, evaluation, in kind and monetary support are:

• the International Community Foundation (ICF) and its sister organization, the Fundación Internacional de la Comunidad

• Iusacell

• the Social Security Institute of Mexico (IMSS)

• the Medical School at the Autonomous University of Baja California (UABC)

• the Scripps Whittier Institute (SWDI)

• Fronteras Unidas PRO SALUD

Thank you Billie Greenwood